Richter Marcus, Schmidt René, Claes Lutz, Puhl Wolfhart, Wilke Hans-Joachim
Department of Orthopedics and SCI, University of Ulm, Sweden.
Spine (Phila Pa 1976). 2002 Aug 15;27(16):1724-32. doi: 10.1097/00007632-200208150-00008.
Six different techniques for atlantoaxial fixation were biomechanically compared in vitro by nondestructive testing.
To evaluate the immediate three-dimensional stability of a new atlas claw combined with transarticular screws and alternative techniques for transarticular screw fixation in comparison with established techniques.
Posterior transarticular screw fixation in combination with wire-bone graft constructs is frequently used for C1-C2 fixation. Sublaminar wire passage carries the potential risk of neurologic complication. Transarticular screw fixation is technically demanding and, for anatomic reasons, not always feasible.
Six human cervical specimens were loaded nondestructively with pure moments, and unconstrained motion at C1-C2 was measured. The six specimens were instrumented with each of the following fixation techniques: Gallie fixation, transarticular screws and Gallie fixation, transarticular screws, transarticular screws and a new atlas claw, isthmic screws in the axis and the atlas claw, and lateral mass screws in the atlas and isthmic screws in the axis connected with rods.
The transarticular screws restricted lateral bending and axial rotation best. The three-point fixations (transarticular + Gallie and transarticular + claw) additionally restricted flexion-extension, with lowest values for transarticular screws and the atlas claw. The alternative techniques were not as stable as the three-point fixations, but more stable than the Gallie fixation.
Biomechanically, the three-point fixation with transarticular screws and the atlas claw provides a rigid internal fixation that is not dependent on bone graft and sublaminar wiring. In cases wherein transarticular screws are not feasible, the isthmic screws and claw or the lateral mass screws and isthmic screws are biomechanical alternatives with less immediate stability.
通过无损检测在体外对六种不同的寰枢椎固定技术进行生物力学比较。
与现有技术相比，评估一种新型寰椎爪联合经关节螺钉以及经关节螺钉固定的替代技术的即时三维稳定性。
后路经关节螺钉固定联合钢丝-骨移植结构常用于C1-C2固定。椎板下钢丝穿过存在神经并发症的潜在风险。经关节螺钉固定技术要求高，且由于解剖学原因，并非总是可行。
对六个人类颈椎标本施加纯力矩进行无损加载，并测量C1-C2的无约束运动。对六个标本分别采用以下固定技术进行器械固定：加里氏固定、经关节螺钉和加里氏固定、经关节螺钉、经关节螺钉和新型寰椎爪、枢椎峡部螺钉和寰椎爪、寰椎侧块螺钉和枢椎峡部螺钉并连接棒。
经关节螺钉对侧方弯曲和轴向旋转的限制最佳。三点固定（经关节螺钉 + 加里氏固定和经关节螺钉 + 寰椎爪）额外限制了屈伸运动，经关节螺钉和寰椎爪的屈伸运动值最低。替代技术不如三点固定稳定，但比加里氏固定更稳定。
在生物力学方面，经关节螺钉和寰椎爪的三点固定提供了一种不依赖于骨移植和椎板下钢丝的坚固内固定。在经关节螺钉不可行的情况下，峡部螺钉和寰椎爪或侧块螺钉和峡部螺钉是生物力学替代方案，但即时稳定性较差。
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