下颈椎经关节螺钉与侧块钉棒固定的生物力学比较

发布时间：2018-01-04 03:13

本文关键词：下颈椎经关节螺钉与侧块钉棒固定的生物力学比较　出处：《中国脊柱脊髓杂志》2015年09期 　论文类型：期刊论文

【摘要】：目的 :比较下颈椎经关节螺钉与侧块钉棒系统固定的生物力学特点。方法 :采用8具新鲜尸体下颈椎标本(C5~T1),用牙托石膏粉包埋后,通过脊柱试验机对标本施加最大2.0Nm纯力偶矩,在不同测试状态下,包括完整(A组)、C5/6后方韧带复合体切除(B组)、C5~C7经关节螺钉固定(C组)、C5~C7侧块钉棒系统固定(D组),测量屈伸、侧弯及旋转方向上的三维运动范围(ROM)。在C6椎体前缘粘贴应变片,测量不同状态下椎体前柱载荷变化。结果:A组C5/6节段屈伸、侧弯和旋转方向上的ROM分别为13.6°±1.2°、6.1°±0.5°、4.2°±1.6°;B组为14.4°±1.2°,6.4°±0.6°,4.8°±0.8°,C组为2.8°±0.7°、0.7°±0.3°、0.4°±0.1°,D组为1.2°±0.3°、0.5°±0.2°、0.8°±0.3°,在屈伸方向上B组的ROM较A组明显增大(P0.05),C组和D组在各方向上均较A组和B组明显减小(P0.05);在屈伸方向上,C组与D组比较有统计学差异(P0.05),在侧弯和旋转方向上,C组和D组无统计学差异(P0.05)。A组C6/7节段屈伸、侧弯和旋转方向上的ROM分别为12.3°±1.4°、5.5°±1.2°、2.7°±0.9°;B组为12.0°±1.3°、5.6°±1.0°、2.8°±0.9°,C组为2.9°±0.9°、0.4°±0.2°、0.4°±0.1°,D组为1.2°±0.3°、0.4°±0.1°、0.7°±0.3°,A、B两组在各方向上的ROM无显著性差异(P0.05);在屈伸方向上,C组和D组的ROM有统计学差异(P0.05),在侧弯和旋转方向上,两组无统计学差异(P0.05)。C组C6椎体前柱的应变在侧弯方向上较A组明显减小(P0.05),D组在前屈、后伸、侧弯方向上较A组明显减小(P0.05),C、D组在前屈方向上比较有统计学差异(P0.05)。结论:下颈椎后方韧带复合体损伤可造成屈伸和侧弯方向上失稳,经关节螺钉固定在轴向旋转和侧弯方向上与侧块钉棒系统固定效果相似,但限制屈伸运动的能力较弱。
[Abstract]:Objective: to compare the biomechanical characteristics of transarticular screw fixation and lateral mass screw system fixation in lower cervical spine. The maximum 2.0 Nm pure couple moments were applied to the specimens by spinal testing machine, and in different test states, including group A, C5 / 6 posterior ligamentum complex resection (group B). Group C was fixed with C _ (5) C _ (5) C _ (5) C _ (7) lateral mass screw system and group D was fixed with C _ (5) C _ (7), and flexion and extension were measured. Three dimensional motion range in lateral bend and rotation direction. Strain gauges were attached to the front edge of the C6 vertebrae to measure the load changes of the anterior column of the vertebral body in different states. Results the C 5 / 6 segment flexion and extension of the C 5 / 6 segment in group A were measured. The ROM in the direction of lateral bend and rotation was 13.6 掳卤1.2 掳卤6.1 掳卤0.5 掳卤4.2 掳卤1.6 掳, respectively. In group B, it was 14.4 掳卤1.2 掳(6.4 掳卤0.6 掳) and 4.8 掳卤0.8 掳(C): 2.8 掳卤0.7 掳(0.7 掳) 卤0.3 掳(0.4 掳卤0.1 掳). The ROM of group D was 1.2 掳卤0.3 掳卤0.5 掳卤0.2 掳卤0.8 掳卤0.3 掳. The ROM of group B was significantly larger than that of group A in flexion and extension direction (P 0.05). Group C and group D were significantly smaller than group A and group B in each direction. There was significant difference in flexion and extension direction between group C and group D (P 0.05), but there was no significant difference between group C and group D in the direction of lateral bend and rotation. There was no significant difference between group C and group D in flexion and extension of C6 / 7 segment. The ROM in the direction of lateral bend and rotation was 12.3 掳卤1.4 掳卤5.5 掳卤1.2 掳卤2.7 掳卤0.9 掳, respectively. Group B (12.0 掳卤1.3 掳) 5.6 掳卤1.0 掳卤2.8 掳卤0.9 掳C was 2.9 掳卤0.9 掳卤0.4 掳卤0.2 掳卤0.4 掳卤0.1 掳. The ROM of group D was 1.2 掳卤0.3 掳卤0.4 掳卤0.1 掳(0.7 掳卤0.3 掳). There was no significant difference in ROM in each direction between group D and group B (P 0.05). In flexion and extension direction, the ROM of group C and group D was significantly different (P 0.05), and in the direction of lateral bend and rotation. There was no statistical difference between the two groups. The strain of the anterior column of the C6 vertebrae in group P0.05. C was significantly lower than that in group A in the lateral bending direction, and that in group D was significantly lower than that in group A. Compared with group A, the lateral bending direction was significantly lower than that in group A (P 0.05). Conclusion: the injury of posterior ligament complex of lower cervical spine can cause instability in flexion extension and lateral bending direction. The effect of joint screw fixation in axial rotation and lateral bending direction is similar to that of lateral block screw rod system, but the ability of limiting flexion and extension motion is weak.
【作者单位】：南方医科大学南方医院脊柱骨科;湖南省郴州市第一人民医院脊柱外科;
【基金】：国家自然科学基金面上项目(编号:81171765) 郴州市第一人民医院优秀青年基金(N2014-005)
【分类号】：R318.01;R687.3
【正文快照】： 510515,China下颈椎不稳通常需要行后路手术固定和融合。目前,侧块螺钉固定和椎弓根螺钉固定是临床上常用的下颈椎后路固定形式,但这两种方法均有各自的局限性。颈椎侧块螺钉导致的血管神经损伤以及术后螺钉松动、脱出等并发症已有文献报道[1、2]。椎弓根螺钉固定可以提供更高

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