[1]王大天 邱锋△.枕颈后路短节段固定的交叉棒与平行棒固定方式生物力学稳定性比较[J].中国中医骨伤科杂志,2022,30(07):19-25.
　WANG Datian QIU Feng.Comparison of Biomechanical Stability between Crossed Rod and Parallel Rod with C0-2 Posterior Fixation[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2022,30(07):19-25.
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枕颈后路短节段固定的交叉棒与平行棒固定方式生物力学稳定性比较()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第30卷
期数:
2022年07期
页码:
19-25
栏目:
临床研究
出版日期:
2022-07-15

文章信息/Info

Title:
Comparison of Biomechanical Stability between Crossed Rod and Parallel Rod with C0-2 Posterior Fixation
文章编号:
1005-0205(2022)07-0019-07
作者:
王大天1 邱锋2△
1海南省中医院(海口,570000)2普宁华侨医院骨科
Author(s):
WANG Datian1 QIU Feng2△
1Department of Orthopaedic,Hainan Hospital of Traditional Chinese Medicine,Haikou 570000,China; 2Department of Orthopaedic,Puning Overseas Chinese Hospital,Puning 515300,Guangdong China.
关键词:
生物力学测试;  板-钉-棒短节段枕颈固定;  交叉棒;  平行棒
Keywords:
biomechanics test;  occipitocervical fixation;  crossed rod;  parallel rod
分类号:
R681.5
文献标志码:
A
摘要:
目的:分别比较枕颈融合中两种内固定方式——枕骨髁Y形板+枢椎一侧椎板螺钉/另一侧椎弓根螺钉(A组)和枕骨髁Y形板+枢椎双侧椎弓根螺钉(B组)的交叉棒和平行棒的生物力学稳定性。方法:取6具新鲜人体尸体颈椎标本,完成完整状态的生物力学测量后,制备寰枢椎失稳模型,每一例标本均植入枕骨髁Y形板及枢椎一侧椎板螺钉、枢椎双侧椎弓根螺钉。按顺序分别测量枢椎一侧椎板螺钉/另一侧椎弓根螺钉平行棒固定(A1组)、枢椎一侧椎板螺钉/另一侧椎弓根螺钉交叉棒固定(A2组)、枢椎双侧椎弓根螺钉平行棒固定(B1组)和枢椎双侧椎弓根螺钉交叉棒固定(B2组)的屈伸、侧屈、旋转活动度。结果:与完整状态组相比较,A1、A2、B1、B2四种内固定组合在屈伸、侧屈、旋转六个方向上的稳定性均强于完整状态组,差异均有统计学意义(P<0.05); A1、A2、B1、B2组间比较在前屈/后伸、左/右侧屈方向上差异均无统计学意义(P>0.05); A1组的稳定性在左/右旋转上较A2、B1、B2三组差,差异有统计学意义(P<0.05); 而A2、B1、B2组间比较在左/右旋转上差异无统计学意义(P>0.05)。结论:枕颈后路短节段固定时,应首选枢椎双侧椎弓根螺钉,当无法置入枢椎椎弓根螺钉时,应尽量选择条件相对允许的一侧置入椎弓根螺钉,另一侧使用椎板螺钉代替。此时,采用交叉棒的连接方式可获得同双侧椎弓根螺钉相似的固定强度。
Abstract:
Objective:To compare the biomechanical stability of the fixation technique for the crossed rod and parallel rod by occipital plate combined with C2 one side lamina screw/other side pedicle screw and occipital plate combined with C2 bilateral pedicle screws.Methods:Six fresh adult craniocervical specimens were used to test the biomechanical stability.Following intact state testing,each specimen was implanted with occipital plate,C2 lateral lamina screws and C2 bilateral pedicle screws.The specimens were then tested in the following sequence:group A1(occipital plate + C2 one side lamina screw/other side pedicle screw + parallel rod),group A2(occipital plate + C2 one side lamina screw/other side pedicle screw + crossed rod),group B1(occipital plate + C2 bilateral pedicle screws + parallel rod),and group B2(occipital plate + C2 bilateral pedicle screws + crossed rod).The ROM of the C0-2 segments were measured in flexion-extension,lateral bending,and axial rotation.Results:The four fixed modes significantly increased stability compared with both the intact group in flexion-extension,lateral bending,and axial rotation(P<0.05).There was no significant difference between the four internal fixd modes in flexion- extension and lateral flexion(P>0.05).In the rotation,the stability of group A1 was worser than the other three groups(P<0.05),and no significant difference among A2,B1 and B2 groups(P>0.05).Conclusion:When C0-2 fixation was required,C2 bilateral pedicle screws should be preferred.when C2 pedicle screws cannot be inserted,try to select the side with relatively allowable conditions to insert one pedicle screw,and use lamina screw to replace it on the other side.At this time,the fixation strength similar to that of C2 bilateral pedicle screws could be obtained by cross rod connection.

