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齿状突螺钉钢板内固定系统的生物力学研究

A biomechanical evaluation of odontoid screw plate fixation system

摘要:

目的 评价自行设计的齿状突螺钉钢板内固定系统在治疗Ⅰ型Hangman骨折伴Ⅱ型齿状突骨折联合C2~C3椎间盘损伤时的生物力学性能.方法 选取8具新鲜尸体颈椎标本(包括C1~C3颈椎节段),在生物力学试验机上依次测试以下各组C1~C2及C2~C3节段的三维运动范围(ROM)值及中性区值:完整标本状态(A组);失稳状态:Hangman Ⅰ型骨折+Ⅱ型齿状突骨折+C2~C3椎间盘切除(B组);颈椎前路钢板+齿状突螺钉+ cage固定组(C组);齿状突螺钉钢板固定组(D组);后路C2~C3椎弓根侧块螺钉+齿状突螺钉固定组(E组)和后路C1~C3椎弓根侧块螺钉固定组(F组),并对结果进行统计学分析.结果 在C1~C2节段,D组和F组的ROMC1~c2值在各个方向上差异均有统计学意义(P<0.05).在C2~C3节段,D组与C组相比,ROMC2~c3值在各个方向上均较小,且差异有统计学意义(P<0.05);D组与E、F组相比,ROMC2~C3值在前屈、后伸方向上较小,且差异有统计学意义(P<0.05).结论 齿状突螺钉钢板内固定系统在治疗Hangman Ⅰ型骨折伴Ⅱ型齿状突骨折联合C2~ C3椎间盘损伤时具有良好的生物力学性能,可以作为治疗此类合并伤的一种补充方法.

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abstracts:

Objective To evaluate the biomechanical stability of anterior odontoid screw plate (AOSP).Methods Eight fresh-frozen cadaveric cervical spine specimens were subjected to stepwise destabilization of the C1-Ca complex,simulating a type Ⅰ Hangman fracture,type Ⅱ odontoid fracture,and the C2-3 disc injury.Intact specimens,fractured specimens,and fractured specimens with posterior,anterior fixation techniques were divided into six groups:control group (intact),injury group of type Ⅱ odontoid fracture and type Ⅰ Hangman fracture combined with C2-3 disk injury,after anterior cervical plate + odontoid screw + cage (ACP + OS + cage) group,after anterior odontoid screw plate (AOSP) fixation system group,after affixing rods from pedicle screws in C2 to lateral mass screws in C3 + odontoid screw (C2PS + C3LMS +OS) group,after affixing rods from pedicle screws in C1 to pedicle screws in C2 and lateral mass screws in C3 (C1 PS + C2PS + C3LMS) group.The range of motion (ROM) and neutral zone of C1-C2 and C2-C3 segment was tested.Results There was statistically significant difference between the C1PS + C2PS + C3LMS fixation group and the AOSP fixation group of ROMC1-C2 (P < 0.05).During all loading modes,AOSP + Bone graft fixation significantly outperformed the ACP + OS + cage fixation in limiting ROMC2-C3.During flexion and extension,AOSP fixation significantly outperformed the C1PS + C2PS + C3LMS fixation and C2PS + C3LMS + OS fixation in limiting ROMC2-C3.Conclusion The AOSP fixation system has excellent biomechanical performance when dealing with type Ⅰ Hangman fracture,type Ⅱ odontoid fracture,and the C2-3 disc injury,and appear to be a safe and effective technique for dealing with the combined injury.

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作者: 胡勇 [1] 董伟鑫 [1] 孙肖阳 [1] 袁振山 [1] 张蛟 [1] 谢辉 [1] 邬春晖 [1]
第一作者: 胡勇
期刊: 《中华外科杂志》2016年54卷3期 212-216页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2016.03.012
发布时间: 2016-03-31
基金项目:
浙江省医药卫生一般研究计划资助项目(2015KYA202) Medical Research Program in General of Zhejiang Province of China
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