硫酸钙骨水泥在胸腰椎爆裂骨折椎体成形术中的生物力学性能  

Experimental research on biomechanics of calcium sulfate cement in thoracolumbar burst fractures

作　　者：张绍东[1] 王宸[1] 姜星杰[2] 杨惠林[3] 唐天驷[3] 

机构地区：[1]东南大学附属中大医院骨科,南京210009 [2]南通大学附属医院骨科,南通226001 [3]苏州大学附属第一医院骨科,苏州215006

出　　处：《中国矫形外科杂志》2009年第4期288-292,共5页Orthopedic Journal of China

基　　金：江苏省卫生厅“135工程”重点学科开放课题(编号:K0618)

摘　　要：[目的]评价硫酸钙骨水泥(CSC)椎体成形术在胸腰椎爆裂骨折中的生物力学性能及临床应用价值。[方法]将16具新鲜小牛胸腰椎标本分为4组,A、B、C3组制成爆裂骨折模型后分别实施CSC磷酸钙骨水泥(CPC)、聚甲基丙烯酸酯(PMMA)椎体成形术,D组为无骨折对照组。测量指标包括:爆裂骨折前、后与复位后及椎体成形术后的椎体前缘高度;达到完全填充时的3种骨水泥的注射量;生物力学检测4组标本的极限抗压强度及刚度。[结果](1)实验组12具标本均形成胸腰椎爆裂骨折模型,平均撞击能量为66.2J;(2)CSC、CPC、PMMA的注射量分别为:4.4ml±0.8ml、3.7ml±0.7ml、4.0ml±0.6ml,组间无差别(P>0.05);(3)3种骨水泥均能有效充填爆裂骨折椎体复位后遗留的骨缺损,显著恢复了伤椎高度(P<0.01);(4)A、B、C、D组的极限抗压强度分别为:1659N±154N、1011N±142N、2821N±897N及2439N±525N。PMMA能够完全恢复骨折椎的抗压强度,CSC、CPC均只能部分恢复骨折椎的强度,但CSC优于CPC(P<0.01);(5)4组椎体的刚度分别为:(140±40)N/mm、(148±33)N/mm、(236±97)N/mm、(224±38)N/mm。CSC的刚度低于完整椎体68.0%,(P<0.05),但与PMMA、CPC无显著差异(P>0.05)。[结论]经CSC椎体成形术的骨折椎强度优于CPC,刚度与PM-MA、CPC相当。将CSC椎体成形术作为一种辅助治疗方式用于胸腰椎爆裂骨折能满足力学要求,手术安全可行。[ Objective ] To evaluate the biomechanical performance of vertebroplasty using calcium sulfate cement for thoracolumbar burst fractures. [ Method ] Sixteen bovine thoracolumbar spines （ T11- L1 ） was divided 4 groups （ A, B, C and D）. After burst-fracture model was created, 12 vertebral bodies in group A, B, C were augmented with calcium sulfate cement （CSC）, calcium phosphate cement （CPC） and polymethacrylate （PMMA） bone cement respectively. Each anterior vertebral body （VB） height was measured with a caliper at 4 time points ： intact conditions （ HInt ）, post-fracture （ HFr）, post-reduction （ HRe ） and post-vertebroplasty （Hw）. The vertebroplasty treatment consisted of inserting a biopsy needle bipedicularly into each VB, and filling the void with different bone cements. The filling volume of 3 different bone cements also was measured. Each VB was compressed at 0.5mm/s using a hinged plating system on a materials testing machine to 50% of the post-vertebroplasty height to determine strength and stiffness. Difference was checked for significance （P 〈 0.05 ） using t tests or One-way ANOVA. [ Result ] The average crash energy was 66.2 J. Vertebroplasty with different cements can sustain VB height without significant difference （ P 〉 0.05 ）. The average filling volume of bone cement in 3 groups was 4.35 ml （ CSC）,3.72 ml （CPC） and 3.95 ml （PMMA） respectively, and there were not statistically significant either （ P 〉 0.05 ）. Vertebroplasty with PMMA completely restored strength （116%） and stiffness （105%） of VBs. Augmented with CSC or CPC only partly recovered vertebral strength and stiffness. However, significantly greater strength restoration was got with CSC （1 659 N ） as compared with CPC （1011 N,P 〈 O. O1 ）. When considering the stiffness, differences between CSC （140 N/mm ± 40N/mm） and the other two bone cements （ CPC ： 148 N/mm ± 33N/ram, PMMA：236N/ mm ±97 N/mm） was not significant （P 〉0.05）. [ Conc

关 键 词：硫酸钙骨水泥 爆裂骨折 生物力学 椎体成形术 

分 类 号：R687.3[医药卫生—骨科学] R318.01[医药卫生—外科学]