用于治疗难复位性寰枢椎脱位的新型经口前路寰枢椎侧块融合器的生物力学研究

发布时间：2018-04-07 16:37

本文选题：经口前路　切入点：寰枢椎　出处：《中国临床解剖学杂志》2017年03期

【摘要】：目的比较新型寰枢椎侧块融合器与传统内固定方式(TARP+髂骨块内固定技术,后路椎弓根钉棒固定技术)的生物力学差异。方法收集40例TARP术后病人的CT扫描数据进行测量并设计新型融合器。挑选6具新鲜上颈椎标本。分别进行完整状态,失稳状态及进行3种内固定方式[(TARP+融合器(A1);TARP+髂骨块(A2);后路椎弓根钉棒技术(B)]处理。再测量不同状态下标本的屈伸,侧屈,旋转6组动作的活动范围(ROM)并进行统计学分析。结果新型融合器有三种型号:13/12/7,12/11/7,11/10/7(长/宽/高);矢状面角设计为:16°/18°/20°。生物力学数据分析显示:Cage组(A1)与髂骨组(A2)在6个方向的活动度差异无统计学差异(P0.05);在屈伸及旋转活动中,TARP固定组(A1、A2)与后路固定组(B)不存在显著差异(P0.05);在侧屈活动中,TARP固定组(A1、A2)与后路固定组(B)存在显著差异(P0.05)。结论配合TARP技术使用的新型融合器与TARP+髂骨块的生物力学稳定性相仿,在侧屈方向优于寰枢椎后路椎弓根螺钉技术。且融合器相对于髂骨块而言,理论上具有以下优势:(1)简化手术步骤;(2)避免取髂骨相关并发症。
[Abstract]:Objective to compare the biomechanical differences between the new atlantoaxial lateral mass fusion cage and the traditional TARP iliac bone fixation technique and the posterior pedicle screw fixation technique.Methods CT scan data of 40 patients after TARP were measured and a new fusion cage was designed.Six fresh specimens of upper cervical vertebrae were selected.The complete state, unstable state and three internal fixation methods were performed respectively [TARP fusion cage A1, TARP iliac bone graft A2, posterior pedicle pedicle screw technique B)].The range of motion of 6 groups of motion were measured under different states, such as flexion and extension, lateral flexion and rotation.Results there are three models of the new fusion device: 13 / 12 / 7 / 12 / 12 / 11 / 11 / 10 / 7 (long / wide / high); the sagittal angle is designed to be: 16 掳/ 18 掳/ 20 掳.Biomechanical data analysis showed that there was no significant difference in activity in 6 directions between the two groups (A1) and iliac bone group (A2), but there was no significant difference between the TARP fixation group (A1A2) and the posterior fixation group (P0.05) in flexion, extension and rotation, while there was no significant difference in lateral flexion activity between the TARP group and the posterior fixation group (P 0.05).There was significant difference between TARP group and posterior fixation group (P 0.05).Conclusion the new fusion cage combined with TARP technique is similar to the biomechanical stability of TARP iliac bone graft and is superior to the posterior atlantoaxial pedicle screw technique in lateral flexion.In theory, the fusion cage has the following advantages over the iliac bone graft: 1) simplify the procedure and avoid the complications associated with iliac bone extraction.
【作者单位】：南方医科大学;广州军区广州总医院;
【基金】：军队十二五重点项目(BWS11C065)
【分类号】：R318.01;R684

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