Résumé
L'instabilité C1-C2 est le plus souvent traitée chirurgicalement. Selon l'indication, peuvent être proposées soit une ostéosynthèse par vissage direct de l'odontoïde, soit une arthrodèse C1-C2. Dans cette étude expérimentale in vitro, on a comparé au plan biomécanique, les trois différentes techniques d'arthrodèse atlanto-axoïdiennes, selon Gallie, Brooks et Magerl. 16 segments C1-C2 présentant des fractures de type II et III ont été testés in vitro dans des conditions bien définies. On a appliqué des moments de flexion et d'extension, des forces de cisaillement antérieur et postérieur et des moments de torsion vers la droite et vers la gauche, et l'on a analysé la mobilité de C1-C2. Les résultats de cette investigation ont clairement démontré que les segments traités par la technique de Magerl avec des vis transarticulaires, présentaient la plus grande rigidité, en comparaison des méthodes de cerclage de Brooks et de Gallie. Ces différences étaient plus évidentes dans le cas du cisaillement postérieur et de la torsion. Dans ces conditions de contrainte, le rapport de rigidité Magerl/Brooks/Gallie était de 10/2/1. Des différences significatives de déformation plastique ont été retrouvées entre les différentes fixations C1-C2 au cours des premiers cycles de mise en charge et décharge, qui renseignent sur la relation entre la stabilité primaire et à long terme.
Summary
Unstable C1-C2 segments are generally treated surgically. Depending on the indication a direct screw fixation of the odontoid or a C1-C2 arthrodesis is a possible technique. In this experimental in vitro study the three different atlantoaxial fusion techniques by Gallie, Brooks, and Magerl were compared biomechanically. Sixteen human C1-C2 segments with odontoid fractures of type II and III were investigated under standardized conditions. Flexion and extension moments, anterior, and posterior shear forces, left and right torsional moments were applied, and the motion of C1 relative to C2 was determined. The results of this investigation show clearly that the segments treated with the technique by Magerl with transarticular screws achieved the highest stiffness, compared to the wiring methods of Brooks and Gallie. These differences were most evident for posterior shear forces and for torsional moments. For these load conditions the ratio of stiffness Magerl: Brooks: Gallie was about 10:2:1. Significant differences for the plastic deformation of the differently fixed C1-C2 segments were found within the first few load/unload cycles, which give information about the relationship between primary and long-term stability.
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Wilke, H.J., Fischer, K., Kugler, A. et al. In vitro investigations of internal fixation systems of the upper cervical spine. Eur Spine J 1, 191–199 (1992). https://doi.org/10.1007/BF00301312
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DOI: https://doi.org/10.1007/BF00301312
Mots-clés
- Biomécanique
- Rachis cervical
- Fracture de l'odontoïde
- Instabilité atlanto-axoïdienne
- Arthrodèse atlanto-axoïdienne postérieure