比较三种 C1-C2 经关节螺钉挽救固定技术的生物力学分析。
Biomechanical analysis comparing three C1-C2 transarticular screw salvaging fixation techniques.
机构信息
Engineering Center for Orthopaedic Research Excellence, Department of Bioengineering, College of Engineering, University of Toledo, Toledo, OH, USA.
出版信息
Spine (Phila Pa 1976). 2010 Feb 15;35(4):378-85. doi: 10.1097/BRS.0b013e3181bc9cb5.
STUDY DESIGN
This is an in vitro biomechanical study.
OBJECTIVE
To compare the biomechanical stability of the 3 C1-C2 transarticular screw salvaging fixation techniques.
SUMMARY AND BACKGROUND DATA
Stabilization of the atlantoaxial complex is a challenging procedure because of its complicated anatomy. Many posterior stabilization techniques of the atlantoaxial complex have been developed with C1-C2 transarticular screw fixation been the current gold standard. The drawback of using the transarticular screws is that it has a potential risk of vertebral artery injury due to a high riding transverse foramen of C2 vertebra, and screw malposition. In such cases, it is not recommended to proceed with inserting the contralateral transarticular screw and the surgeon should find an alternative to fix the contralateral side. Many studies are available comparing different atlantoaxial stabilization techniques, but none of them compared the techniques to fix the contralateral side while using the transarticular screw on one side. The current options are C1 lateral mass screw and short C2 pedicle screw or C1 lateral mass screw and C2 intralaminar screw, or C1-C2 sublaminar wire.
METHODS
Nine fresh human cervical spines with intact ligaments (C0-C4) were subjected to pure moments in the 6 loading directions. The resulting spatial orientations of the vertebrae were recorded using an Optotrak 3-dimensional Motion Measurement System. Measurements were made sequentially for the intact spine after creating type II odontoid fracture and after stabilization with unilateral transarticular screw placement across C1-C2 (TS) supplemented with 1 of the 3 transarticular salvaging techniques on the contralateral side; C1 lateral mass screw and C2 pedicle screw (TS+C1LMS+C2PS), C1 lateral mass and C2 intralaminar screw (TS+C1LMS+C2ILS), or sublaminar wire (TS + wire).
RESULTS
The data indicated that all the 3 stabilization techniques significantly decreased motion when compared to intact in all the loading cases (left/right lateral bending, left/right axial rotation, flexion) except extension. All the 3 instrumented specimens were equally stable in extension/flexion and lateral bending modes. TS+C1LMS+C2PS was equivalent to TS+C1LMS+C2ILS (P > 0.05) and superior to TS + wire in axial rotation (P < 0.05). Also, TS+C1LMS+C2ILS was superior to TS + wire in axial rotation (P < 0.05).
CONCLUSION
Fixation of atlantoaxial complex using unilateral transarticular screw supplemented with contralateral C1 lateral mass and C2 intralaminar screws is biomechanically equivalent to C1 lateral mass and C2 pedicle screws and both are biomechanically superior to C1-C2 sublaminar wire in axial rotation.
研究设计
这是一项体外生物力学研究。
目的
比较 3 种 C1-C2 经关节突螺钉抢救固定技术的生物力学稳定性。
摘要和背景资料
由于寰枢复合体的解剖结构复杂，稳定寰枢复合体是一项具有挑战性的手术。许多寰枢复合体的后路稳定技术已经发展起来，其中 C1-C2 经关节突螺钉固定是目前的金标准。使用经关节突螺钉的缺点是由于 C2 椎骨的横突高位，存在椎动脉损伤的潜在风险，以及螺钉位置不当。在这种情况下，不建议继续插入对侧经关节突螺钉，外科医生应寻找替代方法固定对侧。有许多研究比较不同的寰枢稳定技术，但没有一项研究比较在一侧使用经关节突螺钉固定时对侧的技术。目前的选择是 C1 侧块螺钉和短 C2 椎弓根螺钉或 C1 侧块螺钉和 C2 板内螺钉，或 C1-C2 皮下线。
方法
9 具完整韧带的新鲜人类颈椎标本（C0-C4）在 6 个加载方向上受到纯力矩的作用。使用 Optotrak 三维运动测量系统记录椎体的空间方向。在制作 II 型齿状突骨折后，依次对完整脊柱进行测量，然后在 C1-C2 单侧经关节突螺钉固定（TS）的基础上，在对侧采用 3 种经关节突抢救固定技术中的 1 种进行稳定；C1 侧块螺钉和 C2 椎弓根螺钉（TS+C1LMS+C2PS）、C1 侧块和 C2 板内螺钉（TS+C1LMS+C2ILS）或皮下线（TS+wire）。
结果
数据表明，在所有加载情况下（左侧/右侧侧屈、左侧/右侧轴向旋转、前屈），除伸展外，所有 3 种稳定技术与完整脊柱相比，运动均显著减少。所有 3 个器械固定标本在屈伸和侧屈模式下均具有同等的稳定性。TS+C1LMS+C2PS 与 TS+C1LMS+C2ILS 等效（P>0.05），与 TS+wire 在轴向旋转方面更优（P<0.05）。此外，TS+C1LMS+C2ILS 在轴向旋转方面优于 TS+wire（P<0.05）。
结论
单侧经关节突螺钉联合对侧 C1 侧块和 C2 板内螺钉固定寰枢复合体的生物力学效果与 C1 侧块和 C2 椎弓根螺钉相当，两者在轴向旋转方面均优于 C1-C2 皮下线。
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