颈椎侧块螺钉固定器的研制及测试
|
摘要
目的：结合国人颈椎的解剖学特点，设计新型颈椎侧块螺钉固定器。
背景：下颈椎骨折脱位以及严重退变性疾病、肿瘤等行广泛椎板切除减压术后
需重建颈椎的稳定性。已证实，对于颈椎后结构的损伤，单纯前路植骨及钢板
内固定无法达到有效稳定的目的。颈椎后路内固定中，钢丝及椎板夹要求保持
颈椎后结构的完整性，应用范围有限且固定不确实。侧块螺钉技术无需保持棘
突、椎板的完整，固定可靠，但操作有一定危险性，技术要求较高。颈椎椎弓
根螺钉技术则危险性太高。侧块螺钉钢板在国外已有应用，但其安全性、易操
作性和力学特性尚存在缺陷，国内尚未广泛开展，值得进一步改进。方法：对
国人35套颈椎干燥骨标本及100套颈椎X线片和CT片进行测量，以取得国人
下颈椎后结构的应用解剖学和影像学参数，为新型颈椎侧块螺钉固定器的设计
和手术方式提供参考。在此基础上，针对现有颈椎侧块螺钉钢板存在的问题，
设计一种新型颈椎侧块螺钉固定器及新式颈椎侧块螺钉植入技术。将新型颈椎
侧块螺钉固定器植入5具新鲜颈椎尸体标本，应用脊柱三维运动测量系统和材
料试验机测试其三维稳定性和刚度，并与颈椎棘突钢丝、颈椎侧块螺钉钢板、
颈椎椎弓根螺钉钢板做比较。采用材料试验机测试新式颈椎侧块螺钉植入技术、
颈椎侧块螺钉Roy-Camille植入法、Magerl植入法、颈椎椎弓根螺钉植入法的
螺钉拔出强度。模拟手术操作，用新式颈椎侧块螺钉植入技术、颈椎侧块螺钉
Magerl植入法、颈椎椎弓根螺钉植入法在5具新鲜颈椎尸体标本上植入螺钉，
分别用X线和CT评价螺钉的位置，以确定螺钉植入技术的准确性和安全性。
结果：新型颈椎侧块螺钉固定器宜采用直径3．5 mm，长度14～18 mm螺钉，采
用钉棒结构，螺钉间距可调。新式颈椎侧块螺钉植入技术入钉点位于距侧块外
缘和下缘各2mm处，内倾40°～50°，上倾40°指向椎弓根，进钉至椎弓根
与侧块交界处。生物力学测试表明新型颈椎侧块螺钉固定器对颈椎后结构破坏
所造成的失稳颈椎的稳定作用和刚度与现有的颈椎侧块螺钉钢板近似，优于颈
椎棘突钢丝而逊于颈椎椎弓根螺钉钢板。新式颈椎侧块螺钉植入技术的螺钉拔
出强度优于现有的颈椎侧块螺钉植入技术而小于颈椎椎弓根螺钉植入技术。影
像学评价显示新型颈椎侧块螺钉固定器植入位置准确、安全，无损伤周围重要
神经、血管的危险。结论：新型颈椎侧块螺钉固定器具有与传统颈椎侧块螺钉
钢板相似或更加优良的生物力学性能；颈椎椎弓根螺钉钢板虽力学性能最佳，
但危险性太大。同时新型颈椎侧块螺钉固定器手术更安全，操作更简便。
Objective: In accordance with the anatomic features of the cervical
spine of Chinese people, design a new type of cervical lateral mass screw fixator.
