寰枢椎后路柔性固定的生物力学研究

童杰, 季伟, 黄志平, 周若舟, 房佐忠, 朱青安

doi:10.13418/j.issn.1001-165x.2022.1.14

中国临床解剖学杂志 >

2022 , Vol. 40 >Issue 1: 72 - 77

DOI: https://doi.org/10.13418/j.issn.1001-165x.2022.1.14

临床生物力学

寰枢椎后路柔性固定的生物力学研究

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1.南方医科大学南方医院脊柱骨科，广州 510515； 2.南方医科大学第一临床医学院附属郴州医院
（郴州市第一人民医院）脊柱外科，湖南郴州 423000

童杰（1980-），男，湖南浏阳人，医学博士，主任医师，研究方向：脊柱外科，E-mail：richardtj@sina.com

收稿日期: 2020-06-04

网络出版日期: 2022-01-19

基金资助

国家自然科学基金面上项目（81972110）；郴州市第一人民医院院级科研项目（N2019-008）；郴州市第一人民医院院内技术项目（2020A34）

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Biomechanical research on posterior flexible fixation at atlantoaxial joint

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1. Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; 2. Department of Spine Surgery, Affiliated Chenzhou Hospital, The First School of Clinical Medicine, Southern Medical University(The First People’s Hospital of Chenzhou), Chenzhou 423000, Hunan Province, China

Received date: 2020-06-04

Online published: 2022-01-19

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摘要

目的分析细棒、PEEK棒固定对寰枢关节稳定性的影响。方法采用6具新鲜成人枕骨（occipital bone，Oc）~颈椎C4节段进行测试，模拟以下手术及固定状态：①完整状态；②损伤状态：枢椎齿状突II型骨折；③坚强固定：寰枢椎均采用普通椎弓根螺钉固定，直径3.5 mm钛棒连接；④PEEK棒：直径3.5 mm的PEEK棒连接；⑤细棒：直径2.0 mm钛棒连接。采用重复测量实验设计，在完整、损伤和不同的固定状态下，通过脊柱试验机对标本分别施加1.5 N·m的前屈/后伸、左/右侧弯和左/右轴向旋转的纯力偶矩。采用Optotrak三维运动测量系统连续采集标本运动，分析寰枢椎之间角度运动范围和中性区。结果采用直径3.5 mm的钛棒，2.0 mm的细棒以及3.5 mm的PEEK棒固定后，在前屈、后伸、侧弯和旋转方向上均显著减小了固定节段的运动范围（P<0.05）。直径3.5 mm和2.0 mm的棒固定后的运动范围，在各个方向上无显著性差异。PEEK棒固定的运动范围仅在侧弯方向上大于坚强固定（P＝0.005），其他方向无显著性差异。3种固定方式在屈伸、侧弯和旋转方向上均显著减小了固定节段的中性区（P<0.05）。各种固定方式之间相比较，无显著性差异（P>0.05）。结论在寰枢关节采用直径2.0 mm的细棒固定，与坚强固定的稳定性相当。采用直径3.5 mm的PEEK棒固定，在前屈、后伸、旋转方向上与坚强固定的稳定性相当，在侧弯方向上弱于坚强固定。

关键词： 寰椎； ; ; 枢椎； ; ; 后路； ; ; 柔性固定； ; ; 生物力学

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童杰, 季伟, 黄志平, 周若舟, 房佐忠, 朱青安 . 寰枢椎后路柔性固定的生物力学研究[J]. 中国临床解剖学杂志, 2022 , 40(1) : 72 -77 . DOI: 10.13418/j.issn.1001-165x.2022.1.14

Abstract

Objectives To analyze the influence of thin rod and PEEK rod on the stability of the atlantoaxial joint. Methods A series of in vitro biomechanical tests were performed using six fresh adult cervical spines (occipital bone-C4 segment) to simulate different conditions in surgery including the (1) intact state; (2) injury state: type II odontoid process fracture; (3) rigid fixation: All atlantoaxial pedicle screws were connected by titanium rods with a diameter of 3.5 mm; (4) PEEK rod: atlantoaxial pedicle screws were connected by a PEEK rod with a diameter of 3.5 mm; (5) thin rod: atlantoaxial pedicle screws were connected by a thin rod with a diameter of 2.0 mm. Biomechanical studies of samples were performed under intact, injury and various fixation statements using a spinal testing machine, while applying a constant moment of 1.5 Nm in flexion-extension, left-right lateral bending, and left-right axial rotation directions. A repeated measurement design was employed in all tests. Movement were measured consecutively by an Optotrak Certus 3D measurement system in order to analyze the range of motion (ROM) and neutral zone (NZ) of atlantoaxial joint. Results In the atlantoaxial joint, ROM of fixation segments were significantly reduced in all directions when a 3.5 mm diameter titanium rod, a 2.0 mm diameter titanium rod, and a 3.5 mm diameter PEEK rod was used (P<0.05). There were no significant differences in ROM of fixation segments for rigid fixation and 2.0 mm diameter titanium rod in all directions (P>0.05). In lateral bending, ROM of the PEEK rod was significantly larger compared with rigid fixation (P=0.005). NZs of fixation segments for rigid fixation, 2.0 mm diameter titanium rod, and a 3.5 mm diameter PEEK rod fixation were significantly reduced (P<0.05). There were no significant differences among these fixations (P>0.05). Conclusions In the atlantoaxial joint, stability of using 2.0 mm diameter titanium rod fixation was comparable to rigid fixation, but stability of using PEEK rod fixation was weaker in the lateral bending direction.

Key words： Atlas;　Axis;　Posterior; ; ; Flexible fixation;　Biomechanics

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