C1侧块C2椎板螺钉固定与C1-2关节螺钉固定的生物力学性能比较

目的 比较1侧块C2椎板螺钉固定与后路C1-2关节螺钉固定的牛物力学性能,为枢椎交叉椎板螺钉的临床应用提供参考依据.方法 收集新鲜成年人尸体颈椎标本(C0-C4)10具,男6具,女4具,平均年龄58岁(50～72岁).分别制备成C1-2完整状态的模型(M0)、C1-2失稳的模型(M1)、C1,侧块螺钉C2交义椎板螺钉固定模型(M2)及后路C1-2关节螺钉固定模型(M3),进行三维生物力学测试,记录各组模型在屈伸、轴向旋转和侧屈的运动范围(ROM)和中性区(NZ).结果 屈伸模式下M0、M1、M2、M3的ROM和NZ分别为:(20.4±9.2)°、(10.4±5.8)°;(46.3±17.2))°、(34.5±14.1)°;(4.1±0.9)°、(1.9±0.8)°;(4.3±1.0)°、(2.1±0.7)°.轴向旋转模式下 M0、M1、M2、M3的ROM和NZ分别为:(65.3±12.9)°、(40.8±11.2)°;(91.7±10.5)°、(72.3±12.6)°;(8.9±2.1)°、(4.7±1.8)°;(8.4±2.5)°、(4.4±2.3)°.侧屈模式F M0、M1、M2、M3的ROM和NZ分别为:(11.5±4.3)°、(7.2±3.2)°;(35.0±12.9)°、(21.9±11.8)°;(2.9±1.1)°、(1.4±0.8)°;(2.5±1.4)°、(1.3±1.0)°.在三维运动模式下M2和M3力学稳定性均明显优于M1和M0,然而M2和M3,的差异无统计学意义(P>0.05).结论 C1侧块C2椎板螺钉固定拥有良好的生物力学稳定性,可作为C1-2关节螺钉固定的良好替代.

Biomechanical comparison between C1 lateral mass C2 crossing laminar screws fixation and C1-2 transarticular screw fixation

Objective To compare biomechanical stability between C1, lateral mass C2 crossing laminar screws fixation and C1-2 transarticular screw fixation. Methods Ten fresh adult cervical specimens (CO-C4) were obtained,of which 5 were male and four were female, and mean age was 58 years (50-72 years). All specimens were made up into four different testing models such as C1-2 intact ( M0 ) ,C1-2 insta-bility ( M1 ) ,C1 lateral mass and C2 crossing laminar screws fixation ( M2 ) and C1-2 transarticular screw fixation ( M3 ), and then three-dimension biomechanical testing was performed. The range of motion ( ROM )and natural zone (NZ) were recorded under flexion and extension,axial rotation and lateral bending motion. Results The ROM and NZ of M0,M1 ,M2 and M3 were ((20.4±9.2)°、(10.4±5.8)°;; (46.3±17.2))°,(34.5±14.1)°;(4.1±0.9)°,(1.9±0.8)°;(4.3±1.0)°,(2.1±0.7)°. respectively under flexion and extension. The ROM and NZ of M0, M1, M2 and M3 were (65.3±12.9)°、(40.8±11.2)°;(91.7±10.5)°,(72.3±12.6)°;(8.9±2.1)°,(4.7±1.8)°;(8.4±2.5)°,(4.4±2.3)°;respectively under axial rotation. The ROM and NZ of M0, M1, M2 and M3 were (11.5±4.3)°、(7.2±3.2)°;(35.0±12.9)°,(21.9±11.8)°;(2.9±1.1)°,(1.4±0.8)°;(2.5±1.4)°,(1.3±1.0)°;respectively under lateral bending. The stability of M2 and M3 was superior to M0and M1, under three-dimensional biomechanical testing. However,the difference in stability between M2 and M3 had no significance (P > 0.05 ). Conclusion C2 crossing laminar screws fixation has good biomechanical stability and is an alternative fixation of C2 pedicle screws.