中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2015年
4期
345-349
,共5页
黄菊英%聂庆斌%王兴文%张璨%菅凤增
黃菊英%聶慶斌%王興文%張璨%菅鳳增
황국영%섭경빈%왕흥문%장찬%관봉증
颅颈交界区%寰枢外侧关节%寰枢椎脱位%压力%运动范围
顱頸交界區%寰樞外側關節%寰樞椎脫位%壓力%運動範圍
로경교계구%환추외측관절%환추추탈위%압력%운동범위
Craniocervical junction%Atlantoaxial lateral joint%Atlantoaxial dislocation%Stress%Range of motion
目的 分析单纯性韧带切除造成的颅颈交界区不稳对寰枢椎(C1～2)运动节段的中性区、三维运动范围及寰枢侧方关节最大压力影响.方法 6例新鲜尸体标本被使用.采用重复测量的方法,对标本进行屈伸、侧弯及轴向旋转的纯力矩加载,分别测试2.0 Nm纯力矩载荷下正常对照组和颅颈交界不稳组C1～2运动节段的中性区和运动范围,以及1.0 Nm纯力矩载荷下正常对照组及颅颈交界不稳组寰枢侧方关节的压力.结果 颅颈交界不稳组C1～2运动节段的中性区在屈伸、侧弯及轴向旋转载荷下分别为26.67°±4.70°、9.13°±1.32°和63.11°±5.87°,正常组在屈伸、侧弯及轴向旋转载荷下C1～2运动节段的中性区分别为14.12°±2.40°,4.15°±0.75°和50.75°±5.84°,颅颈交界不稳组C1～2运动节段的中性区在屈伸、侧弯及轴向旋转载荷下比正常组的显著增加(P＜0.05).颅颈交界不稳组C1～2运动节段的运动范围在屈伸、侧弯及轴向旋转载荷下分别为42.37°±3.96°、13.67°±1.10°和78.50°±4.00°,正常组在屈伸、侧弯及轴向旋转载荷下C1～2运动节段的运动范围分别为27.43°±2.41°、6.97°±0.59°和65.26°±4.08°,颅颈交界不稳组C1～2运动节段的运动范围在屈伸、侧弯及轴向旋转载荷下比正常组的显著增加(P＜0.05).在前屈、左右侧弯及左旋载荷下,颅颈交界不稳组寰枢椎左右侧方关节的最大压力比正常组的减小.后伸和右旋载荷下,颅颈交界不稳组寰枢椎右侧方关节的最大压力也比正常组的减小.但后伸载荷下,颅颈交界不稳组寰枢椎左侧方关节的最大压力不变,右旋载荷下,颅颈交界不稳组寰枢椎左侧方关节的最大压力稍有增加.结论 颅颈交界区单纯性的韧带切除可以造成寰枢椎不稳,在屈伸、侧弯及轴向旋转情况下运动范围比正常情况下显著性增加.寰枢椎的不稳,导致寰枢外侧关节失去正常的承重功能,进而最终造成寰枢椎脱位.
目的 分析單純性韌帶切除造成的顱頸交界區不穩對寰樞椎(C1～2)運動節段的中性區、三維運動範圍及寰樞側方關節最大壓力影響.方法 6例新鮮尸體標本被使用.採用重複測量的方法,對標本進行屈伸、側彎及軸嚮鏇轉的純力矩加載,分彆測試2.0 Nm純力矩載荷下正常對照組和顱頸交界不穩組C1～2運動節段的中性區和運動範圍,以及1.0 Nm純力矩載荷下正常對照組及顱頸交界不穩組寰樞側方關節的壓力.結果 顱頸交界不穩組C1～2運動節段的中性區在屈伸、側彎及軸嚮鏇轉載荷下分彆為26.67°±4.70°、9.13°±1.32°和63.11°±5.87°,正常組在屈伸、側彎及軸嚮鏇轉載荷下C1～2運動節段的中性區分彆為14.12°±2.40°,4.15°±0.75°和50.75°±5.84°,顱頸交界不穩組C1～2運動節段的中性區在屈伸、側彎及軸嚮鏇轉載荷下比正常組的顯著增加(P＜0.05).顱頸交界不穩組C1～2運動節段的運動範圍在屈伸、側彎及軸嚮鏇轉載荷下分彆為42.37°±3.96°、13.67°±1.10°和78.50°±4.00°,正常組在屈伸、側彎及軸嚮鏇轉載荷下C1～2運動節段的運動範圍分彆為27.43°±2.41°、6.97°±0.59°和65.26°±4.08°,顱頸交界不穩組C1～2運動節段的運動範圍在屈伸、側彎及軸嚮鏇轉載荷下比正常組的顯著增加(P＜0.05).在前屈、左右側彎及左鏇載荷下,顱頸交界不穩組寰樞椎左右側方關節的最大壓力比正常組的減小.後伸和右鏇載荷下,顱頸交界不穩組寰樞椎右側方關節的最大壓力也比正常組的減小.但後伸載荷下,顱頸交界不穩組寰樞椎左側方關節的最大壓力不變,右鏇載荷下,顱頸交界不穩組寰樞椎左側方關節的最大壓力稍有增加.結論 顱頸交界區單純性的韌帶切除可以造成寰樞椎不穩,在屈伸、側彎及軸嚮鏇轉情況下運動範圍比正常情況下顯著性增加.寰樞椎的不穩,導緻寰樞外側關節失去正常的承重功能,進而最終造成寰樞椎脫位.
