中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (17): 3089-3092.doi: 10.3969/j.issn.1673-8225.2011.17.013

• 骨科植入物 orthopedic implant • 上一篇    下一篇

椎弓根钉棒系统治疗不稳定性Jefferson骨折的生物力学分析

蒋小红1，肖增明1，温洁明2，唐  林3，蒋雄健1   

  1. 1广西医科大学第一附属医院脊柱骨病外科，广西壮族自治区南宁市   530021
    2广西大学机械工程学院，广西壮族自治区南宁市 530004
    3广西壮族自治区人民医院骨外科，广西壮族自治区南宁市  530000
  • 收稿日期:2010-12-10 修回日期:2011-02-24 出版日期:2011-04-23 发布日期:2011-04-23
  • 通讯作者: 肖增明，硕士，主任医师，广西医科大学第一附属医院脊柱骨病外科，广西壮族自治区南宁市 530021
  • 作者简介:蒋小红★，男，1986年生，广西壮族自治区桂林市人，汉族，广西医科大学在读硕士，主要从事脊柱骨病研究。 285278504@qq.com

Instable Jefferson fracture fixed with the single or double side atlantoaxial pedicle screw-rod system: A biomechanical study

Jiang Xiao-hong1, Xiao Zeng-ming1, Wen Jie-ming2, Tang Lin3, Jiang Xiong-jian1   

  1. 1Department of Spinal and Bone Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning  530021, Guangxi Zhuang Autonomous Region, China
    2College of Mechanical Engineering, Guangxi University, Nanning  530004, Guangxi Zhuang Autonomous Region, China
    3Department of Bone Surgery, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning  530000, Guangxi Zhuang Autonomous Region, China
  • Received:2010-12-10 Revised:2011-02-24 Online:2011-04-23 Published:2011-04-23
  • Contact: Xiao Zeng-ming, Master, Chief physician, Department of Spinal and Bone Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
  • About author:Jiang Xiao-hong★, Studying for master’s degree, Department of Spinal and Bone Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China 285278504@qq.com

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被引次数

2

摘要：

背景：目前后路寰枢椎椎弓根螺钉有取代Magerl技术趋势，成为治疗寰枢椎不稳的新标准术式。
目的：评价单、双侧椎弓根钉棒系统治疗不稳定性Jefferson骨折的力学稳定性，为临床应用提供实验依据。
方法：在6具完整枕骨颈椎(C0~4)湿润标本切断寰椎前后弓与侧块的联接部位，并切断寰椎横韧带，制成不稳定性 Jefferson骨折模型，分别安装单侧寰枢椎椎弓根螺钉系统和双侧寰枢椎椎弓根螺钉系统，通过摄像记录在1.53 N•m载荷下C1~2的三维运动，测定正常组、骨折模型组及各内固定组的三维运动范围，评价其重建寰枢椎即时稳定性的效果。
结果与结论：在屈伸、侧屈及轴向旋转的运动中，单侧寰枢椎椎弓根螺钉系统组的三维运动范围均明显大于双侧寰枢椎椎弓根钉棒系统组(P < 0.05)。提示在治疗不稳定性 Jefferson骨折时，双侧寰枢椎椎弓根钉棒系统内固定治疗稳定性好；单侧寰枢椎椎弓根螺钉系统固定效果不佳，尤其是抗旋转能力差，不能满足增强稳定性、植骨融合的要求，应尽量避免单独使用。

关键词: 椎弓根螺钉, 生物力学, Jefferson骨折, 硬组织植入物, 植骨融合

Abstract:

BACKGROUND: At present, posterior atlanto-axial pedicle screws have a trend to replace Magerl technology, and become the new standard operation for vertebral instability.
OBJECTIVE: To evaluate the mechanical stability of the single or double side atlantoaxial pedicle screw-rod system for treatment of instable Jefferson fracture, in order to provide the basis for clinical application.
METHODS: After gross observation and X-radiography confirmation of the specimen’s integrity and no osseous abnormality, six adult wet-cadvaveric spinal (C0-4) specimens were used to test the biomechanical stability. The specimens were intact, after instable Jefferson fracture and transverse ligament section, and after stabilization fellow the two techniques: the single or double side atlantoaxial pedicle screw-rod system. The three dimensional movements of C1-2 were recorded though photogrametry with a pure moment of 1.53 N·m. The range of motion (ROM) of each specimen in two fixations was calculated. Statistical analysis was performed with one-way analysis of variance, Fish’s least significant difference test to evaluate the immediate stability of the fixation with the two methods.
RESULTS AND CONCLUSION: In flexion, lateral flexion and axial rotation of sports, the ROM in the single side atlantoaxial pedicle screw-rod system group was significantly more than that in the double side atlantoaxial pedicle screw-rod system group (P < 0.05). In the treatment of instable Jefferson fracture, the double side atlantoaxial pedicle screw-rod system can provide excellent stability; Fixed effect of the single side atlantoaxial pedicle screw-rod system is not good, and its anti-rotation ability is poor and cannot satisfy the demands of the strengthen stability, graft fusion, which should avoid to be used alone.  

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