颅脊交界区交叉棒固定技术建立及生物力学稳定性评价

发布时间：2018-04-11 18:18

本文选题：交叉棒 + 平行棒　；参考：《广州中医药大学》2015年硕士论文

【摘要】：目的：对于寰枢椎失稳,坚强的内固定是治疗最有效的方式。目前颅脊交界区固定方式众多,目前以由枕骨髁钢板、寰椎螺钉及枢椎螺钉组成的板-棒-钉系统或钉-棒系统的三维稳定性最佳,术后骨性融合率最高。当前颅脊交界固定棒的连接方法是左、右各一,构成近似于“Ⅱ”形的框架固定结构。我们建立的枕颈交叉固定棒技术,两根连接棒呈交叉状连接,呈“X”形,其结构类似于多个三角形组成,而三角形的结构最稳定,可进一步增强其结构稳定性。本研究基于临床建立并应用的枕-颈交叉棒技术及寰枢交叉棒技术,通过不同枢椎螺钉固定方法与寰椎椎弓根螺钉、枕骨板组成不同的固定方法,分别将其与传统平行棒固定方法进行生物力学三维稳定性比较,评价颅脊交界区板-棒-钉固定系统及钉-棒固定系统的生物力学稳定性,以期能对其开展应用及临床选择提供理论支持。方法：枕颈融合组：6具新鲜人体颈椎标本,切除寰椎前弓、齿状突及寰枢间韧带等结构制造寰枢椎失稳模型,对每具标本先后进行6种固定方式固定：Al组(枕骨板+C2双侧椎板螺钉+平行棒固定)、A2组(枕骨板+C2双侧椎板螺钉+交叉棒固定)、B1组(枕骨板+C2左侧椎板螺钉右侧椎弓根螺钉+平行棒固定)、B2组(枕骨板+C2左侧椎板螺钉右侧椎弓根螺钉+交叉棒固定)、C1组(枕骨板+C2双侧椎弓根螺钉+平行棒固定)、C2组(枕骨板+C2左侧椎板螺钉右侧椎弓根螺钉+交叉棒固定),A1、A2、B1、B2、C1、C2进行组间比较并分别于N组(寰枢椎失稳状态CO-2活动度)进行对比,在脊柱三维运动机上比较其屈伸、侧屈、旋转三维稳定性。寰枢固定组：在枕颈固定组同一标本上先后进行以下6种固定方式：Dl组(C1双侧椎弓根螺钉+C2双侧椎板螺钉+平行棒固定)、D2组(C1双侧椎弓根螺钉+C2双侧椎板螺钉+交叉棒固定)、E1组(C1双侧椎弓根螺钉+C2左侧椎板螺钉右侧椎弓根螺钉+平行棒固定)、E2组(C1双侧椎弓根螺钉+C2左侧椎板螺钉右侧椎弓根螺钉+交叉棒固定)、F1组(C1双侧椎弓根螺钉+C2双侧椎弓根螺钉+平行棒固定)、F2组(C1双侧椎弓根螺钉+C2双侧椎弓根螺钉+交叉棒固定),D1、D2、E1、E2、F1、F2行组间比较并分别于M组(寰枢椎失稳状态Cl-2活动度)进行对比,在脊柱三维运动机上比较其屈伸、侧屈、旋转三维稳定性。成果：枕颈固定组：在后伸稳定性上,六种固定方式(A1、A2、B1、B2、C1、C2)间无统计学意义(P0.05),均优于对照组N组(P0.05)；在前屈稳定性上,六种固定方式间无统计学意义(P0.05),均优于对照组N组(P0.05)；在左侧屈稳定性上,六种固定方式间无统计学意义(P0.05),均优于对照组N组(P0.05)；在右侧屈稳定性上,六种固定方式间无统计学意义(P0.05),均优于对照组N组(P0.05)；在左旋稳定性上,六种固定方式均优于对照组N(P0.05),其中B2、C2、B1、A2、C1五组间比较无统计学意义(P0.05),A1组稳定性较其他组略差(P0.05)；在右旋稳定性上,六种固定方式均优于对照组N(P0.05),其中B2、C2、B1、A2、C1五组间比较无统计学意义(P0.05),A1组稳定性较其他组略差(P0.05)。寰枢固定组：在后伸稳定性上,六种固定方式(D1、D2、E1、E2、F1、F2)均优于对照组M组(P0.05),其中E2、D2、F2、E1组之间,以及F2、E1、F1、D1组之间无统计学意义(P0.05),但E2、D2稳定性优于D1组(P0.05)；在前屈稳定性上,六种固定方式间无统计学意义(P0.05),均优于对照组M组(P0.05)；在左侧屈稳定性上,六种固定方式均优于对照组M(P0.05),D1组稳定性较其他组略差(P0.05)；在右侧屈稳定性上,六种固定方式均优于对照组M(P0.05),D1组稳定性较E2、E1组略差(P0.05)；在左旋稳定性上,六种固定方式均优于对照组M(P0.05),D2、E2、F2三组稳定性较D1、E1、E2强(P0.05)；在右旋稳定性上,六种固定方式均优于对照组M(P0.05),E2、D2稳定性优于D1组(P0.05)。结论：无论枕颈固定还是寰枢固定,12种固定方式均可提供足够的生物力学稳定性。在枕颈固定,交叉棒固定方式可进一步提升枕骨与C2椎板螺钉组成的板-钉-棒系统的轴向旋转稳定性；在寰枢固定,交叉棒固定方式可进一步提升C1椎弓根螺钉与C2螺钉组成的钉-棒系统的轴向旋转稳定性,可提升C1椎弓根螺钉与C2椎板螺钉组成的钉-棒系统的后伸、侧屈稳定性。
[Abstract]:Objective : To compare the three - dimensional stability of atlantoaxial instability with the three - dimensional stability of the occipital - cervical spinal fixation system and the atlantoaxial cross - rod fixation system . In F2 group ( C1 bilateral pedicle screw + C2 bilateral pedicle screw + crossed rod fixation ) , D1 , D2 , E1 , E2 , F1 and F2 were compared and compared with group M ( atlantoaxial instability state Cl - 2 activity ) . Results : There was no significant difference between the two groups ( P0.05 ) .
