本文選題：交叉棒 + 平行棒��； 參考：《廣州中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：目的：對(duì)于寰樞椎失穩(wěn),堅(jiān)強(qiáng)的內(nèi)固定是治療最有效的方式。目前顱脊交界區(qū)固定方式眾多,目前以由枕骨髁鋼板、寰椎螺釘及樞椎螺釘組成的板-棒-釘系統(tǒng)或釘-棒系統(tǒng)的三維穩(wěn)定性最佳,術(shù)后骨性融合率最高。當(dāng)前顱脊交界固定棒的連接方法是左、右各一,構(gòu)成近似于“Ⅱ”形的框架固定結(jié)構(gòu)。我們建立的枕頸交叉固定棒技術(shù),兩根連接棒呈交叉狀連接,呈“X”形,其結(jié)構(gòu)類似于多個(gè)三角形組成,而三角形的結(jié)構(gòu)最穩(wěn)定,可進(jìn)一步增強(qiáng)其結(jié)構(gòu)穩(wěn)定性。本研究基于臨床建立并應(yīng)用的枕-頸交叉棒技術(shù)及寰樞交叉棒技術(shù),通過不同樞椎螺釘固定方法與寰椎椎弓根螺釘、枕骨板組成不同的固定方法,分別將其與傳統(tǒng)平行棒固定方法進(jìn)行生物力學(xué)三維穩(wěn)定性比較,評(píng)價(jià)顱脊交界區(qū)板-棒-釘固定系統(tǒng)及釘-棒固定系統(tǒng)的生物力學(xué)穩(wěn)定性,以期能對(duì)其開展應(yīng)用及臨床選擇提供理論支持。方法：枕頸融合組：6具新鮮人體頸椎標(biāo)本,切除寰椎前弓、齒狀突及寰樞間韌帶等結(jié)構(gòu)制造寰樞椎失穩(wěn)模型,對(duì)每具標(biāo)本先后進(jìn)行6種固定方式固定：Al組(枕骨板+C2雙側(cè)椎板螺釘+平行棒固定)、A2組(枕骨板+C2雙側(cè)椎板螺釘+交叉棒固定)、B1組(枕骨板+C2左側(cè)椎板螺釘右側(cè)椎弓根螺釘+平行棒固定)、B2組(枕骨板+C2左側(cè)椎板螺釘右側(cè)椎弓根螺釘+交叉棒固定)、C1組(枕骨板+C2雙側(cè)椎弓根螺釘+平行棒固定)、C2組(枕骨板+C2左側(cè)椎板螺釘右側(cè)椎弓根螺釘+交叉棒固定),A1、A2、B1、B2、C1、C2進(jìn)行組間比較并分別于N組(寰樞椎失穩(wěn)狀態(tài)CO-2活動(dòng)度)進(jìn)行對(duì)比,在脊柱三維運(yùn)動(dòng)機(jī)上比較其屈伸、側(cè)屈、旋轉(zhuǎn)三維穩(wěn)定性。寰樞固定組：在枕頸固定組同一標(biāo)本上先后進(jìn)行以下6種固定方式：Dl組(C1雙側(cè)椎弓根螺釘+C2雙側(cè)椎板螺釘+平行棒固定)、D2組(C1雙側(cè)椎弓根螺釘+C2雙側(cè)椎板螺釘+交叉棒固定)、E1組(C1雙側(cè)椎弓根螺釘+C2左側(cè)椎板螺釘右側(cè)椎弓根螺釘+平行棒固定)、E2組(C1雙側(cè)椎弓根螺釘+C2左側(cè)椎板螺釘右側(cè)椎弓根螺釘+交叉棒固定)、F1組(C1雙側(cè)椎弓根螺釘+C2雙側(cè)椎弓根螺釘+平行棒固定)、F2組(C1雙側(cè)椎弓根螺釘+C2雙側(cè)椎弓根螺釘+交叉棒固定),D1、D2、E1、E2、F1、F2行組間比較并分別于M組(寰樞椎失穩(wěn)狀態(tài)Cl-2活動(dòng)度)進(jìn)行對(duì)比,在脊柱三維運(yùn)動(dòng)機(jī)上比較其屈伸、側(cè)屈、旋轉(zhuǎn)三維穩(wěn)定性。