목적 분석단순성인대절제조성적로경교계구불은대환추추(C1～2)운동절단적중성구、삼유운동범위급환추측방관절최대압력영향.방법 6례신선시체표본피사용.채용중복측량적방법,대표본진행굴신、측만급축향선전적순력구가재,분별측시2.0 Nm순력구재하하정상대조조화로경교계불은조C1～2운동절단적중성구화운동범위,이급1.0 Nm순력구재하하정상대조조급로경교계불은조환추측방관절적압력.결과 로경교계불은조C1～2운동절단적중성구재굴신、측만급축향선전재하하분별위26.67°±4.70°、9.13°±1.32°화63.11°±5.87°,정상조재굴신、측만급축향선전재하하C1～2운동절단적중성구분별위14.12°±2.40°,4.15°±0.75°화50.75°±5.84°,로경교계불은조C1～2운동절단적중성구재굴신、측만급축향선전재하하비정상조적현저증가(P＜0.05).로경교계불은조C1～2운동절단적운동범위재굴신、측만급축향선전재하하분별위42.37°±3.96°、13.67°±1.10°화78.50°±4.00°,정상조재굴신、측만급축향선전재하하C1～2운동절단적운동범위분별위27.43°±2.41°、6.97°±0.59°화65.26°±4.08°,로경교계불은조C1～2운동절단적운동범위재굴신、측만급축향선전재하하비정상조적현저증가(P＜0.05).재전굴、좌우측만급좌선재하하,로경교계불은조환추추좌우측방관절적최대압력비정상조적감소.후신화우선재하하,로경교계불은조환추추우측방관절적최대압력야비정상조적감소.단후신재하하,로경교계불은조환추추좌측방관절적최대압력불변,우선재하하,로경교계불은조환추추좌측방관절적최대압력초유증가.결론 로경교계구단순성적인대절제가이조성환추추불은,재굴신、측만급축향선전정황하운동범위비정상정황하현저성증가.환추추적불은,도치환추외측관절실거정상적승중공능,진이최종조성환추추탈위.
Object To analyze the effects of craniocervical junction instability caused by ligament resection on the neutral zones(NEs) and range of motions(ROMs) in C1-2 motion segment,and the maximum pressure of atlantoaxial lateral joint.Methods 6 cases of fresh cadaver specimens were used.By using the method of repeated measurements,NZs and ROMs in C1～2 motion segment were measured for normal control group and the craniocervical instability group under 2.0Nm and 1.0Nm pure moment loading of flexion extension,lateral bending and axial rotation,respectively.Results The NZs in C1-2 motion under the loadings of flexion and extension,lateral bending and axial rotation for craniocervical junction instability group were 26.67° ±4.70° 、9.13° ± 1.32°and 63.11° ± 5.87°,respectively.The NZs in C1～2 motion under the loadings of flexion and extension,lateral bending and axial rotation for craniocervical junction instability group were 14.12° ± 2.40°,4.15° ± 0.75°and 50.75° ± 5.84°,respectively.The NZs in C1 ～2 motion segment for craniocervical instability group in the loadings of flexion and extension,lateral bending and axial rotation were significantly greater than those for intact group (P ＜ 0.05).The ROMs in C1～2 motion under the loadings of flexion and extension,lateral bending and axial rotation for craniocervical junction instability group were 42.37°± 3.96° 、13.67°± 1.10°and 78.50° ±4.00°,respectively.The ROMs in C1 ～2 motion under the loadings of flexion and extension,lateral bending and axial rotation for craniocervical junction instability group were 27.43° ±2.41° 、6.97° ±0.59°and 65.26° ±4.08°,respectively.The ROMs for craniocervical junction instability group in the loadings of flexion and extension,lateral bending and axial rotation significantly were higher than those for the intact group (P ＜ 0.05).For flexion,lateral bending and left axial rotation,the maximum stress of the atlantoaxial lateral joints for craniocervical instability group was less than that for the intact group.In the loadings of extension and right axial rotation,the maximum stress of the atlantoaxial right lateral joints for craniocervical instability group was less than that for the intact group,too.Howerer the atlantoaxial right lateral joint was unchanged under the extension laoding,and the left joint is a litte higher than that of the intact group under right axial loading.Conclusion Simple ligament resection in craniocervical junction could cause atlantoaxial instability.The range of motion for the loadings of flexion and extension,lateral bending and axial rotation is higher than that of the intact group.Atlantoaxial instability might lead to loss of load-bearing function of atlantoaxial lateral joint,and ultimately result in atlantoaxial dislocation.
