颈长肌肌瓣交叉固定防止颈椎植骨块滑脱的生物力学研究及临床应用  

Bimechanical Study and Clinical Use of Longus Collies Muscle Flap to Prevent the Slip of Bone Graft in the Cervical Anterior Decompression

作　　者：张英泽[1] 王庆贤[1] 潘进社[1] 彭阿钦[1] 宋连新[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心,石家庄市050051

出　　处：《骨与关节损伤杂志》2003年第2期73-75,共3页The Journal of Bone and Joint Injury

摘　　要：目的　为防止颈椎前路减压植骨术后植骨块的滑脱 ,我们在对颈长肌的定量解剖学研究基础上 ,设计了切取双侧颈长肌内侧肌瓣交叉缝合固定植骨块的新术式。并进行了生物力学测试和临床应用。方法　采用成年尸体 10具 ,去除颈部浅层肌肉及软组织 ,显露双侧颈长肌及交感干 ,测量C3 ～C7节段颈交感干与颈长肌内缘的距离及双侧颈长肌内缘之间的距离。并在 10个颈椎上模拟了颈椎前路减压植骨 ,利用颈长肌肌瓣交叉缝合 ,在CSS - 110 1c型生物力学测试机上测定了该肌瓣对植骨块的阻挡效果。在此基础上 ,对 11例患者纵行切取颈长肌内侧肌瓣 ,交叉缝合至对侧颈长肌 ,防止颈椎前路减压植骨块滑脱。结果　①双侧颈长肌内缘之间的距离见正文表 1。②在植骨块向前方移位 1 0mm、 2 0mm、 3 0mm时 ,颈长肌肌瓣对植骨块的阻挡力分别为 4 10± 0 32N ,6 0 7± 1 0 9N及 10 2 8± 2 17N。③本组病例随访 0 5～ 6年 ,未出现食道瘘、食管痉挛 ,吞咽困难及呛咳等并发症 ,全部骨性愈合。 7例颈椎病 5例缓解 ;2例减轻 ;4例颈椎骨折脱位患者 3例好转 ,1例无效。所有植骨块均获骨性融合 ,无滑脱。所有患者颈部屈曲及旋转功能正常。结论　颈长肌肌瓣交叉缝合对颈椎前路减压植骨块有阻挡作用。Objective In order to prevent the slip of bone graft in the cervical anterior decompression, we perform an anatomical research of the longus collis muscle(LCM). On this basis, longus collis muscle flaps were made to prevent the slip of bone graft in the patients with cervical anterior decompression. Then biomecharical test was performed and this new operation style was used in this patients.Methods Ten adult cadavers were used for dissection and measurements.The distance between the sympathetic trunk(ST) and the medial border of the LCM and the distance between the medial borders of the LCM were measured form C 3 to C 7 level. Then biomechanical test was performed to deternime its effect on the cervical spine of the sheep. On this basis, LCM flaps were made on 11 patients. Then they were sutured to the contralateral LCM in a cross shape. The cross part of the left and right LCM flaps was on the bone graft in the cervical anterior decompression.Results ①The sympathetic trunk ran in a superior and lateral direction the distance between the ST and the medial border of the LCM were measured table one.②The force of the LCM flap against the bone graft was 4 10±0 32 N,6 07±1 09 N and 10 28±2 17 N when the anterior displacement of the bone gvaft was 1 0 mm, 2 0 mm and 3 0 mm.③Eleven cases were followed up from six months to six years.In the seven cases of cervical spondylosis, five cases recovered and the other cases symptom was alleviated. In the four cases of cervical fractures or dislocations, three cases' symptom was alleviated and one case was in valid. Osteal healing occurred in all bone grafts. The rotational and flexion extension function were normal.Conclusion LCM flap can be sutured crossly to prevent the slip of bone graft in the cervical anterior decompression.

关 键 词：颈椎前路减压植骨术 植骨块滑脱 颈长肌肌瓣交叉固定 生物力学 

分 类 号：R687.34[医药卫生—骨科学]