CAJ | 학술논문

目的观察正常情况下横韧带断裂后及行后路寰枢椎椎弓根内固定后标本寰枢关节的三维运动变化.方法新鲜尸体含完整上颈椎标本6例,均死于急性颅脑损伤,均为男性,年龄26 ～57岁,平均39.7岁.标本分为3组:标本完整状态组(intact组)、寰椎横韧带离断组(destabilized组)、寰枢椎椎弓根内固定组(fix组).通过脊柱三维运动加载系统对标本施加2.5 kg·m-2·s-2纯力偶矩,首先对正常标本进行测试,然后再制成横韧带损伤模型进行测试,最后对标本行后路寰枢椎椎弓根内固定术进行测试.结果在寰椎横韧带离断后,前屈、后伸的运动范周增大,与intact组相比较差异有统计学意义(7.8°比3.5°,P＜0.05),而左/右侧屈、左/右轴向旋转与intact组相比差异无有统计学意义.行后路寰枢椎椎弓根内固定后,标本6个方向的运动范围较完整标本均明显减小,差异均有统计学意义(1.3±0.2比15.1±2.7,0.6±0.0比11.1±2.4,均P＜0.05).结论当横韧带断裂后,寰枢关节前屈及后伸运动范围显著变大,尤其前屈范围变化最为显著,侧屈和轴位旋转运动范围的增大与完整标本差异无有统计学意义.采取寰枢椎椎弓根内固定后,寰枢关节的前屈、后伸、侧屈及轴位旋转范围较正常情况均减小,其中左/右轴向旋转功能的丧失尤其明显.
목적 관찰정상정황하횡인대단렬후급행후로환추추추궁근내고정후표본환추관절적삼유운동변화.방법 신선시체함완정상경추표본6례,균사우급성로뇌손상,균위남성,년령26 ～57세,평균39.7세.표본분위3조:표본완정상태조(intact조)、환추횡인대리단조(destabilized조)、환추추추궁근내고정조(fix조).통과척주삼유운동가재계통대표본시가2.5 kg·m-2·s-2순력우구,수선대정상표본진행측시,연후재제성횡인대손상모형진행측시,최후대표본행후로환추추추궁근내고정술진행측시.결과 재환추횡인대리단후,전굴、후신적운동범주증대,여intact조상비교차이유통계학의의(7.8°비3.5°,P＜0.05),이좌/우측굴、좌/우축향선전여intact조상비차이무유통계학의의.행후로환추추추궁근내고정후,표본6개방향적운동범위교완정표본균명현감소,차이균유통계학의의(1.3±0.2비15.1±2.7,0.6±0.0비11.1±2.4,균P＜0.05).결론 당횡인대단렬후,환추관절전굴급후신운동범위현저변대,우기전굴범위변화최위현저,측굴화축위선전운동범위적증대여완정표본차이무유통계학의의.채취환추추추궁근내고정후,환추관절적전굴、후신、측굴급축위선전범위교정상정황균감소,기중좌/우축향선전공능적상실우기명현.
Objective To explore the three-dimensional movement of atlantoaxial joint,complete transverse ligament and cracked transverse ligament after posterior atlantoaxial fixation.Methods The fresh upper cervical cadaveric specimens were collected from 6 males dead from active craniocerebral injury.The average age was 39.7 years old ( range:26 - 57 ).The specimens were divided into 3 groups of intact (Group Ⅰ),transverse ligament cracked (Group D) and posterior atlantoaxial fixation (Group F).They were tested consecutively.Results The range of sagittal movement increased when the transverse ligament became cracked.And it had significant difference compared with the Group Ⅰ ( P ＜0.05 ).But the ranges of lateral flexion and rotation showed no significant difference. When posterior atlantoaxial fixation was performed,all three-dimensional movements decreased.And significant differences existed as compared with Group Ⅰ (P ＜ 0.05 ).Conclusion Under normal conditions,the main movement of atlantoaxial joint is rotation with lesser sagittal movement and lest lateral flexion.The range of sagittal movement increases significantly when transverse ligament is cracked (P ＜0.05),especially so for anteflexion movement.The increase of lateral flexion and rotation has no significant difference compared with Group Ⅰ.When posterior atlantoaxial Fixation is performed,all three-dimensional movements decrease significantly as compared with Group Ⅰ ( P ＜ 0.05 ),especially loss of rotation function.