本文關(guān)鍵詞：下頸椎經(jīng)關(guān)節(jié)螺釘與側(cè)塊釘棒固定的生物力學(xué)比較　出處：《中國脊柱脊髓雜志》2015年09期 　論文類型：期刊論文

  更多相關(guān)文章： 頸椎 經(jīng)關(guān)節(jié)螺釘 側(cè)塊螺釘 生物力學(xué) 后路融合

【摘要】：目的 :比較下頸椎經(jīng)關(guān)節(jié)螺釘與側(cè)塊釘棒系統(tǒng)固定的生物力學(xué)特點。方法 :采用8具新鮮尸體下頸椎標本(C5~T1),用牙托石膏粉包埋后,通過脊柱試驗機對標本施加最大2.0Nm純力偶矩,在不同測試狀態(tài)下,包括完整(A組)、C5/6后方韌帶復(fù)合體切除(B組)、C5~C7經(jīng)關(guān)節(jié)螺釘固定(C組)、C5~C7側(cè)塊釘棒系統(tǒng)固定(D組),測量屈伸、側(cè)彎及旋轉(zhuǎn)方向上的三維運動范圍(ROM)。在C6椎體前緣粘貼應(yīng)變片,測量不同狀態(tài)下椎體前柱載荷變化。結(jié)果:A組C5/6節(jié)段屈伸、側(cè)彎和旋轉(zhuǎn)方向上的ROM分別為13.6°±1.2°、6.1°±0.5°、4.2°±1.6°;B組為14.4°±1.2°,6.4°±0.6°,4.8°±0.8°,C組為2.8°±0.7°、0.7°±0.3°、0.4°±0.1°,D組為1.2°±0.3°、0.5°±0.2°、0.8°±0.3°,在屈伸方向上B組的ROM較A組明顯增大(P0.05),C組和D組在各方向上均較A組和B組明顯減小(P0.05);在屈伸方向上,C組與D組比較有統(tǒng)計學(xué)差異(P0.05),在側(cè)彎和旋轉(zhuǎn)方向上,C組和D組無統(tǒng)計學(xué)差異(P0.05)。A組C6/7節(jié)段屈伸、側(cè)彎和旋轉(zhuǎn)方向上的ROM分別為12.3°±1.4°、5.5°±1.2°、2.7°±0.9°;B組為12.0°±1.3°、5.6°±1.0°、2.8°±0.9°,C組為2.9°±0.9°、0.4°±0.2°、0.4°±0.1°,D組為1.2°±0.3°、0.4°±0.1°、0.7°±0.3°,A、B兩組在各方向上的ROM無顯著性差異(P0.05);在屈伸方向上,C組和D組的ROM有統(tǒng)計學(xué)差異(P0.05),在側(cè)彎和旋轉(zhuǎn)方向上,兩組無統(tǒng)計學(xué)差異(P0.05)。C組C6椎體前柱的應(yīng)變在側(cè)彎方向上較A組明顯減小(P0.05),D組在前屈、后伸、側(cè)彎方向上較A組明顯減小(P0.05),C、D組在前屈方向上比較有統(tǒng)計學(xué)差異(P0.05)。結(jié)論:下頸椎后方韌帶復(fù)合體損傷可造成屈伸和側(cè)彎方向上失穩(wěn),經(jīng)關(guān)節(jié)螺釘固定在軸向旋轉(zhuǎn)和側(cè)彎方向上與側(cè)塊釘棒系統(tǒng)固定效果相似,但限制屈伸運動的能力較弱。
[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 擄鹵1.2 擄鹵6.1 擄鹵0.5 擄鹵4.2 擄鹵1.6 擄, respectively. In group B, it was 14.4 擄鹵1.2 擄(6.4 擄鹵0.6 擄) and 4.8 擄鹵0.8 擄(C): 2.8 擄鹵0.7 擄(0.7 擄) 鹵0.3 擄(0.4 擄鹵0.1 擄). The ROM of group D was 1.2 擄鹵0.3 擄鹵0.5 擄鹵0.2 擄鹵0.8 擄鹵0.3 擄. 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 擄鹵1.4 擄鹵5.5 擄鹵1.2 擄鹵2.7 擄鹵0.9 擄, respectively. Group B (12.0 擄鹵1.3 擄) 5.6 擄鹵1.0 擄鹵2.8 擄鹵0.9 擄C was 2.9 擄鹵0.9 擄鹵0.4 擄鹵0.2 擄鹵0.4 擄鹵0.1 擄. The ROM of group D was 1.2 擄鹵0.3 擄鹵0.4 擄鹵0.1 擄(0.7 擄鹵0.3 擄). 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.
【作者單位】： 南方醫(yī)科大學(xué)南方醫(yī)院脊柱骨科;湖南省郴州市第一人民醫(yī)院脊柱外科;
【基金】：國家自然科學(xué)基金面上項目(編號:81171765) 郴州市第一人民醫(yī)院優(yōu)秀青年基金(N2014-005)
【分類號】：R318.01;R687.3
【正文快照】： 510515,China下頸椎不穩(wěn)通常需要行后路手術(shù)固定和融合。目前,側(cè)塊螺釘固定和椎弓根螺釘固定是臨床上常用的下頸椎后路固定形式,但這兩種方法均有各自的局限性。頸椎側(cè)塊螺釘導(dǎo)致的血管神經(jīng)損傷以及術(shù)后螺釘松動、脫出等并發(fā)癥已有文獻報道[1、2]。椎弓根螺釘固定可以提供更高

【共引文獻】

相關(guān)期刊論文 前4條

1 李瑞青;荊鑫;;下頸椎后路內(nèi)固定技術(shù)的應(yīng)用與進展[J];中外醫(yī)療;2008年33期

2 孫韶華;劉觀q，

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