脊柱内固定系统生物力学研究与临床应用  

BIOMECHANICAL STUDY AND CLINICAL APPLICATION OF DISTRACTION REDUCTION FIXATION SYSTEM FOR TREATING THORACOLUMBAR VERTEBRAL FRACTURE

作　　者：李禾[1] 邢更彦[1] 杨传铎[1] 张新宇[1] 姜川[1] 吴奋起[1] 白晓东[1] 高春华[1] 叶启彬[2] 

机构地区：[1]武警总医院骨科,北京100039 [2]中国协和医科大学中国医学科学院北京协和医院骨科

出　　处：《中国修复重建外科杂志》2008年第8期923-927,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：武警部队科研资助项目(WZ200502)~~

摘　　要：目的评价自行研制的脊柱撑开复位内固定系统(distraction reduction fixation system,DRFS)的生物力学特性及其治疗胸腰椎骨折的临床疗效。方法选用12个市售新鲜猪T11～S2脊柱标本,行前屈20°、后伸10°、左右侧屈30°、左右旋转20°完整标本刚度测试后,行L3椎体楔形截骨,后方小关节切除,制备椎体骨折脱位标本,并进行DRFS内固定,同法测试脱位后及内固定后各项运动刚度。1998年4月-2002年10月,对31例胸腰椎骨折脱位患者采用DRFS内固定治疗。男19例,女12例;年龄17～46岁,平均32.1岁。损伤节段:T112例,T1211例,L114例,L24例。骨折类型按Denis分型,单纯压缩骨折2例,爆裂骨折16例,骨折脱位13例。结果骨折脱位标本前屈、后伸、左屈、右屈、左旋及右旋的刚度较完整标本减小,差异有统计学意义(P<0.05)。DRFS内固定后标本各项运动的刚度均高于骨折脱位标本,差异有统计学意义(P<0.05)。固定后标本后伸刚度高于完整标本,差异有统计学意义(P<0.05);余运动刚度差异无统计学意义(P>0.05)。术后患者均获随访,随访时间5～20个月,平均10.2个月。骨折愈合时间5～11个月,平均8个月。伤椎前、后缘高度分别由46.2%±7.5%和76.4%±2.4%恢复至89.8%±4.6%和94.1%±1.5%,伤椎中点高度由术前60.8%±6.4%恢复至90.7%±2.9%,Cobb角由术前(26.3±5.9)°降至(5.2±1.8)°,以上各项指标术前、术后比较差异均有统计学意义(P<0.05)。滑脱椎体均复位。脊髓神经功能按Frankel分级,术前5例A级,恢复至B级2例,3例无变化;6例B级恢复至C级4例,D级2例;13例C级恢复至D级6例,E级7例;7例D级均恢复至E级。结论自行研制的DRFS能提供足够的稳定性,符合脊柱生理活动要求。DRFS具有良好的撑开、复位功能,内固定牢固,操作简便,是治疗胸腰椎骨折的良好内固定器械。Objective To investigate the biomechanical characteristics of self-developed distraction reduction fixation system （DRFS） and to evaluate its clinical effect on thoracolumbar vertebrate fracture. Methods Twelve fresh porcine spines were prepared for the biomechanical test. The stiffness of each intact specimen were recorded on forward bending （20^o）, backward bending （10^o）, lateral bending （30^o） and axial rotation （20^o）, and then specimens of fracture dislocation were made by cuneiform osteotomy of L3 vertebral body and excision of posterior facet joints. Finally, DRFS internal fixation was performed on each specimen. The stiffness of specimens in fracture dislocation and after DRFS fixation were measured during the same movements mentioned above, respectively. The clinical effect of DRFS on thoracolumbar vertebrate fracture in 31 patients （aged 17-46 years with an average of 32.1） from April 1998 to October 2002 was summarized. Fracture types were classified according to Denis classification： 2 patients suffered simple compressed fracture, 16 burst fracture, and 13 fracture dislocation, including 2 cases of T11, 11 cases of T12, 14 cases of L I and 4 cases of L2. Frankel and X-ray examination were adopted to assess the results. Results The stiffness during forward bending, backward bending, lateral bending and axial rotation in the fracturedislocation state was markedly lower than that of the corresponding movements of the intact porcine spines （P 〈 0.05）. After DRFS, the stiffness during various movements increased to the level that significantly higher than that in the fracture-dislocation state （P 〈 0.05）, and the stiffness during backward bending was of significant difference （P 〈 0.05）, but without significant difference during the rest three movements （P 〉 0.05） when compared to that in intact spines. Regarding clinical observation, the operation time was 2.2-4.1 hours （2.7 hours on average） and blood loss was 250-600 mL （450 mL on average）. The

关 键 词：脊柱撑开复位内固定系统 生物力学 胸腰椎骨折 

分 类 号：R687.3[医药卫生—骨科学]