Backgrounds: It was needed to reconstruct the stability of the cervical spine in lower
cervical fractures and dislocations, post-expansive laminectomy in severe
degenerative diseases and tumors. But it was confirmed that pure anterior bone
implantation and anterior plate fixation could not achieve effective stability in
posterior cervical structure injuries. Among posterior cervical flxators, the process
wire and the interlaminar clamp need the posterior cervical structures keep intact, the
use of them is limited and their fixation effects are unreliable. The lateral mass screw
technique does not need the process and the lamina keeps intact and its fixation effect
is reliable. But in operation, this technique need some experiences and may have
some dangerous. The cervical pedicle screw technique is too dangerous. The cervical
lateral mass screw plate has already been used abroad, but its safety, easy of operation
and biomechanical features have some defects. The use of them in domestic is limited,
and it is worth to improve on. Methods: In order to give consults to the designing of
the new type cervical lateral mass screw fixator and the new operation methods,
measurements were done on 35 dry cervical vertebral samples and 100 cervical X-ray
films and CT films to get anatomic and imaging parameters of the lower cervical
posterior structures of Chinese people. On the basis of the anatomical study, directing
to the problems of now available cervical lateral mass screw plate systems, a new type
of cervical lateral mass screw fixator and a new cervical lateral mass screw implant
technique were designed. The new type cervical lateral mass screw fixators were
implanted into five fresh cervical samples, and the three dimensional stability and
rigidity were tested using the spinal three dimensional motion testing system and the
material testing machine. The constructs were the cervical process wire, the cervical
lateral mass screw plate, and the cervical pedicle screw plate. The screw pull-out
strength of the new cervical lateral mass screw technique, the cervical lateral mass
Roy-Camille technique, Magerl technique, and the cervical pedicle screw technique
were tested using the material testing machine. The screws were implanted into five
fresh cervical samples using the new cervical lateral mass screw technique, the
cervical lateral mass Magerl technique, and the cervical pedicle screw technique
imitating operative situation. The screw positions were evaluated by the X-ray and CT
4
filIns tO defor the accuracy and safety of the ecbo haPlantation tecboques. ReSult8:
Ih the new tw cervical larend mass screw fixator, the diamatr of the screw should
be 3.5 nnn, the length should be l4~l8 nun. The diStane between screws shouId be
adjuStale and the nail-stick Strutw was used. In the new cervical lateral mass screw
imPlan technique, the diStalle of the screw eine point to the lateral and inferior
of the lateral mass should be 2 rnm. The implat direction should be 40" ~50"
medial and 40" cephalad, directed to the pedicle, and ethece to the connection of
the lateral mass and the Pedicle. Biomechanical tests show tha the stabiliZaion to the
Mle cervical spine due tO posterior structure injUry and the rigidity of the new
cervical lateral mass screw fixator were equal to the traditional cervical latCtal mass
screw plate, superior to the cervical process wire and inferior to the cervical Pedicle
screw plate. The screw Pull-out strength of the new
背景：下颈椎骨折脱位以及严重退变性疾病、肿瘤等行广泛椎板切除减压术后
需重建颈椎的稳定性。已证实，对于颈椎后结构的损伤，单纯前路植骨及钢板
内固定无法达到有效稳定的目的。颈椎后路内固定中，钢丝及椎板夹要求保持
颈椎后结构的完整性，应用范围有限且固定不确实。侧块螺钉技术无需保持棘
突、椎板的完整，固定可靠，但操作有一定危险性，技术要求较高。颈椎椎弓
根螺钉技术则危险性太高。侧块螺钉钢板在国外已有应用，但其安全性、易操
作性和力学特性尚存在缺陷，国内尚未广泛开展，值得进一步改进。方法：对
国人35套颈椎干燥骨标本及100套颈椎X线片和CT片进行测量，以取得国人
下颈椎后结构的应用解剖学和影像学参数，为新型颈椎侧块螺钉固定器的设计
和手术方式提供参考。在此基础上，针对现有颈椎侧块螺钉钢板存在的问题，
设计一种新型颈椎侧块螺钉固定器及新式颈椎侧块螺钉植入技术。将新型颈椎
