不同后路内固定治疗颅底凹陷寰枢椎脱位的生物力学研究  

Biomechanical Study on Atlantoaxial Dislocation Combined with Basilar Invagination by Different Posterior Internal Fixation Methods

作　　者：宋梅 赵改平[1] 段婉茹[2] 陈赞[2] 夏小淇 李富超 张文韬 SONG Mei;ZHAO Gaiping;DUAN Wanru;CHEN Zan;XIA Xiaoqi;LI Fuchao;ZHANG Wentao(School of Health Sciences and Engineering,University of Shanghai for Science and Technology,Shanghai 200093,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical Universiy,Bejing 100053,China)

机构地区：[1]上海理工大学健康科学与工程学院,上海200093 [2]首都医科大学宣武医院神经外科,北京100053

出　　处：《医用生物力学》2023年第1期37-44,共8页Journal of Medical Biomechanics

基　　金：国家自然科学基金项目(11502146);北京市医院管理中心临床医学发展专项经费(XMLX202138)。

摘　　要：目的 探讨两种后路内固定治疗颅底凹陷寰枢椎脱位(basilar invagination with atlantoaxial dislocation,BI-AAD)的生物力学差异。方法 基于BI-AAD患者枕颈CT数据和临床手术方案,建立寰枢椎关节间融合器+后路枕骨板+C2椎弓根螺钉(Cage+C2PS+OP)和Cage+C1侧块螺钉+C2PS(Cage+C1LMS+C2PS)有限元模型,分析不同运动工况下寰枢关节稳定性、C2终板和植入器械应力分布特征。结果 与Cage+C1LMS+C2PS模型相比,Cage+C2PS+OP模型在前屈、后伸、侧弯和旋转工况下寰枢关节活动度分别降低了5.26%、33.33%、43.75%、-5.56%,钉棒系统应力峰值分别降低了47.81%、60.90%、48.45%、39.14%。两种内固定方式下C2终板和融合器应力均主要分布于运动受压侧,螺钉与椎体接触处和螺钉尾部都承受较大的载荷。结论 两种内固定方法都能提供相似的稳定性,但Cage+C1LMS+C2PS中钉棒系统应力集中较明显,螺钉松动和断裂发生的可能性较大。Objective To investigate biomechanical differences of two posterior occipitocervical internal fixation techniques for treating basilar invagination with atlantoaxial dislocation(BI-AAD).Methods Intra-articular cage +posterior occipital plate+C2 pedicle screw(Cage+C2PS+OP),and intra-articular cage+C1 lateral mass screw+C2PS(Cage+C1LMS+C2PS) models were established based on occipitocervical CT data of the BI-AAD and clinical operation scheme,and the stability of atlantoaxial joint and stress distribution characteristics of C2 endplate and implanted instruments under different motion states were analyzed.Results Compared with the Cage+C1LMS+C2PS model,the atlantoaxial range of motion(ROM) under flexion,extension,lateral bending and axial rotation in the Cage+C2PS+OP model were reduced by 5.26%,33.33%,43.75%,-5.56%,and stress peak of screw-rod fixation system were reduced by 47.81%,60.90%,48.45%,39.14%,respectively.Under two internal fixation modes,stresses of C2 endplate and cage were mainly distributed on the compressive side during the motion,and both the screw-bone interface and the caudal side of screw subjected to large loading.Conclusions Two internal fixation methods could provide similar stability.However,the stress concentration of screw-rod system was more obvious and the possibility of screw loosening and fracture was greater under Cage+C1LMS+C2PS fixation.

关 键 词：颅底凹陷 寰枢椎脱位 关节间融合器 钉棒系统 

分 类 号：R318.01[医药卫生—生物医学工程]