枢椎单侧椎弓根螺钉联合对侧椎板、峡部或棘突螺钉的有限元分析  

Finite element analysis of axial unilateral pedicle screw combined with contralateral lamina isthmus or spinous screw

作　　者：胡利华 刘观燚[2] 沈锋 周雷杰[2] 马维虎[2] 廖旭昱[2] 韩金明[2] Hu Lihua;Liu Guanyi;Shen Feng;Zhou Leijie;Ma Weihu;Liao Xuyu;Han Jinming(School of Medicine,Ningbo University,Ningbo 3152ll,China;Department of Spine Surgery,Ningbo No.6 Hospital,Ningbo 315040,China;Department of Orthopedics,Ningbo Huamei Hospital,University of Chinese Academy of Sciences,Ningbo 315099,China)

机构地区：[1]宁波大学医学院,宁波315211 [2]宁波市第六医院脊柱外科,宁波315040 [3]中国科学院大学宁波华美医院骨科,宁波315099

出　　处：《中华实验外科杂志》2023年第7期1294-1297,共4页Chinese Journal of Experimental Surgery

基　　金：浙江省基础公益研究计划(LGF20H060007);浙江省医药卫生科技项目(2020RC110)

摘　　要：目的通过有限元方法对比枢椎单侧椎弓根螺钉联合对侧椎板、峡部或棘突螺钉在寰枢和枕颈固定中的生物力学稳定性。方法基于宁波市第六医院2022年1月就诊的1例成年男性志愿者颈椎电子计算机断层扫描(CT)数据, 其枢椎单侧枢椎椎弓根狭窄。构建枢椎单侧椎弓根细小畸形的上颈椎有限元模型, 分别模拟寰椎及齿状突骨折, 继而进行枕颈和寰枢固定。枢椎解剖正常侧采用椎弓根螺钉固定, 变异侧分别采用椎板、峡部或棘突螺钉固定, 其中棘突螺钉分别采用水平、垂直和斜向三种固定技术, 并植入枕骨或寰枢螺钉完成枕颈和寰枢固定模型的建立。最后分别计算各组模型活动度(ROM)和应力分布情况。内固定模型ROM与完整模型ROM比较使用单样本t检验。结果在枕颈固定中, 各螺钉固定组在C0~C1、C1~C2节段ROM均低于完整组(P<0.05);在寰枢固定中, 各螺钉固定组在C1~C2节段ROM均低于完整组(P<0.05)。与完整模型ROM比较, 椎板螺钉组、峡部螺钉组、水平棘突螺钉组、垂直棘突螺钉组和斜向棘突螺钉组在C1~C2旋转方向ROM降幅均最大, 在枕颈固定中分别下降98.47%、98.19%、97.30%、98.71%、98.95%, 在寰枢固定模型中分别下降99.13%、98.81%、99.24%、99.06%、99.06%。结论枢椎单侧椎弓根螺钉联合对侧椎板、峡部或棘突螺钉在寰枢和枕颈固定中均具有良好的稳定性。Objective To compare the biomechanical stability of axial pedicle screw combined with lamina,pars or spinous process screw in atlantoaxial and occipitocervical fixation by finite element method.Methods Based on the cervical spine computed tomography(CT)data of an adult male volun-teer admitted to the Ningbo No.6 Hospital in January 2022,the patient had unilateral axial pedicle steno-sis.The upper cervical finite element model of unilateral pedicle small deformity of axis was constructed to simulate atlas and odontoid fracture respectively,and then occipitocervical and atlantoaxial fixation was per-formed.The normal anatomical side of the axis was fixed with pedicle screws,while the anatomical varia-tion side was fixed with lamina,pars or spinous process screws.The spinous process screws were fixed with oblique,vertical and horizontal fixation techniques,and the occipitocervical or atlantoaxial screws were im-planted to complete the establishment of occipitocervical and atlantoaxial fixation models.Finally,the range of motion(ROM)and stress distribution of each model were calculated respectively.ROM of internal fixation model was compared with that of complete model by sample t test.Results In occipitocervical fix-ation,the ROM in CO-C1 and C1-C2 segments of each screw fixation group was lower than that in intact group(P<0.05).In atlantoaxial fixation,the ROM in C1-C2 segments of all screw fixation groups was lower than that in intact group(P<O.05).Compared with the complete model,the ROM in the lamina screw group,the pars screw group,the horizontal spinous process screw group,the vertical spinous process screw group and the oblique spinous process screw group was decreased in the rotation direction of C1-C2 by 98.47%,98.19%,97.30%,98.71%,98.95%in occipitocervical fixation and 99.13%,98.81%,99.24%,99.06%,99.06%in atlantoaxial fixation,respectively.Conclusion Axial unilateral pedicle screw combined with contralateral lamina,pars or spinous process screw has good stability in atlantoaxial and occipitocervical fixati

关 键 词：上颈椎 内固定 有限元分析 螺钉 

分 类 号：R687.3[医药卫生—骨科学]