参考文献/References:

[1] 马维虎.寰枢椎后路钉棒固定融合技术的合理应用[J].中华医学杂志,2020,100(45):3562-3565.
[2] HALE A T,SAY I,SHAH S,et al.Traumatic occipitocervical distraction injuries in children:a systematic review[J].Pediatr Neurosurg,2019,54(2):75-84.
[3] 孙岩,董春科,王好,等.后路枕颈融合内固定联合椎体成形术治疗枢椎转移瘤病理性骨折的疗效观察[J].中华骨与关节外科杂志,2021,14(2):86-91.
[4] PAN J,HUANG D,HAO D,et al.Occipitocervical fusion:fix to C2 or C3[J].Clin Neurol Neurosurg,2014,127:134-139.
[5] 马向阳,尹庆水,吴增晖,等.枢椎椎板螺钉与椎弓根螺钉抗拔出强度的比较[J].中国脊柱脊髓杂志,2007(2):137-139.
[6] 邓轩赓,熊小明,石华刚,等.枢椎椎板钉治疗可复性寰枢椎脱位的近期疗效[J].中国修复重建外科杂志,2019,33(11):1419-1423.
[7] GABRIEL J P,MUZUMDAR A M,KHALIL S,et al.A novel crossed rod configuration incorporating translaminar screws for occipitocervical internal fixation:an in vitro biomechanical study[J].Spine J,2011,11(1):30-35.
[8] 高延征,邢帅,高坤,等.枢椎椎板螺钉固定与枢椎椎弓根螺钉固定对枕颈融合术临床疗效的影响[J].脊柱外科杂志,2016,14(3):129-134.
[9] 马向阳,杨进城,邱锋,等.枕颈交叉棒临床固定技术的建立与临床应用[J].中国骨与关节损杂志,2015,30(11):1121-1123.
[10] 邱锋,许喜林,马向阳,等.枕骨髁Y形板联合C2双侧椎板螺钉交叉棒固定稳定性的生物力学研究[J].中国修复重建外科杂志,2020,34(12):1545-1549.
[11] 邱锋,许喜林,马向阳,等.C2椎板螺钉短节段钉棒固定系统中交叉棒与平行棒固定的生物力学比较[J].中国组织工程研究,2021,25(12):1805-1809.
[12] CHEN J,ZHOU F,NI B,et al.New posterior atlantoaxial restricted non-fusion fixation for atlantoaxial instability:a biomechanical study[J].Neurosurgery,2016,78(5):735-741.
[13] LIU S,SONG Z,LIU L,et al.Biomechanical evaluation of C1 lateral mass and C2 translaminar bicortical screws in atlantoaxial fixation:an in vitro human cadaveric study[J].Spine J,2018,18(4):674-681.
[14] WILKE H J,WENGER K,CLAES L.Testing criteria for spinal implants:recommendations for the standardization of in vitro stability testing of spinal implants[J].Eur Spine J,1988,7(2):148-154.
[15] 王圣林,田英轮,许南方,等.颈椎后路“组合式”内固定治疗寰枢关节不稳或脱位的临床疗效[J].中国脊柱脊髓杂志,2020,30(4):338-345.
[16] 郑建章,吴宏,胡世平,等.寰枢椎椎弓根钉内固定术治疗寰枢椎不稳疗效分析[J].中国骨与关节损伤杂志,2020,35(3):252-254.
[17] 付松,邵诗泽,刘海军,等.枕颈融合与寰枢椎融合治疗上颈椎失稳症的疗效比较[J].骨科,2012,3(2):93-94.
[18] JOAQUIM A F,OSORIO J A,RIEW K D.Occipitocervical fixation:general considerations and surgical technique[J].Global Spine J,2020,10(5):647-656.
[19] 王正光,周勇.单侧枢椎棘突椎板螺钉治疗寰枢椎不稳定的临床研究[J].深圳中西医结合杂志,2021,31(14):102-104.
[20] CRISTANTE A F,TORELLI A G,KOHLMANN R B,et al.Feasibility of intralaminar,lateral mass,or pedicle axis vertebra screws in children under 10 years of age:a tomographic study[J].Neurosurgery,2012,70(4):835-838.
[21] 金根洋,赵杰,连小峰,等.4种不同后路枕颈内固定方式的生物力学研究[J].颈腰痛杂志,2007(5):356-361.
[22] SHEN K,DENG Z,YANG J,et al.Biomechanical study of novel unilateral C1 posterior arch screws and C2 laminar screws combined with an ipsilateral crossed C1-C2 pedicle screw-rod fixation for atlantoaxial instability[J].Arch Orthop Trauma Surg,2017,137(10):1349-1355.

备注/Memo

备注/Memo:
基金项目:海南省临床医学中心建设项目(琼卫医函〔2021〕276号)
△通信作者 E-mail:spineqf@163.com
更新日期/Last Update: 1900-01-01