【作者】 蒋伟宇；

【导师】 徐荣明；

【作者基本信息】 浙江中医药大学 ， 中医骨伤科学， 2012， 博士

【摘要】 目的结合国人寰枢椎的解剖学特点,原创性设计新型的寰枢椎后路动态固定系统,评价其生物力学稳定性,为完善设计与临床应用提供基础理论依据。方法研究由二个部分组成：(一)新型的寰枢椎后路动态内固定系统的设计与制作。取100例正常成人上颈椎CT三维重建图像,测量相关解剖参数,并与文献国人颈椎的解剖学参数比较,设计新型的寰枢椎后路动态内固定系统,并制作样品。(二)新型的寰枢椎后路动态内固定系统的生物力学研究。采集较为新鲜颈椎枕颈CO-C48具,分成完整状态组、失稳状态组、寰枢椎后路动态内固定以及寰枢椎后路椎弓根固定组四个组。用生物力学三维运动测试仪分别进行位移、刚度等测试,以完整状态的节段运动为对照组,对其在维持局部稳定性、保存运动功能以及对下位椎间活动度的影响等方面进行生物力学评价,结果进行统计学处理。结果新型的寰枢椎后路动态内固定系统的设计符合国人颈椎解剖特点。生物力学测试显示在屈曲、伸展、左右侧屈、旋转等工况下,新型寰枢椎后路动态固定系统组的寰枢椎的ROM与完整状态相比,呈无明显差异(P>0.05),常规寰枢椎椎弓根螺钉固定组寰枢椎的ROM与完整状态相比呈非常显著性差异(P<0.001),两种固定方法组寰枢椎的ROM相比,呈非常显著性差异(P<0.001)。新型寰枢椎后路动态固定系统组的颈2/3节段ROM与完整状态相比,呈无明显差异(P>0.05),常规寰枢椎椎弓根螺钉固定组颈2/3节段的ROM与完整状态相比呈非常显著性差异(P<0.001)；两种固定方法组颈2/3节段的ROM相比,呈非常显著性差异(P<0.001)。稳定指数和颈椎总体刚度测定也体现了动态固定的优越性。结论全新寰枢椎后路动态固定系统具有良好的生物力学性能,且符合国人颈椎解剖要求；生物力学实验研究表明它既能恢复寰枢椎的稳定性又能保留其生理运动功能,并可有效减少对邻近节段的影响。更多还原

【Abstract】 Objective A new type Atlantoaxial dynamic stabilization system were original designed based on the anatomic character of Chinese People. The biomechanics of the new dynamic stabilization system were investigated, to provide theoretical principle for clinic application and optimize design.Methods This study was divided in two Parts. Part one:The design and manufacture a new type Atlantoaxial dynamic stabilization system based on the anatomic character of100normal Chinese People through three dimension CT of upper cervical. Part two:Biomechanical study of the new type Atlantoaxial dynamic stabilization system.8fresh adult cervical spine (C0-C4) sample were made into four groups successively, include integrity status group,Unstable status group, dynamic stabilization system fixation group, pedicle screw fixation group. ROM of the segment and stiffness were tested by mechanical test machine. Compared with integrity status respectively, analyzed the influence to the ROM of the stabilized segment, motion function and influence of adjacent segment. The consequence were analyzed by statistics.Results The Atlantoaxial dynamic stabilization system is in accordance with the feature cervical spine of Chinese People. The biomechanical study shows the ROM of Cl/2in integrity status group and dynamic stabilization system fixation group under various models such as flexion, extension, Lateral bending and rotation was no significant difference (P>0.05), integrity status group and pedicle screw fixation group under various models was obvious significant difference (P<0.001),dynamic stabilization system fixation group, and pedicle screw fixation group under various models was obvious significant difference (P<0.001). The ROM of C2/3in integrity status group and dynamic stabilization system fixation group under various models such as flexion, extension, Lateral bending and rotation was no significant difference (P>0.05), integrity status group and pedicle screw fixation group under various models was obvious significant difference (P<0.001),dynamic stabilization system fixation group, and pedicle screw fixation group under various models was obvious significant difference (P<0.001). Consequence of stability and stiffness also illustrated the advantage of dynamic stabilization system.Conclusion A new type of dynamic stabilization system can provide an sufficient biomechanical stability, and correspond with characteristic of Chinese people anatomy. The new type of dynamic stabilization system not only can recover stability of Cl/2,but retain the motion function of C1/2,and decrease influence to the adjacent segment effectively.更多还原