双节段与单节段记忆合金加压钉矫正特发性脊柱侧凸的效果对比  

Contrast on Dual-level Versus Single-level Shape Memory Alloy Staple Correction of Idiopathic Scoliosis in a Goat Model

作　　者：孟传龙[1] 张永刚[1] 郑国权[1] 张如意[1] 宋迪煜[1] 白林[1] 

机构地区：[1]解放军总医院骨科医院,北京100853

出　　处：《医学临床研究》2008年第5期779-782,共4页Journal of Clinical Research

基　　金：国家高技术研究发展计划(863计划)课题(编号:2006AA02Z4D6)

摘　　要：【目的】通过对比双节段与单节段Staple钉对未成年山羊特发性脊柱侧凸模型的矫形效果,探讨长节段Staple钉对脊柱生长的调节作用。【方法】5-8周龄,体重6-8kg的健康雌性山羊15只,采用椎弓根钉不对称栓系加凸侧肋骨部分切除的方法建立脊柱侧凸动物模型,观察至少2个月。建模成功后手术解除拴系,随机分为单间隙钉组、双间隙钉组和对照组3组（n=5）分别进行处理：2个实验组行开胸手术,将记忆合金加压钉以侧凸顶椎为中心,纵跨与其毗邻的4-5个椎间盘,沿主弯的凸侧（右侧）纵行植入椎体,单间隙钉组植入跨单个椎间隙的Staple钉,双间隙钉组植入跨两个椎间隙的Staple钉,对照组不予治疗。术后即刻及其后每隔4-6周摄胸椎正侧位X线片（观察期至少2个月）,测量Cobb角,比较角度的变化。【结果】成模14只。X线片显示2个实验组在矫形术后即刻矫形效果明显（P〈0.01）,侧凸的Cobb角随着时间推移有逐渐减小的趋势。在观察期内,实验组的Cobb角比矫形初期明显减小（P〈0.01）,对照组则没有显著的变化（P〉0.05）。双间隙钉组的有效矫形角度（矫形术后即刻角度-观察期结束时角度）为17.8°±4.0°,较单间隙钉组（14.0°±7.6°）高,而且数据分布范围比较集中。两个实验组的有效矫形角度均比对照组大（P〈0.05）,但两实验组之间则无统计学差异（P〉0.05）。【结论】两种记忆合金加压钉均可以有效地矫正脊柱侧凸的进展,双间隙钉能够达到甚至超过常规单间隙钉的矫形效果,但二者没有统计学差异。[Objective]To investigate the spinal growth modulation of long-level staple by contrasting the correction of dual level versus single-level shape memory alloy staples in an immature goat model. [Methods] Experimental seoliosis was created in 15 healthy female goats （age, 5-8 weeks; weight, 6-8 kg） in the way of asymmetric tethering by using a pediele screw system and convex rib partial resection. All goats were followed for over 2 months. Goats with progressive seoliosis were randomly divided into 3 groups （5 for each）. All tethers were removed and goats in treatment groups underwent followed thoraeotomy. Shape memory alloy staples were laterally implanted into vertebral bodies spanning 4-5 discs close to the apical vertebra, along the convexity （right side） of the maximal curvature. Goats in single-level staple group were implanted staples spanning one disc each, and goats in dual-level staple group were implanted staples spanning two disc each, and goats in control group were only removed the tethers without treatment. Anterioposterior and lateral plain radiographs were taken right after the surgery and subsequently every 4-6 weeks to measure the Cobb angles of the spine. All goats were observed for at least 2 additional weeks. [Results]Forteen goats achieved progressive structural seoliosis successfully. Radiographs showed that two treatment groups attained an immediate correction right after the surgery （ P 〈0. 01）, and the Cobb angles of the seoliosis showed a tendency of decrease with time. Compared with the initial stage of the stapling, the Cobb angles of the treatment groups decreased significantly during the observation period （ P 〈0. 01）, whereas little changes were shown in the control group （ P 〉0.05）. Goats in dual-level staple group attained larger virtual correcting angle （immediate angle after surgery and terminal angle at the end of the observation） of 17.8°± 4.0°and narrower range of data distribution than those in single-level staple group（14.0°± 7.6°�

关 键 词：脊柱侧凸/外科学 合金 

分 类 号：R682.3[医药卫生—骨科学]