目的 探讨钉尾横连在后路寰-枢椎椎弓根钉棒内固定系统中生物力学稳定性。 方法 6具新鲜人体枕颈标本分为完整状态组（A组）,在完整状态组上建立II型齿状突骨折的寰枢椎失稳模型（B组），在失稳组上对每具标本先后进行后路寰枢椎椎弓根钉棒内固定（C1~C2 pedicle screw-rod fixation C1~C2 PSR）（C组），在C组基础上分别装置传统棒-棒横连（horizontal rod-rod crosslink，hR-R CL）为D组和钉尾横连(horizontal screw-screw crosslink，hS-S CL)为E组，E组包括上横连（两寰椎螺钉钉尾）E1组和下横连（两枢椎螺钉钉尾）E2组,在三维运动机上将标本模型按顺序进行前屈、后伸、左右侧屈和左右旋转测试，获取每组标本的寰枢椎活动度(ROM)。运用重复测量方差分析评价各组的生物力学特性。 结果 ①在各种状态下，完整组及内固定组活动度小于失稳组，有显著差异(P<0.05)；②在前屈、后伸状态下，4种内固定组活动度无统计学差异(P>0.05)，活动度（ROM）：A组0.05)，E1和E2组在各种状态下活动度也无计学差异(P>0.05)。 结论 横连在后路寰枢椎钉棒内固定中具有良好的抗轴向旋转稳定性；钉尾横连具有与传统棒-棒横连相同的生物力学稳定性；钉尾横连安装在寰椎侧和枢椎侧生物力学性能基本相同。
关键词：
横连； ; ; 后路； ; ; 寰枢椎； ; ; 生物力学
Objective To investigate the biomechanical stability of the horizontal screw-screw crosslink in C1-C2 pedicle screw-rod fixation (C1-C2 PSR). Methods Six fresh human occipitocervical specimens were divided into the intact state group (group A), and the atlantoaxial instability model of type II odontoid fracture was established on the intact state group (group B). The C1-C2 PSR was performed on each specimen in the instability group (group C). In group C, horizontal rod-rod crosslink (hR-R CL) and horizontal screw-screw crosslink (hS-S CL) were successively installed in each specimen of group C to form group D and group E, respectively. Group E included upper transverse connection (two atlas screw tails) E1 group and lower transverse connection (two axis screw tails) E2 group. The specimen models were tested in order of flexion, extension, lateral flexion and lateral rotation on a three dimensional motion machine, and the atlantoaxial ROM of each group of specimens was obtained. Repeated measure ANOVA was used to evaluate the biomechanical properties of each group. Results ① In all directions, the ROM the intact group and the internal fixation group was lower than that of the instability group, and there were significant differences (P< 0.05). ② In the direction of flexion and extension, there was no statistical difference in the ROM among the four internal fixation groups (P>0.05), ROM: Group A < Group C = Group D = Group E1/E2 < Group B, in the direction of lateral flexion and rotation, the ROM of the crosslink internal fixation group was lower than that of the non-crosslink internal fixation group, and there was significant difference (P<0.05), ROM) : Group A < Group C < Group D = Group E1/E2 < Group B. ③ There were no statistical differences between group D and E1/E2 group in all directions (P>0.05), and no statistical differences between group E1 and E2 in all directions (P> 0.05). Conclusions Crosslink has good anti-axial rotation stability in C1-C2 pedicle screw-rod fixation. The hR-R CL has the same biomechanical stability as the traditional hS-S CL. The biomechanical properties of the hR-R CL are basically the same when it is installed on the atlas side and the axial side.
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