CAJ | 학술논문

目的通过体外力学实验对前路双侧经寰枢关节螺钉、Harms钢板、Brooks钢丝、Magerl双侧螺钉、Magerl双螺钉加Gal ie钢丝固定技术的稳定性进行比较.方法取5具新鲜冰冻人体颈椎标本,依次按:正常试验组、寰枢椎不稳组、前路双侧经寰枢关节螺钉组、Harms钢板组、Brooks组、Magerl双螺钉加Gal ie组、Magerl双螺钉组顺序测试.将标本固定于测力机的移动平台上,造成寰椎前屈,后伸,右侧弯运动,施力点均位于寰椎中心(齿状突基底后缘中点)3.8cm处.测定寰椎移位1mm时的负荷,速度为1mm/min.在自制旋转测力机测试右轴向旋转时设定旋转角度为3°,测试各组刚度,比较其差异.结果与正常组和损伤组相比,所有内固定方法均显著提高寰枢椎各向活动的刚度(P<0.01).Magerl双螺钉加Gallie组刚度最大、最稳定(P<0.05).前路双侧经寰枢关节螺钉组与Magerl双螺钉组在各种状态下的刚度均无统计学差异(P>0.05).Brooks组在前屈、后伸及旋转时的刚度最低(P<0.05),而其侧弯稳定性与Harms钢板组相当(P>0.05).结论 Magerl双螺钉加Gal ie组的各方向稳定性均最优,被认为是金标准.前路双侧经寰枢关节螺钉组、Magerl双螺钉组均为两点固定法,目前仍然是临床应用的主流术式.Harms钢板组及Brooks组固定强度较差,术后建议使用外固定器加固.
목적통과체외역학실험대전로쌍측경환추관절라정、Harms강판、Brooks강사、Magerl쌍측라정、Magerl쌍라정가Gal ie강사고정기술적은정성진행비교.방법취5구신선빙동인체경추표본,의차안:정상시험조、환추추불은조、전로쌍측경환추관절라정조、Harms강판조、Brooks조、Magerl쌍라정가Gal ie조、Magerl쌍라정조순서측시.장표본고정우측력궤적이동평태상,조성환추전굴,후신,우측만운동,시력점균위우환추중심(치상돌기저후연중점)3.8cm처.측정환추이위1mm시적부하,속도위1mm/min.재자제선전측력궤측시우축향선전시설정선전각도위3°,측시각조강도,비교기차이.결과여정상조화손상조상비,소유내고정방법균현저제고환추추각향활동적강도(P<0.01).Magerl쌍라정가Gallie조강도최대、최은정(P<0.05).전로쌍측경환추관절라정조여Magerl쌍라정조재각충상태하적강도균무통계학차이(P>0.05).Brooks조재전굴、후신급선전시적강도최저(P<0.05),이기측만은정성여Harms강판조상당(P>0.05).결론 Magerl쌍라정가Gal ie조적각방향은정성균최우,피인위시금표준.전로쌍측경환추관절라정조、Magerl쌍라정조균위량점고정법,목전잉연시림상응용적주류술식.Harms강판조급Brooks조고정강도교차,술후건의사용외고정기가고.
Objective To compare the biomechanical stability with different methods of atlantoaxial internal fixation. Methods Five intact adult craniocervical (C0~C7) specimens were tested in seven different groups by turns:intact group, unstable group, anterior C1~C2 transariticular hibateral screw fixation group, Harms plate fixation group, Brooks wiring fixation group, Magerl hibateral screw fixation combined with Gallie wiring fixation group and Magerl hibateral screw fixation group. The speci-mens were fixed on the lifting platform of a material testing machine to test the stresses of anterior flexion, extension and right bending movements when the detecting head of the testing machine applied the loads at a distance of 3.8cm from the center of the vertebra. The C1 vertebra displacement was 1mm, and the speed was 1 mm/min. Rotation stiffness was tested on a home-made machine and the angle of the specimen's right rotation was set to 3°. We compared the difference of the stiffness. Results Compared with the intact group and the unstable group,all of the internal fixations showed conspicuous intensification for the atlantoaxial stiffness of multidirectional movement(P<0.01). Magerl hibateral screw fixation combined with Gal ie wiring fixation provided the most stabilization under al test modes (P<0.05).The stiffness of anterior C1~C2 transariticular hibateral screw fixa-tion was not significantly difference from that of Magerl hibateral screw fixation (P>0.05). Brooks wiring fixation had a lowest stiff-ness compared with others in anterior flexion, extension and rotation (P<0.05), but it had no significant difference in stabilization compared with Harms plate fixation in right bending movement (P>0.05). Conclusion The Magerl hibateral screw fixation com-bined with Gal ie wiring fixation provides highest stiffness in al fixation methods and is regarded as the gold standard at present. Two-point fixations such as anterior C1~C2 transariticular hibateral screw fixation and Magerl hibateral screw fixation are used by most doctors at present. Harms plate fixation and Gal ie wiring fixation show poor stabilities and should be used with postop-erative external fixation.