Wu Hai-Hao, Tang Tao, Pang Qing-Jiang, Yuan Xin-Hua, Zhou Chun-Guang
Department of Orthopaedics, Ningbo NO.2 Hospital, Ningbo 315010, Zhejiang, China.
Department of Orthopaedics, Ningbo NO.2 Hospital, Ningbo 315010, Zhejiang, China;
Zhongguo Gu Shang. 2018 Jan 25;31(1):74-78. doi: 10.3969/j.issn.1003-0034.2018.01.013.
To compare the stability of subaxial cervical anterior transpedicular screw(ATPS) fixation and three traditional fixations for three-column injury.
Six specimens of cervical spine were prepared. After measurememt of the range of motion(ROM) in intact state, the specimens were made into three-column injury models. The models were reconstructed with an anterior cervical cage, and stabilized by ATPS, anterior plate(AP), anterior plate + lateral mass screw(AP+LMS) and posterior transpedicular screw(PTPS). The ROM of the models in the four states were measured, and the results of data were compared after standardization.
The normalized ROM of ATPS state in flexion-extension, lateral bending, axial rotation were(77.17±4.75)%, (82.00±2.61)%, (83.17±2.23)%, which were significant small than those in intact state(<0.05). The normalized ROM of AP state in flexion-extension, lateral bending, axial rotation were(119.67±7.42)%, (116.33±7.53)%, (112.67±5.99)% , which were significant larger than those in intact state(<0.05). The normalized ROM of AP in all directions were significant larger than those of ATPS(<0.05). There was no significant difference between normalized ROM of PTPS state and those of ATPS state in flexion-extension and lateral bending(>0.05). The normalized ROM of PTPS state in axial rotation was(6.83±2.48)% and was significant larger than that of ATPS state(=0.009). The normalized ROM of AP+LMS state in flexion-extension was(68.50±2.43)%, which was significant smaller than that of ATPS state(=0.003). There was no significant difference between the normalized ROM of AP+LMS state and those of ATPS state in lateral bending and axial rotation(>0.05).
Subaxial cervical three-column injury model reconstruction by ATPS can provide the adequate primary stability, of which biomechanics property is superior compared to AP and PTPS, and is similar to that of AP+LMS. It can be applied to the patients with no need to decompression and reduction through posterior approach.
比较下颈椎前路经椎弓根螺钉（ATPS）固定与三种传统固定方式治疗三柱损伤的稳定性。
制备6个颈椎标本。在测量完整状态下的活动范围（ROM）后，将标本制成三柱损伤模型。模型采用颈椎前路椎间融合器重建，并用ATPS、前路钢板（AP）、前路钢板+侧块螺钉（AP+LMS）和后路经椎弓根螺钉（PTPS）进行固定。测量模型在四种状态下的ROM，并对标准化后的数据结果进行比较。
ATPS状态下屈伸、侧屈、轴向旋转的标准化ROM分别为（77.17±4.75）%、（82.00±2.61）%、（83.17±2.23）%，均显著小于完整状态（<0.05）。AP状态下屈伸、侧屈、轴向旋转的标准化ROM分别为（119.67±7.42）%、（116.33±7.53）%、（112.67±5.99）%，均显著大于完整状态（<0.05）。AP在各个方向的标准化ROM均显著大于ATPS（<0.05）。PTPS状态与ATPS状态在屈伸和侧屈时的标准化ROM无显著差异（>0.05）。PTPS状态下轴向旋转的标准化ROM为（6.83±2.48）%，显著大于ATPS状态（=0.009）。AP+LMS状态下屈伸的标准化ROM为（68.50±2.43）%，显著小于ATPS状态（=0.003）。AP+LMS状态与ATPS状态在侧屈和轴向旋转时的标准化ROM无显著差异（>0.05）。
采用ATPS重建下颈椎三柱损伤模型可提供足够的初始稳定性，其生物力学性能优于AP和PTPS，与AP+LMS相似。它可应用于无需后路减压和复位的患者。
