【摘要】 目的通过离体生物力学研究方法,比较3种后路寰枢椎融合技术的力学稳定性。方法将8具新鲜尸体的颈椎标本(C1～4)置于1.5 Nm载荷下,测量C1、2关节的三维运动范围(ROM)。每具标本依双侧经寰枢关节间隙螺钉结合Gallie内固定术、双侧经寰枢关节间隙螺钉结合寰椎椎板钩内固定术、双侧寰椎侧块螺钉结合枢椎椎弓根螺钉内固定术的顺序实施固定,每次固定后测量三维运动范围。结果包含经寰枢关节间隙螺钉的内固定组在旋转和侧屈方向上具有最小的ROM角度,其中新型的双侧经寰枢关节间隙螺钉结合寰椎椎板钩内固定组在前屈后伸运动方向上也具有最小ROM角度。寰椎侧块螺钉结合枢椎椎弓根螺钉内固定组在旋转方向上ROM角度显著大于单独经寰枢关节螺钉内固定组,但在侧屈和前屈后伸方向上ROM角度近似于经寰枢关节间隙螺钉,差异无统计学意义。结论双侧经寰枢关节间隙螺钉结合寰椎椎板钩内固定术具有最强的生物力学稳定性;双侧寰椎侧块螺钉结合枢椎椎弓根螺钉内固定术与双侧经寰枢关节间隙螺钉结合寰椎椎板钩内固定技术比较,具有相似的力学稳定性。更多还原

【Abstract】 Objective To compare the immediate three-dimensional biomechanical stability of three posterior atlantoaxial fixations.Methods Eight human specimens(C1～4) were loaded nondestructively with 1.5 Nm in the unconstrained testing apparatus and specimens were respectively instrumented with each of the following techniques:transarticular screws fixation and Gallie fixation,transarticular screws combined with atlas laminar hook fixation,lateral mass screws in the atlas combined with isthmic screws in the axis connected with rods.After each operation,the range of motion(ROM) at the level of C1、2 was measured in flexion-bending,lateral bending,axial rotation directions.Results The data indicated that destabilization via intact significantly increased the range of motion of C1、2.All screws techniques significantly decreased the range of motion of C1、2,as compared with the Gallie wiring method in lateral bending and axial rotation,P<0.05 for q test.In fixation techniques with transarticular screws fixation,the largest difference of the range of motion(ROM) happened in the anterior-posterior direction,P<0.05 for q test,the differences in other directions were not statistically significant,paired q tests P>0.05.As lateral mass screws in the atlas combined with isthmic screws in the axis fixation was compared to different fixation techniques with transarticular screws fixation,the most noticeable difference of the range of motion happened in axial rotation with 1.5 Nm load,P<0.05 for q test.Conclusion The transarticular screws combined with atlas laminar hook fixation technique provides the best biomechanical stability.The lateral mass screws in the atlas combined with isthmic screws in the axis connected with rods fixation is nearly as stable as the transarticular screws fixation.It provides a much excellent biomechanical stability when transarticular screws are not feasible.更多还原