成果：枕頸固定組：在后伸穩(wěn)定性上,六種固定方式(A1、A2、B1、B2、C1、C2)間無統(tǒng)計(jì)學(xué)意義(P0.05),均優(yōu)于對(duì)照組N組(P0.05)；在前屈穩(wěn)定性上,六種固定方式間無統(tǒng)計(jì)學(xué)意義(P0.05),均優(yōu)于對(duì)照組N組(P0.05)；在左側(cè)屈穩(wěn)定性上,六種固定方式間無統(tǒng)計(jì)學(xué)意義(P0.05),均優(yōu)于對(duì)照組N組(P0.05)；在右側(cè)屈穩(wěn)定性上,六種固定方式間無統(tǒng)計(jì)學(xué)意義(P0.05),均優(yōu)于對(duì)照組N組(P0.05)；在左旋穩(wěn)定性上,六種固定方式均優(yōu)于對(duì)照組N(P0.05),其中B2、C2、B1、A2、C1五組間比較無統(tǒng)計(jì)學(xué)意義(P0.05),A1組穩(wěn)定性較其他組略差(P0.05)；在右旋穩(wěn)定性上,六種固定方式均優(yōu)于對(duì)照組N(P0.05),其中B2、C2、B1、A2、C1五組間比較無統(tǒng)計(jì)學(xué)意義(P0.05),A1組穩(wěn)定性較其他組略差(P0.05)。寰樞固定組：在后伸穩(wěn)定性上,六種固定方式(D1、D2、E1、E2、F1、F2)均優(yōu)于對(duì)照組M組(P0.05),其中E2、D2、F2、E1組之間,以及F2、E1、F1、D1組之間無統(tǒng)計(jì)學(xué)意義(P0.05),但E2、D2穩(wěn)定性優(yōu)于D1組(P0.05)；在前屈穩(wěn)定性上,六種固定方式間無統(tǒng)計(jì)學(xué)意義(P0.05),均優(yōu)于對(duì)照組M組(P0.05)；在左側(cè)屈穩(wěn)定性上,六種固定方式均優(yōu)于對(duì)照組M(P0.05),D1組穩(wěn)定性較其他組略差(P0.05)；在右側(cè)屈穩(wěn)定性上,六種固定方式均優(yōu)于對(duì)照組M(P0.05),D1組穩(wěn)定性較E2、E1組略差(P0.05)；在左旋穩(wěn)定性上,六種固定方式均優(yōu)于對(duì)照組M(P0.05),D2、E2、F2三組穩(wěn)定性較D1、E1、E2強(qiáng)(P0.05)；在右旋穩(wěn)定性上,六種固定方式均優(yōu)于對(duì)照組M(P0.05),E2、D2穩(wěn)定性優(yōu)于D1組(P0.05)。結(jié)論：無論枕頸固定還是寰樞固定,12種固定方式均可提供足夠的生物力學(xué)穩(wěn)定性。在枕頸固定,交叉棒固定方式可進(jìn)一步提升枕骨與C2椎板螺釘組成的板-釘-棒系統(tǒng)的軸向旋轉(zhuǎn)穩(wěn)定性；在寰樞固定,交叉棒固定方式可進(jìn)一步提升C1椎弓根螺釘與C2螺釘組成的釘-棒系統(tǒng)的軸向旋轉(zhuǎn)穩(wěn)定性,可提升C1椎弓根螺釘與C2椎板螺釘組成的釘-棒系統(tǒng)的后伸、側(cè)屈穩(wěn)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 .

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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本文編號(hào)：1737139