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两种下颈椎经关节固定技术的静力学比较
作者姓名:Liu GY  Xu RM  Ma WH  Sun SH  Huang L  Yin JW  Jiang WY
作者单位:1. 浙江中医药大学
2. 315040,宁波市第六医院骨科
基金项目:由衷感谢上海大学上海生物力学工程研究所王以进教授和宁波市第六医院影像科王国平、夏华杰等老师对下颈椎经关节螺钉系列研究的大力支持和指导
摘    要:目的 比较两种下颈椎经关节固定技术的静力学拔出强度。方法 10具新鲜尸体颈椎标本(C3-T1),游离成3个颈椎运动节段(C3-C4,C5-C6,C7-T1),在椎体两侧随机进行经关节椎弓根螺钉(TPS)固定和经关节螺钉(TAS)固定,置入直径为3.5mm的皮质骨螺钉。经关节椎弓根螺钉以上位节段侧块外下象限中心点为进钉点,螺钉在横断面内倾约45°,在矢状面尾倾约50°,由上位节段下关节突经关节突关节、下位节段的椎弓根,置入下位节段的椎体内;经关节螺钉以上位节段侧块中心点内侧1mm为进钉点,进钉角度为尾倾35—40°,外倾15~20°,螺钉向前下方固定关节突关节复合体。置钉后行拔出强度试验,比较二种螺钉的最大轴向拔出强度。结果 下颈椎经关节椎弓根螺钉平均拔出强度为668kg·m·s^-2,而经关节螺钉的平均拔出强度为414kg·m·s^-2,两者间差异有统计学意义(t=23.09,P〈0.05).经关节椎弓根螺钉与经关节螺钉在颈椎各节段间差异无统计学意义(TPS和TAS组的F值分别为F=2.17,2.03,P〉0.05)。结论 下颈椎经关节椎弓根螺钉的静力学拔出强度明显优于经关节螺钉,在生物力学上具有应用可行性。

关 键 词:颈椎  内固定器
修稿时间:2007-02-26

A static mechanical comparison between two transarticular internal fixation techniques in the lower cervical spine
Liu GY,Xu RM,Ma WH,Sun SH,Huang L,Yin JW,Jiang WY.A static mechanical comparison between two transarticular internal fixation techniques in the lower cervical spine[J].National Medical Journal of China,2007,87(23):1599-1602.
Authors:Liu Guan-Yi  Xu Rong-Ming  Ma Wei-Hu  Sun Shao-Hua  Huang Lei  Yin Jiang-Wei  Jiang Wei-Yu
Institution:Department of Orthopaedics, Ningbo Sixth People's Hospital, Ningbo 315040, China.
Abstract:OBJECTIVE: To compare static mechanical difference between two transarticular internal fixation techniques in the lower cervical spine. METHODS: Ten fresh human cadaveric cervical spines were harvested. On one side, transarticular pedicle screws were placed at the C3-4, C5-6, and C7-T1 levels, and transarticular screws were placed on the other side. The screw insertion technique at each level was randomized for right or left. The starting point for transarticular pedicle screw insertion was located at the midpoint of the inferolateral quadrant of the lateral mass and the direction of the screw was about 50 degrees caudally in the sagittal plane and about 45 degrees medially in the axial plane, and the starting point for transarticular screw insertion was 1 mm medial to the midpoint of the lateral mass, aiming in a 15 - 20 degrees caudally and 35 - 40 degrees lateral position. After screw placement, each set of vertebral bodies were mounted in a custom jig for axial pullout testing using a servohydraulic testing machine. The load-displacement curves were obtained for each screw pullout. RESULTS: The mean pullout strength for the transarticular pedicle screws was 668 N. This compares with 414 N for the transarticular screws (P < 0.05), but there was not significant difference statistically between different cervical levels (P > 0.05). CONCLUSION: The static mechanical strength of transarticular pedicle screws is superior to the transarticular screws, and the transarticular pedicle screw fixation has the biomechanical feasibility of clinical application.
Keywords:Cervical vertebrae  Internal fixators
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