经枢椎体至寰椎侧块螺钉联合Gallie法内固定的生物力学研究

Biomechanical study of fixation stability with anterior approach screw fixation through C_2 vertebral body to C_1 lateral mass and Gallie's technique

目的：评价前路经枢椎体至寰椎侧块螺钉联合Gallie法内固定重建寰枢椎不稳的三维稳定性。方法：25具成人标本（C0-3），随机分成5组：完整状态（Intact组）、齿状突Ⅱ型骨折（OTF组）、Magerl螺钉内固定术（PTS组）、前路经枢椎体至寰椎侧块螺钉内固定（ASM组）、前路经枢椎体至寰椎侧块螺钉联合Gallie法内固定术（ASMG组），每组5个标本。测定5种状态下的寰枢椎三维运动范围，并进行统计分析。结果：ASMG组、PTS组及ASM组都显著减少寰枢椎的三维运动范围；ASMG组与PTS组及ASM组在屈伸及左右侧弯方面有显著性差异（P〈0．05），在左右旋转方面无显著性差异（P〉0．05）。结论：前路经枢椎体至寰椎侧块螺钉联合Gallie法内固定在重建寰枢关节的稳定有独特的优势，更能控制屈伸及左右侧弯。为陈旧性寰枢椎不稳定或脱位患者提供了一种可靠的手术方式。

Objective：To determine the three-dimensional stability of atlantoaxial reconstruction with anterior approach screw fixation through C2 vertebral body to CI lateral mass and Gallie＇s technique for C1-2 instability Methods：25 human cadaveric specimens were randomly divided into 5 groups.The three-dimensional range of motion C1 relatively C2 was measured under five different conditions,the intact state（intact group）,odontoid tape Ⅱ fracture（group OTF）,fixation with posterior C1-2 transarticular screw（group PTS）,anterior approach screw fixation through C2 vertebral body to C1 lateral mass（group ASM）,ASM and Gallie＇s technique（group ASMG）. The obtained data were statistically analyzed. Results：The range of motion in all directions group ASMG,ASM and PTS was significantly decreased.There was significant difference among group ASMG,ASM and PTS in flexion/extension and lateral bendings by statistical analysis（P〈0.05）,and no difference in axial rotation by statistical analysis （P〉0.05）. Conclusion：In vivo biomechanics studies showed that ASMG had unique superiority in the reconstruction of the atlantoaxial stability,especially in controlling the instability of flexion/extension and lateral bendings.It was one kind of reliable surgical choice for the treatment of the obsolete instability or dislocation of C1-2 joint.