解剖结构逐级损伤对Hangman骨折稳定性影响的生物力学研究

Biomechanical Study of Gradually Anatomic Structure Injury of Hangman Fracture

目的测试C2、3椎间解剖结构逐级损伤对Hangman骨折稳定性的影响并探讨其临床意义。方法8具新鲜C1～4颈椎标本,按Hangman骨折病理诊断标准模拟C2、3椎间解剖结构逐级损伤,并在脊柱三维运动实验机上依次按照:①对照组(正常状态);②切断双侧椎弓峡部组;③切断双侧椎弓峡部及后纵韧带组;④切断双侧椎弓峡部及前、后纵韧带组顺序测试其三维运动范围(ROM),对结果进行统计学分析。结果随着解剖结构逐级破坏,ROM值逐渐增大。切断双侧椎弓峡部组与对照组相比除旋转有显著性差异外,余均无显著性差异;而切断双侧椎弓峡部及后纵韧带组、切断双侧椎弓峡部及前后纵韧带组与对照组相比均有显著性差异。切断双侧椎弓峡部及后纵韧带组与切断双侧椎弓峡部组相比除后伸无显著性差异外,余均有显著性差异;切断双侧椎弓峡部及前后纵韧带组与其他组相比均有显著性差异(P<0.05)。结论对旋转运动影响最大的是峡部,前后纵韧带对屈伸运动影响明显,而侧弯运动则随着各椎间结构的破坏逐步下降;准确判断Hangman骨折的具体损伤部位对骨折稳定性的认识和手术方法的选择有着重要作用。

Objective To evaluate the biomechanical stability of gradually C2,3 anatomic structure injury of Hangman tracture anti mvesngate the clinic meaning. Methods Eight fresh adult human cervical specimens simulated different anatomic structure injury of Hangman fracture according to pathologic diagnostic criteria and their three - dimensional motion stability compared. They were divided into four groups： （1）control （intact）, （2）injury group of both interarticularis, （3）injury group of both interarticularis and posterior longitudinal ligament, （4）injury group of both interarticularis and anterior, posterior longitudinal ligament; range of motion （ROM） was test. Results The ROM became wider gradually with more anatomic structure injury, group （2） had no statistically significant difference with the intact group except the ROM of rotation. And each ROM of group （3） and group （4） had statistically significant difference with the intact group. Group （3） fracture had statistically significant difference with group （2） except the ROM of extension, and group （4） had statistically significant difference with each group （P〈 0.05）. Conclusion Interarticularis injury affects the rotation obviously, The anterior, posterior longitudinal ligament affects flexion obviously. The correct diagnosis of C2,3 anatomic structure injury has important effect for the realization of stability and choice of operation of Hangman fracture.