侧块螺钉固定器植入5具新鲜颈椎尸体标本，应用脊柱三维运动测量系统和材
料试验机测试其三维稳定性和刚度，并与颈椎棘突钢丝、颈椎侧块螺钉钢板、
颈椎椎弓根螺钉钢板做比较。采用材料试验机测试新式颈椎侧块螺钉植入技术、
颈椎侧块螺钉Roy-Camille植入法、Magerl植入法、颈椎椎弓根螺钉植入法的
螺钉拔出强度。模拟手术操作，用新式颈椎侧块螺钉植入技术、颈椎侧块螺钉
Magerl植入法、颈椎椎弓根螺钉植入法在5具新鲜颈椎尸体标本上植入螺钉，
分别用X线和CT评价螺钉的位置，以确定螺钉植入技术的准确性和安全性。
结果：新型颈椎侧块螺钉固定器宜采用直径3．5 mm，长度14～18 mm螺钉，采
用钉棒结构，螺钉间距可调。新式颈椎侧块螺钉植入技术入钉点位于距侧块外
缘和下缘各2mm处，内倾40°～50°，上倾40°指向椎弓根，进钉至椎弓根
与侧块交界处。生物力学测试表明新型颈椎侧块螺钉固定器对颈椎后结构破坏
所造成的失稳颈椎的稳定作用和刚度与现有的颈椎侧块螺钉钢板近似，优于颈
椎棘突钢丝而逊于颈椎椎弓根螺钉钢板。新式颈椎侧块螺钉植入技术的螺钉拔
出强度优于现有的颈椎侧块螺钉植入技术而小于颈椎椎弓根螺钉植入技术。影
像学评价显示新型颈椎侧块螺钉固定器植入位置准确、安全，无损伤周围重要
神经、血管的危险。结论：新型颈椎侧块螺钉固定器具有与传统颈椎侧块螺钉
钢板相似或更加优良的生物力学性能；颈椎椎弓根螺钉钢板虽力学性能最佳，
但危险性太大。同时新型颈椎侧块螺钉固定器手术更安全，操作更简便。
Objective: In accordance with the anatomic features of the cervical
spine of Chinese people, design a new type of cervical lateral mass screw fixator.
Backgrounds: It was needed to reconstruct the stability of the cervical spine in lower
cervical fractures and dislocations, post-expansive laminectomy in severe
degenerative diseases and tumors. But it was confirmed that pure anterior bone
implantation and anterior plate fixation could not achieve effective stability in
posterior cervical structure injuries. Among posterior cervical flxators, the process
wire and the interlaminar clamp need the posterior cervical structures keep intact, the
use of them is limited and their fixation effects are unreliable. The lateral mass screw
technique does not need the process and the lamina keeps intact and its fixation effect
is reliable. But in operation, this technique need some experiences and may have
some dangerous. The cervical pedicle screw technique is too dangerous. The cervical
lateral mass screw plate has already been used abroad, but its safety, easy of operation
and biomechanical features have some defects. The use of them in domestic is limited,
and it is worth to improve on. Methods: In order to give consults to the designing of
the new type cervical lateral mass screw fixator and the new operation methods,
measurements were done on 35 dry cervical vertebral samples and 100 cervical X-ray
films and CT films to get anatomic and imaging parameters of the lower cervical
posterior structures of Chinese people. On the basis of the anatomical study, directing
to the problems of now available cervical lateral mass screw plate systems, a new type
of cervical lateral mass screw fixator and a new cervical lateral mass screw implant
technique were designed. The new type cervical lateral mass screw fixators were
implanted into five fresh cervical samples, and the three dimensional stability and
rigidity were tested using the spinal three dimensional motion testing system and the
material testing machine. The constructs were the cervical process wire, the cervical
lateral mass screw plate, and the cervical pedicle screw plate. The screw pull-out
strength of the new cervical lateral mass screw technique, the cervical lateral mass
Roy-Camille technique, Magerl technique, and the cervical pedicle screw technique
were tested using the material testing machine. The screws were implanted into five
fresh cervical samples using the new cervical lateral mass screw technique, the
cervical lateral mass Magerl technique, and the cervical pedicle screw technique
imitating operative situation. The screw positions were evaluated by the X-ray and CT
4
filIns tO defor the accuracy and safety of the ecbo haPlantation tecboques. ReSult8:
Ih the new tw cervical larend mass screw fixator, the diamatr of the screw should
be 3.5 nnn, the length should be l4~l8 nun. The diStane between screws shouId be
adjuStale and the nail-stick Strutw was used. In the new cervical lateral mass screw
imPlan technique, the diStalle of the screw eine point to the lateral and inferior
of the lateral mass should be 2 rnm. The implat direction should be 40" ~50"
medial and 40" cephalad, directed to the pedicle, and ethece to the connection of
