颈椎前路钛网钢板内固定及自体髂骨植骨在不同颈椎节段中的生物力学研究

BIOMECHANICAL EVALUATION OF TITANIUM MESH WITH ANTERIOR PLATE FIXATION OR ILIUM AUTOGRAFT IN ANTERIOR CERVICAL DECOMPRESSION

目的 采用颈椎前路钛网钢板及自体髂骨植骨对不同颈椎节段进行内固定，分析其生物力学改变。方法 取自愿捐赠的6具新鲜尸体C3～7标本，C5、C5.6及C4～6椎体次全切除后，分别行髂骨植骨和钛网前路钢板内固定术，测量各节段的前屈、后伸、左、右侧弯及左、右旋转运动变化，以完整标本作为对照组。结果 自体髂骨的植入使失稳颈椎的稳定性提高，其侧弯、屈伸运动度减少，与对照组比较，差异有统计学意义（P〈0．05），但抗旋转运动减少不明显（P〉0．05）。不同颈椎节段开槽减压椎间撑开钛网前路钢板内固定状态下，手术节段的即刻稳定性比对照组及撑开植骨状态增加（P〈0．05）。结论 颈椎前路椎体次全切除之后，植骨仅能部分改善其稳定性，但应用颈椎前路钛网钢板内固定可明显增强颈椎的稳定性，也较完整颈椎运动功能单位稳定。

Objective To evaluate the biomechanical characteristics of titanium mesh with anterior plate fixation or ilium autograft in anterior cervical decompression. Methods Six fresh cervical spine specimens （C3-7） of young cadaver were used in the biomechanical test. After C5, C5.6 and C4-6 were given vertebrectomy,ilium autograft and titanium mesh with anterior plate fixation were performed. Their stabilities of flexion ,bilateral axial rotation ,the lateral bending and the extension were tested. Intact cervical spine specimens served as control group. Results Ilium autograft improved the stability of the unstable cervical vertebrae and decreased the flexion, the lateral bending or the extension, showing a significant difference when compared with control group （P〈0.05）. Whereas, axial rotational motion was decreased insignificantly（P〉0.05）. Titanium mesh with anterior plate fixation improved the stability of the unstable spine and decreased the flexion, the bilateral axial rotation,the lateral bending or the extension, showing a significant difference when compared with control group（P〈0. 05）. Conclusion The vertebrectomy and anterior cervical fusion by ilium autograft was the least stable construct of all modes tested,and the titanium mesh implantation is stabler than the intact cervical sample.