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Should we recommend occipital plate fixation using bicortical screws or inverted occipital hooks to optimize occipito-cervical junction fusion? A biomechanical study combining an experimental and analytical approach.
Clinical Biomechanics ( IF 1.8 ) Pub Date : 2020-09-12 , DOI: 10.1016/j.clinbiomech.2020.105173
Arnaud Germaneau , Tanguy Vendeuvre , Alexandre Delmotte , Samuel D'Houtaud , Cyril Brèque , Louis Petureau , Pascal Doumalin , Jean-Christophe Dupré , Fabrice Brémand , Philippe Maxy , Jean-Pierre Richer , Philippe Rigoard

Background

Occipito-cervical fusion can be necessary in case of cranio-cervical junction instability. Proximal stabilisation is usually ensured by bi-cortical occipital screws implanted through one median or two lateral occipital plate(s). Bone thickness variability as well as the proximity of vasculo-nervous elements can induce substantial morbidity. The choice of site and implant type remains difficult for surgeons and is often empirically based. Given this challenge, implants with smaller pitch to increase bone interfacing are being developed, as is a surgical technique consisting in inverted occipital hook clamps, a potential alternative to plate/screws association. We present here a biomechanical comparison of the different occipito-cervical fusion devices.

Methods

We have developed a 3D mark tracking technique to measure experimental mechanical data on implants and occipital bone. Biomechanical tests were performed to study the mechanical stiffness of the occipito-cervical instrumentation on human skulls. Four occipital implant systems were analysed: lateral plates+large pitch screws, lateral plates+hooks, lateral plates+small pitch screws and median plate+small pitch screws. Mechanical responses were analysed using 3D displacement field measurements from optical methods and compared with an analytical model.

Findings

Paradoxical mechanical responses were observed among the four types of fixations. Lateral plates+small pitch screws appear to show the best accordance of displacement field between bone/implant/system interface providing higher stiffness and an average maximum moment around 50 N.m before fracture.

Interpretation

Stability of occipito-cervical fixation depends not only on the site of screws implantation and occipital bone thickness but is also directly influenced by the type of occipital implant.



中文翻译:

我们是否应该建议使用双皮质螺钉或倒置的枕骨钩来固定枕骨板,以优化枕颈融合的效果?结合了实验和分析方法的生物力学研究。

背景

如果颅颈交界不稳定,可能需要枕颈融合。通常通过通过一个或两个枕骨外侧板植入双皮质枕骨螺钉来确保近端稳定。骨厚度的变异性以及血管神经元的邻近程度都可能引起发病。对于外科医生而言,部位和植入物类型的选择仍然很困难,并且通常基于经验。面对这一挑战,正在开发具有较小间距以增加骨界面的植入物,以及一种包括倒置枕骨钩夹的外科技术,这是板/螺钉结合的潜在替代方案。我们在这里介绍了不同的枕颈融合设备的生物力学比较。

方法

我们已经开发了3D标记跟踪技术来测量植入物和枕骨上的实验机械数据。进行了生物力学测试,以研究枕骨颈器械在人类头骨上的机械刚度。分析了四个枕骨植入系统:侧板+大螺距螺钉,侧板+钩,侧板+小螺距螺钉和正中板+小螺距螺钉。使用光学方法的3D位移场测量来分析机械响应,并与分析模型进行比较。

发现

在四种固定方式中观察到矛盾的机械反应。侧板+小螺距螺钉似乎显示出骨/植入物/系统界面之间位移场的最佳一致性,从而提供更高的刚度和骨折前50 Nm左右的平均最大力矩。

解释

枕颈固定的稳定性不仅取决于螺钉植入的部位和枕骨的厚度,而且还直接受枕植入物类型的影响。

更新日期:2020-09-30
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