the lateral mass and the Pedicle. Biomechanical tests show tha the stabiliZaion to the
Mle cervical spine due tO posterior structure injUry and the rigidity of the new
cervical lateral mass screw fixator were equal to the traditional cervical latCtal mass
screw plate, superior to the cervical process wire and inferior to the cervical Pedicle
screw plate. The screw Pull-out strength of the new
引文
1． Jeannert B, Magerl F, Ward EW, et al. Posterior stabilization of the cervical spine with hook plates. Spine,1991,16(3s):56-63
2． Ebraheim NA, An HS, Jackson WT, et al. Internal fixation of the unstable cervical spine using posterior Roy-Camille plates: preliminary report. J Orthop Trauma,1989,3(1) :23-8
3． Abumi K, Itoh H, Taneichi H, et al. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord,1994,7(1) :19-28
4． Gill K, Paschal S, Corrin J, et al. Posterior plating of the cervical spine. A biomechanical comparison of different posterior fusion techniques. Spine, 1988,13(7) :813-6
5． Coe JD, Warden KE, Sutterlin CE 3d, et al. Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine,1989,14(10) :1122-31
6． Stanescu S, Ebraheim NA, Yeasting R, et al. Morphometric evaluation of the cervico-thoracic junction. Practical considerations for posterior fixation of the spine. Spine, 1994,19(18) :2082-8
7． Xu RM, Ebraheim NA, Yeasting R, et al. Anatomy of C_7 lateral mass and projection of pedicle axis on its posterior aspect. J Spinal Disord, 1995,8(2) : 116-20
8． Heller JG, Silcox D, Sutterlin CE. Complications of posterior cervical plating. Spine ,1995,20(22) :2442-8
9． Ebraheim NA, Rupp RE, Savolaine ER, et al. Posterior plating of the cervical spine. J Spine Disord, 1995,8(2) : 111-5
10． Pait TG, Mc Allister PV, Kaufen HH. Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine. J Neurosurg,1995,82:1011-4
11． Miller RM, Ebraheim NA, Xu RM, et al. Anatomic consideration of transpedicular screw placement in the cervical spine. An analysis of two approaches. Spine, 1996,21 (20) :2317-22
12． Jonsson H Jr, Rawschuing W. Anatomical and morphometric studies in posterior cervical spinal screw-plate systems. J Spinal Disord, 1994,7(5) :429-38
2． Ebraheim NA, An HS, Jackson WT, et al. Internal fixation of the unstable cervical spine using posterior Roy-Camille plates: preliminary report. J Orthop Trauma,1989,3(1) :23-8
3． Abumi K, Itoh H, Taneichi H, et al. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord,1994,7(1) :19-28
4． Gill K, Paschal S, Corrin J, et al. Posterior plating of the cervical spine. A biomechanical comparison of different posterior fusion techniques. Spine, 1988,13(7) :813-6
5． Coe JD, Warden KE, Sutterlin CE 3d, et al. Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine,1989,14(10) :1122-31
6． Stanescu S, Ebraheim NA, Yeasting R, et al. Morphometric evaluation of the cervico-thoracic junction. Practical considerations for posterior fixation of the spine. Spine, 1994,19(18) :2082-8
7． Xu RM, Ebraheim NA, Yeasting R, et al. Anatomy of C_7 lateral mass and projection of pedicle axis on its posterior aspect. J Spinal Disord, 1995,8(2) : 116-20
8． Heller JG, Silcox D, Sutterlin CE. Complications of posterior cervical plating. Spine ,1995,20(22) :2442-8
9． Ebraheim NA, Rupp RE, Savolaine ER, et al. Posterior plating of the cervical spine. J Spine Disord, 1995,8(2) : 111-5
10． Pait TG, Mc Allister PV, Kaufen HH. Quadrant anatomy of the articular pillars (lateral cervical mass) of the cervical spine. J Neurosurg,1995,82:1011-4
11． Miller RM, Ebraheim NA, Xu RM, et al. Anatomic consideration of transpedicular screw placement in the cervical spine. An analysis of two approaches. Spine, 1996,21 (20) :2317-22
12． Jonsson H Jr, Rawschuing W. Anatomical and morphometric studies in posterior cervical spinal screw-plate systems. J Spinal Disord, 1994,7(5) :429-38