摘要
目的 分析单纯性韧带切除造成的颅颈交界区不稳对寰枢椎（C1～2）运动节段的中性区、三维运动范围及寰枢侧方关节最大压力影响.方法 6例新鲜尸体标本被使用.采用重复测量的方法,对标本进行屈伸、侧弯及轴向旋转的纯力矩加载,分别测试2.0 Nm纯力矩载荷下正常对照组和颅颈交界不稳组C1～2运动节段的中性区和运动范围,以及1.0 Nm纯力矩载荷下正常对照组及颅颈交界不稳组寰枢侧方关节的压力.结果 颅颈交界不稳组C1～2运动节段的中性区在屈伸、侧弯及轴向旋转载荷下分别为26.67°±4.70°、9.13°±1.32°和63.11°±5.87°,正常组在屈伸、侧弯及轴向旋转载荷下C1～2运动节段的中性区分别为14.12°±2.40°,4.15°±0.75°和50.75°±5.84°,颅颈交界不稳组C1～2运动节段的中性区在屈伸、侧弯及轴向旋转载荷下比正常组的显著增加（P＜0.05）.颅颈交界不稳组C1～2运动节段的运动范围在屈伸、侧弯及轴向旋转载荷下分别为42.37°±3.96°、13.67°±1.10°和78.50°±4.00°,正常组在屈伸、侧弯及轴向旋转载荷下C1～2运动节段的运动范围分别为27.43°±2.41°、6.97°±0.59°和65.26°±4.08°,颅颈交界不稳组C1～2运动节段的运动范围在屈伸、侧弯及轴向旋转载荷下比正常组的显著增加（P＜0.05）.在前屈、左右侧弯及左旋载荷下,颅颈交界不稳组寰枢椎左右侧方关节的最大压力比正常组的减小.后伸和右旋载荷下,颅颈交界不稳组寰枢椎右侧方关节的最大压力也比正常组的减小.但后伸载荷下,颅颈交界不稳组寰枢椎左侧方关节的最大压力不变,右旋载荷下,颅颈交界不稳组寰枢椎左侧方关节的最大压力稍有增加.结论 颅颈交界区单纯性的韧带切除可以造成寰枢椎不稳,在屈伸、侧弯及轴向旋转情况下运动范围比正常情况下显著性增加.寰枢椎的不稳,导致寰枢外侧关节失去正常的承重功能,进而最终造成寰枢椎脱位。
Object To analyze the effects of craniocervical junction instability caused by ligament resection on the neutral zones（NEs） and range of motions（ROMs） in C1-2 motion segment,and the maximum pressure of atlantoaxial lateral joint.Methods 6 cases of fresh cadaver specimens were used.By using the method of repeated measurements,NZs and ROMs in C1～2 motion segment were measured for normal control group and the craniocervical instability group under 2.0Nm and 1.0Nm pure moment loading of flexion extension,lateral bending and axial rotation,respectively.Results The NZs in C1-2 motion under the loadings of flexion and extension,lateral bending and axial rotation for craniocervical junction instability group were 26.67° ±4.70° 、9.13° ± 1.32°and 63.11° ± 5.87°,respectively.The NZs in C1～2 motion under the loadings of flexion and extension,lateral bending and axial rotation for craniocervical junction instability group were 14.12° ± 2.40°,4.15° ± 0.75°and 50.75° ± 5.84°,respectively.The NZs in C1 ～2 motion segment for craniocervical instability group in the loadings of flexion and extension,lateral bending and axial rotation were significantly greater than those for intact group （P 〈 0.05）.The ROMs in C1～2 motion under the loadings of flexion and extension,lateral bending and axial rotation for craniocervical junction instability group were 42.37°± 3.96° 、13.67°± 1.10°and 78.50° ±4.00°,respectively.The ROMs in C1 ～2 motion under the loadings of flexion and extension,lateral bending and axial rotation for craniocervical junction instability group were 27.43° ±2.41° 、6.97° ±0.59°and 65.26° ±4.08°,respectively.The ROMs for craniocervical junction instability group in the loadings of flexion and extension,lateral bending and axial rotation significantly were higher than those for the intact group （P 〈 0.05）.For flexion,lateral bending and left axial rotation,the maximum stress of the atlantoaxial lateral joints for craniocervical instability group was less than that for the intact group.In the loadings of extension and right axial rotation,the maximum stress of the atlantoaxial right lateral joints for craniocervical instability group was less than that for the intact group,too.Howerer the atlantoaxial right lateral joint was unchanged under the extension laoding,and the left joint is a litte higher than that of the intact group under right axial loading.Conclusion Simple ligament resection in craniocervical junction could cause atlantoaxial instability.The range of motion for the loadings of flexion and extension,lateral bending and axial rotation is higher than that of the intact group.Atlantoaxial instability might lead to loss of load-bearing function of atlantoaxial lateral joint,and ultimately result in atlantoaxial dislocation.
出处
《中华神经外科杂志》
CSCD
北大核心
2015年第4期345-349,共5页
Chinese Journal of Neurosurgery
基金
国家自然科学基金（81271519）
首都医科大学基础临床合作项目（14JLl7）
北京市教育委员会科技计划面上项目（KM201510025010）
关键词
颅颈交界区
寰枢外侧关节
寰枢椎脱位
压力
运动范围
Craniocervical junction
Atlantoaxial lateral joint
Atlantoaxial dislocation
Stress
Range of motion