There was no significant difference between the six fixation methods ( P0.05 ) .
There was no significant difference between the six fixation methods ( P0.05 ) on the left flexion stability , which was superior to that of the control group ( P0.05 ) .
There was no significant difference between the six fixation methods ( P0.05 ) on the right flexion stability , which was superior to the control group N ( P0.05 ) .
On the left - hand stability , the six fixation methods were better than that of the control group ( P0.05 ) , among which B2 , C2 , B1 , A2 and C1 had no statistical significance ( P0.05 ) , and the stability of the A1 group was slightly worse than that of the other group ( P0.05 ) ;
There was no significant difference between the two groups ( P0.05 ) . There was no significant difference between the two groups ( P0.05 ) . There was no significant difference between the two groups ( P0.05 ) .
There was no significant difference between the six fixation methods ( P0.05 ) .
Compared with the control group M ( P0.05 ) , the stability of D1 group was slightly worse than that of control group ( P0.05 ) .
On the right flexion stability , six fixation methods were better than control group M ( P0.05 ) , the stability of D1 group was lower than that in control group ( P0.05 ) .
Compared with control group M ( P0.05 ) , D2 , E2 and F2 were more stable than those in control group ( P0.05 ) .
Conclusion : There are two kinds of fixation methods which are superior to the control group M ( P0.05 ) , E2 and D2 are superior to the D1 group ( P0.05 ) .
The axial rotational stability of the nail - rod system consisting of the C1 pedicle screw and the C2 screw can be further improved in the atlantoaxial fixation and the cross bar fixing mode , and the posterior and lateral flexion stability of the nail - rod system consisting of the C1 pedicle screw and the C2 vertebral plate screw can be improved .

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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