枕颈区后路柔性动态固定的生物力学研究

doi:10.13418/j.issn.1001-165x.2022.3.13

中国临床解剖学杂志 ›› 2022, Vol. 40 ›› Issue (3): 315-319.doi: 10.13418/j.issn.1001-165x.2022.3.13

枕颈区后路柔性动态固定的生物力学研究

童杰1,2，季伟1，黄志平1，周若舟1,2，房佐忠2，朱青安1*

1.南方医科大学南方医院脊柱骨科，广州 510515； 2.南方医科大学第一临床医学院附属郴州医院
（郴州市第一人民医院）脊柱外科，湖南郴州 423000

收稿日期:2020-10-13 出版日期:2022-05-25 发布日期:2022-06-02
通讯作者: 朱青安，教授，博士生导师，E-mail：qinganzhu@gmail.com
作者简介:童杰（1980- ），男，医学博士，主任医师，研究方向：脊柱外科，Tel：0735-2343235, E-mail：richardtj@sina.com
基金资助:
国家自然科学基金面上项目（81972110）；郴州市科学技术局科技发展计划项目（ZDYF2020015）；郴州市第一人民医院科研项目（N2019-008）；郴州市第一人民医院院内技术项目（2020A34）；湘南学院科研项目（2020XJ134）

Biomechanical study of posterior flexible and dynamic fixations in the occipitocervical region

Tong Jie1,2, Ji Wei1, Huang Zhiping1, Zhou Ruozhou1,2, Fang Zuozhong2, Zhu Qingan1*

1. Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; 2. Department of Spine Surgery, Affiliated Chenzhou Hospital, The First School of Clinical Medicine, Southern Medical University(The First People’s Hospital of Chenzhou), Chenzhou 423000, China

Received:2020-10-13 Online:2022-05-25 Published:2022-06-02

摘要/Abstract

摘要： 目的探讨柔性和动态固定方式对枕颈区稳定性的影响。方法采用6具新鲜成人枕颈区Oc~C4节段进行测试，模拟以下状态：（1）完整状态；（2）损伤状态：齿状突II型骨折加寰枕关节囊损伤；（3）坚强固定：C1、C2用普通椎弓根螺钉固定，C3侧块螺钉，直径3.5 mm钛棒连接；(4)柔性固定：直径2.0 mm钛棒连接；(5)C1用2枚转动钉固定；(6)C1、C2用4枚转动钉固定；（7）C1、C2、C3用6枚转动钉固定。通过脊柱试验机对标本施加1.5 Nm的纯力偶矩，三维运动测量系统分析枕颈区Oc~C3角度运动范围和中性区。结果直径2.0 mm的棒固定后的运动范围，在各个方向上均大于坚强固定，有显著性差异（P<0.05）。与坚强固定比较，在 C1、C2采用2~4枚转动钉固定，在各方向上运动范围相当（P>0.05）。 C1、C2、C3使用6枚转动钉固定仅在旋转方向上明显增加了Oc~C3运动范围，差别有统计学意义（P=0.031）。不同固定方式在屈伸、侧弯和旋转方向上均显著减小了固定节段的中性区（P<0.05）。结论枕颈区Oc~C3节段，采用直径2.0 mm的细棒固定，各方向的稳定性均弱于坚强固定。在C1、C2采用2~4枚转动钉固定，与坚强固定的稳定性相当。在C1、C2、C3采用6枚转动钉固定，仅在旋转方向上弱于坚强固定。

关键词: 寰椎； , , 枢椎； , , 枕颈区； , , 柔性固定； , , 动态固定； , , 稳定性； , , 生物力学

Abstract: Objective To analyze the effects of flexible and dynamic fixation on the stability of the occipitocervical region. Methods Biomechanical tests were performed by using six fresh adult cervical spines (occipital bone-C4 segment, Oc~C4), with the fixation site extended from the occipital bone to the C3 vertebra. The following conditions were stimulated: (1) Intact state; (2) Injury state: a combination of type II odontoid fractures and atlanto-occipital capsule injury; (3)Rigid fixation: a 3.5 mm diameter titanium rod was used to connect C3 lateral mass screws, C1, and C2 were fixed with common pedicle screws; (4) Flexible fixation: a 2.0 mm diameter titanium rod was used to fix Oc~C3 with locking connections between the screws and rods; (5) Fixation by using two rotating pedicle screws; (6) C1 and C2 were fixed with four rotating pedicle screws; (7) C1, C2 and C3 were fixed with six rotating pedicle screws. Biomechanical studies were performed by using a spinal testing machine, while applying a constant moment of 1.5 Nm in flexion-extension, left-right lateral bending, and left-right axial rotation directions were measured to analyze the range of motion (ROM) and neutral zone (NZ) of Oc~C3 segments. Results ROM of 2.0mm diameter rod fixation was significantly larger than that of rigid fixation in all directions (P<0.05). Compared with the rigid fixation, ROM of Oc~C3 in C1 and C2with a fixation that used 2~4 rotating pedicle screws was similar in all directions (P>0.05). The application of six rotating pedicle screws in C1~C3 significantly increased ROM for rotation in Oc~C3 with statistical significance (P=0.031). Different fixation methods significantly reduced the neutral zone of fixed segment in flexion, extension, lateral bending and rotation directions (P<0.05). Conclusions In the occipital cervical region Oc~C3, the stability of all directions with using flexible fixation was weaker than that of rigid fixation. In the occipital cervical region, the stability of using two or four rotating screw fixations in C1 and C2 is similar to that of rigid fixation. Using six rotating screw fixations is as stable as rigid fixation in directions of flexion, extension and lateral bending, but weaker in the direction of rotation.

Key words: Atlas; , , Axis; , Occipital cervical region; , Flexible fixation； , Dynamic fixation; , , Stability; , , Biomechanics

中图分类号:

R318.01

童杰, 季伟, 黄志平, 周若舟, 房佐忠, 朱青安. 枕颈区后路柔性动态固定的生物力学研究[J]. 中国临床解剖学杂志, 2022, 40(3): 315-319.

Tong Jie, Ji Wei, Huang Zhiping, Zhou Ruozhou, Fang Zuozhong, Zhu Qingan. Biomechanical study of posterior flexible and dynamic fixations in the occipitocervical region[J]. Chinese Journal of Clinical Anatomy, 2022, 40(3): 315-319.

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枕颈区后路柔性动态固定的生物力学研究

Biomechanical study of posterior flexible and dynamic fixations in the occipitocervical region

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