CAJ | 학술논문

目的：测试单纯寰椎侧块螺钉固定治疗不稳定寰椎骨折的生物力学稳定性，为临床应用提供理论依据。方法：取新鲜成人的完整枕骨及颈椎（C0-C3）标本6具，聚甲基丙烯酸甲酯包埋，在电子生物力学试验机上分别测定完整标本（A组），寰椎骨折合并横韧带离断+寰椎侧块螺钉固定（B组），横韧带、纵向韧带离断+寰椎侧块螺钉固定（C组）的前屈/后伸、左/右侧屈的运动变化以及前屈时C1-2的相对位移ADI （atlantodental interval）值，进行统计学分析，评价单纯寰椎侧块螺钉固定治疗不稳定寰椎骨折的生物力学稳定性，分析上颈椎韧带复合体的生物力学作用。结果：寰椎横韧带切断内固定后，载荷为50~90N时，A组与B组的ADI值、前屈、后伸相比，无统计学差异（P＞0.05）；当载荷为100N时，B组ADI值2.76mm、前屈11.66°、后伸14.05°，载荷为150N时，B组ADI值3.15mm、前屈15.27°、后伸16.25°，与A组相比均有统计学差异（P＜0.05）。横韧带切断后，载荷小于100N时，B组左、右侧屈与A组比较差异均无统计学意义（P＞0.05）；载荷100N 时，B 组左侧屈7.51°，与A组比较差异无统计学意义（P＞0.05），B组右侧屈8.43°，与A组相比存在统计学差异（P＜0.05）；载荷150N时，B组左侧屈8.79°、右侧屈10.67°，与A组比较均有统计学差异（P＜0.05）。进一步切断纵向韧带，稳定性明显丧失，C组的ADI值和前屈、后伸、左右侧屈范围与A组相比均有显著统计学差异（P＜0.05）。结论：单纯寰椎侧块螺钉固定治疗寰椎骨折，恢复C0-2之间的高度，即恢复纵向韧带的张力能够维持生理载荷下寰枢椎的稳定性。
목적：측시단순환추측괴라정고정치료불은정환추골절적생물역학은정성，위림상응용제공이론의거。방법：취신선성인적완정침골급경추（C0-C3）표본6구，취갑기병희산갑지포매，재전자생물역학시험궤상분별측정완정표본（A조），환추골절합병횡인대리단+환추측괴라정고정（B조），횡인대、종향인대리단+환추측괴라정고정（C조）적전굴/후신、좌/우측굴적운동변화이급전굴시C1-2적상대위이ADI （atlantodental interval）치，진행통계학분석，평개단순환추측괴라정고정치료불은정환추골절적생물역학은정성，분석상경추인대복합체적생물역학작용。결과：환추횡인대절단내고정후，재하위50~90N시，A조여B조적ADI치、전굴、후신상비，무통계학차이（P＞0.05）；당재하위100N시，B조ADI치2.76mm、전굴11.66°、후신14.05°，재하위150N시，B조ADI치3.15mm、전굴15.27°、후신16.25°，여A조상비균유통계학차이（P＜0.05）。횡인대절단후，재하소우100N시，B조좌、우측굴여A조비교차이균무통계학의의（P＞0.05）；재하100N 시，B 조좌측굴7.51°，여A조비교차이무통계학의의（P＞0.05），B조우측굴8.43°，여A조상비존재통계학차이（P＜0.05）；재하150N시，B조좌측굴8.79°、우측굴10.67°，여A조비교균유통계학차이（P＜0.05）。진일보절단종향인대，은정성명현상실，C조적ADI치화전굴、후신、좌우측굴범위여A조상비균유현저통계학차이（P＜0.05）。결론：단순환추측괴라정고정치료환추골절，회복C0-2지간적고도，즉회복종향인대적장력능구유지생리재하하환추추적은정성。
Objectives: A biomechanical analysis was performed to investigate the stability of the direct pos-terior C1 lateral mass screws compression reduction for treatment of instable Jefferson fracture and provide the theoretical basis for clinical applications. Methods: Six fresh cadaveric whole upper cervical spine(UCS) spec-imens were harvested and embedded in polymethylmethacrylate (PMMA). Three dimensional movements includ-ing flexion, extension, right and left lateral bending as well as the C1-2 displacement in flexion(atlantodental interval, ADI) were measured on an electromechanical testing machine by stereophotogrammetry. Specimens were tested in the following states in sequence: the intact specimens were tested(group A), after destabilization of C1-C2, the specimens underwent C1 lateral mass screw fixation (group B), then specimens with transverse ligament and longitudinal ligaments transected(group C) were tested. Results: The motion of ADI, flexion and extension had no signicant difference (P>0.05) between group A and group B under the physiological loading (50-90N). At the loading of 100N and 150N, significant difference was detected between the two groups(P<0.05), at the loading of 100N and 150N, the average of ADI, flexion and extension was 2.76mm, 11.66°,14.05° and 3.15mm, 15.27°, 16.25°. The motion of left and right lateral bending between group B and group A had no statistical difference indicated under physiological loading range. At the loading of 100N, the aver-age of left lateral bending was 7.51° (P>0.05), whereas significant difference was detected when the loading was more than 150N(P<0.05). The motion of right lateral bending had significant difference when the loading was more than 100N, and at the loading of 100N, 150N, the average of left lateral bending was 8.43°, 10.67°(P<0.05). The three-dimensional motion of group C indicated obvious instability, significant difference was found in the comparison with group A and group B. Conclusions: The stability of atlantoaxial joint can be maintained by collaboration of series of ligaments. The longitudinal ligaments can maintain the stable of atlantoaxial joint under physiological loading range.