枕颈临时固定的生物力学评价及临床应用

Biomechanical evaluation and clinical application of occipto-cervical fusion fixed by Temporary occipito-cervical fusion

目的评价枕颈临时固定的生物力学作用和评价其临床应用效果。方法实验中选用3枕颈部模型制成颈1～2脱位模型，分别采用枕颈临时固定，枕颈钢板和枕颈后路钢丝固定，比较脱位模型在不同内固定组别下的三维运动范围。临床应用枕颌临时固定术选择性治疗寰枢椎脱位12例，术后定期X线检查，随访骨性融合时间，神经功能恢复及并发症出现的情况。结果枕颈临时固定组C0～C2节段的前屈、后伸、轴向旋转和侧弯的运动范围分别是6．6°，6．4°，11．8°和7．2°，后路钢丝组的运动范围是10．3°、11．4°、28．2°、17．6°，后路钢丝组的运动范围是4．5°、9．5°、25．2°、12．2°，临床12例患者全部随访，平均随访达22个月，全部病例均完成骨性融合，平均骨性融合的时间为3个月，神经功能情况按照美国脊柱损伤学会（ASIA）脊髓功能分级均有不同程度的恢复。结论枕颈临时固定能够较有效重建枕颈部的即时稳定性，临床应用骨性融合率高。

Objective To evaluate the biomechanical role of Temporary occipito - cervical fusion in reconstructing the stability of occipito - cervical junction and the effect of its clinical application. Methods C1 - 2 fracture dislocations were simulated on three Neck pillow Model, oecipito - cervical plate and posterior wiring randomly. Ranges of the three dimensional movements in different internal fixation group were compared. Twelve patients diagnosed as atlantoaxial dis- location were managed with Temporary occipito - cervical fusion. The x - ray film in different duration after operation, the time from surgery to sold fusion, the neurological improvement and the failure of internal fixation were followed - up. Re- suits In Temporary occipito - cervical fusion group, ROM in flexion,exteution, axial rotation and lateral bending were 5.6,5.4,10. 8 and 6. 2 degrees respectively. In posterior wiring group werel0. 3,11.4,28.2,17.6 degrees and in occip- ital cervical plate group were 4. 5,9.5,25.2, 12. 2 degrees. All patients were followed - up for an average of 22 months. Bony union was obtained in all case and the average time from surgery to solid fusion was 3 months. The neuro- logical improvement was satisfactory. Conclusion Temporary oecipito - cervical fusion can effectively reconstruct the stability of occipito - cervical junction. The incidence of solid fusion was distinctively higher despite less postoperative immobilization. And it is safe and simple.