CAJ | 학술논문

目的：比较枕颈部后路4种不同植入方式的螺钉在施加生理载荷时所承受的应力，评价各自在生理环境中的机械性能。方法对16例新鲜人体枕颈部标本（含Oc~C3），采用后路枕寰枢复合体经关节螺钉固定和SUMMIT系统枕颈固定。对固定后的经寰枕关节螺钉（Oc~C1组）、经寰枢关节螺钉（C1~C2组）、枢椎椎弓螺钉（C2 PS组）和枕骨螺钉（Oc Screw组）在生理载荷下三维六自由度运动时，运用应变电阻测定法测定4种螺钉的应力，数据进行统计学处理。结果在侧屈状态下，电测法测得的4种螺钉局部应变均接近于0。在前屈、后伸、左旋和右旋运动时，随着加载载荷增大，测得的应力均逐步增大。在前屈和旋转时螺钉不同程度承受拔出应力，在后伸时，螺钉所受的为压应力。枕骨螺钉（Oc Screw组）在屈伸和旋转运动状态下，在所有3种载荷下所承受的应力均大于其它3种植钉方法，差异有统计学意义（P＜0.05）。结论生理环境下，枕骨螺钉承受的拔出应力最大，其可能更易出现内植物相关并发症，具体应用时应结合临床实际。
목적：비교침경부후로4충불동식입방식적라정재시가생리재하시소승수적응력，평개각자재생리배경중적궤계성능。방법대16례신선인체침경부표본（함Oc~C3），채용후로침환추복합체경관절라정고정화SUMMIT계통침경고정。대고정후적경환침관절라정（Oc~C1조）、경환추관절라정（C1~C2조）、추추추궁라정（C2 PS조）화침골라정（Oc Screw조）재생리재하하삼유륙자유도운동시，운용응변전조측정법측정4충라정적응력，수거진행통계학처리。결과재측굴상태하，전측법측득적4충라정국부응변균접근우0。재전굴、후신、좌선화우선운동시，수착가재재하증대，측득적응력균축보증대。재전굴화선전시라정불동정도승수발출응력，재후신시，라정소수적위압응력。침골라정（Oc Screw조）재굴신화선전운동상태하，재소유3충재하하소승수적응력균대우기타3충식정방법，차이유통계학의의（P＜0.05）。결론생리배경하，침골라정승수적발출응력최대，기가능경역출현내식물상관병발증，구체응용시응결합림상실제。
Objective To compare the extracting stress of four kinds of craniovertibral screws by strain electronic mea-surements. Methods Posterior craniovertebral transarticular screw fixation and SUMMIT occipitocervical fixation were performed in succession on 16 fresh craniovertebral junction specimens(containing Oc- C3). Using the strain electronic measurement, the ex-tracting stress was measured on Oc- C1 transarticular screws (Oc- C1 TA group), C1- C2 transarticular screws (C1- C2 TA group), C2 pedicle screws (C2 PS group) and occipital screws (Oc Screw group), when these screws were bearing biological load under the condition of three- dimensional motion in six directions. Results The strain electronic measurements showed that the local stress of al screws was near zero under lateral flexion. Stress increased with increasing load under anterior flexion, posterior flexion, left rotation and right rotation. The screws bore pul ing and extending stress of varying degrees under anterior flexion and rotation, and pressure stress under posterior flexion. The Oc Screw group bore greater stress under flexion, extension and rotation than the other screw fixation groups (P<0.05). Conclusion In vivo biomechanics studies show that the occipital screws bear the greatest extracting stress among 4 kinds of craniovertebral fixation screws, suggesting that the occipital screws are more likely to induce related complications under physiological conditions, and therefore individual clinical conditions should be taken into account when this technique is used.