[1]谢天浩　马生辉　丁慧超　姚国杰　宋　健　徐国政　马廉亭.齿状突切除术后两种后路内固定方式的生物力学比较[J].中国临床神经外科杂志,2020,(07):447-450.[doi:10.13798/j.issn.1009-153X.2020.07.011]
　XIE Tian-hao,MA Sheng-hui,DING Hui-chao,et al.Biomechanical comparison of two posterior internal fixation methods after dentectomy[J].,2020,(07):447-450.[doi:10.13798/j.issn.1009-153X.2020.07.011]
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齿状突切除术后两种后路内固定方式的生物力学比较()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2020年07期
页码:
447-450
栏目:
实验研究
出版日期:
2020-07-25

文章信息/Info

Title:
Biomechanical comparison of two posterior internal fixation methods after dentectomy
文章编号:
1009-153X（2020）07-0447-04
作者:
谢天浩　马生辉　丁慧超　姚国杰　宋　健　徐国政　马廉亭
430070 武汉，中国人民解放军中部战区总医院神经外科（谢天浩、马生辉、丁慧超、姚国杰、宋　健、徐国政、马廉亭）
Author(s):
XIE Tian-hao;  MA Sheng-hui;  DING Hui-chao;  YAO Guo-jie;  SONG Jian;  XU Guo-zheng;  MA Lian-ting.
Department of Neurosurgery, General Hospital of Cnetral Theater Command, PLA, Wuhan 430070, China
关键词:
颅颈交界区; 齿状突切除术; 脊柱稳定性; 枕骨~颈2内固定; 颈1~2内固定; 生物力学
Keywords:
Craniocervical junction;  Odontectomy;  Spinal stability;  Occipital~ cervical 2 fixation;  Cervical 1~2 fixation
分类号:
R 651
DOI:
10.13798/j.issn.1009-153X.2020.07.011
文献标志码:
A
摘要:
目的 比较齿状突切除术后枕骨~颈2内固定及颈1~2内固定的生物力学特点，为临床选择内固定治疗方案提供生物力学依据。方法 基于前期已构建的带枕骨全颈椎有限元模型，进一步构建齿状突切除模型，继而在齿状突切除模型中分别加载枕骨~颈2内固定及颈1~2内固定构建两种内固定模型，在ABAQUS 6.12.-1软件中计算手术模型各个节段前屈-后伸、左右旋转及左右侧屈的活动度及内固定应力情况。结果 齿状突切除术可引起枕骨~颈1后伸及侧弯活动度较正常模型模型增加，均增加超过50%。枕骨~颈2内固定模型及颈1~2内固定模型颈1~2节段的内固定效果基本相同，均可明显限制颈1~2的活动度。枕骨~颈2内固定可明显限制枕骨~颈1节段各方向活动度，使其处于相对固定状态；而颈1~2内固定对枕骨~颈1节段无明显限制作用。结论 齿状突切除后枕骨~颈1节段稳定性存在一定程度下降，而枕骨~颈1内固定会造成枕颈活动度严重下降；对于术前枕骨~颈1节段相对稳定的病人，可仅行颈1~2节段内固定，术后动态复查X线检查严密随访枕骨~颈1节段的稳定性；对于术前枕骨~颈1已经存在畸形或存在不稳定因素（如关节脱位等）的病人，应采用枕颈固定融合
Abstract:
Objective To compare the biomechanical characteristics of occipito (C0)-cervical 2 (C2) fixation and posterior C1~C2 fixation after the odontoidectomy in oeder to provide biomechanical basis for the clinical selection of internal fixation treatment plan. Methods Based on the pre-constructed finite element model of the cervical spine with occipital bone, the odontoidectomy model was further constructed, and then the C0~C2 fixation and C1~C2 fixation were respectively loaded in the odontoidectomy model to construct two kinds of internal fixation model. The flexion-extension, left-right rotation, left-right rotation and left-right lateral flexion activity and internal fixation stress of each segment of the surgical model were calculated using the ABAQUS 6.12.-1 software. Results The motion of C0~C1 in extension and lateral bending increased by more than 50% after the odontoidectomy than the intact model. The motion of the C0~C2 fixation model and the C1~C2 fixation model were almost the same, both with a low mobility. C0~C2 fixation can significantly reduce the range of motion in all directions at C0~C1 level, while the C1~C2 fixation model showed no effect on C0~C1. Conclusions The stability of C0~C1 will decrease to a certain extent after the odontoidectomy, and C0~C1 fixation will cause significant decrease in the occiput-cervical mobility. Therefore, we suggest that C1~C2 fixation should be performed for patients with preoperitive stable C0~C1, and the follow up of postoperative X-ray should be performed to observe the stability of C0~C1. For patients with pre-exist deformity or unstable factors of C0~C1, occipito-cervical fixation and fusion should be used

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备注/Memo

备注/Memo:
（2020-06-11收稿，2020-06-20修回）基金项目：国家自然科学基金（81701355）；武汉市中青年医学骨干人才培养工程 通讯作者：马廉亭，E-mail：mlt1937@163.com
更新日期/Last Update: 2020-07-20