骶骨切除范围对髂骨钉重建腰-髂固定结构稳定性的生物力学影响  被引量:3

BIOMECHANICAL EFFECTS OF SACRECTOMY EXTENTS ON STABILITY OF LUMBO-ILIAC FIXATION USING ILIAC SCREW TECHNIQUES

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作  者:庄新明[1] 于滨生[1] 李泽民[1] 郑召民[1] 梁春祥[1] 李浩淼[1] 韩国伟[1] 

机构地区:[1]中山大学附属第一医院脊柱外科骨科研究所,广州510700

出  处:《中国修复重建外科杂志》2010年第4期430-434,共5页Chinese Journal of Reparative and Reconstructive Surgery

基  金:广东省科技计划项目(2008B050100012);广东省卫生厅科研项目(A2008161)~~

摘  要:目的评价骶骨切除范围对使用髂骨钉技术的腰-髂固定结构稳定性的生物力学影响,以明确髂骨双钉技术的使用时机。方法取自愿捐献的9具成年新鲜尸体L2至骨盆标本用于实验。首先行L3~5椎弓根钉固定,并将此结构定义为腰-髂部的完整状态(完整状态组)。完整状态测试后,在同一标本上行阶段性骶骨部分切除并联合L3~髂骨钉棒系统固定如下,A组:S1以下切除加双侧髂骨单钉的腰-髂固定(以下称Single);B组:1/2S1以下切除加Single;C组:单侧骶髂关节切除加Single;D组:骶骨完全切除加Single;E组:骶骨完全切除加双侧髂骨双钉的腰-髂固定。在MTS材料测试机上,给标本分别施加0~800N轴向压缩和-7~7N?m轴向扭转载荷,计算并比较各组的结构压缩和扭转刚度。结果完整状态组的压缩刚度值为(392±119)N/mm,A~E组L3~髂骨重建结构的压缩刚度分别是完整状态组的106.4%±9.5%、102.7%±8.0%、92.2%±10.1%、72.7%±8.0%和107.7%±10.7%。A、B、C组及完整状态组4组间比较差异无统计学意义(P>0.05),4组的压缩刚度显著高于D组(P<0.05);E组与A、B组和完整状态组比较差异无统计学意义(P>0.05),但显著高于C、D组(P<0.05)。完整状态组的扭转刚度值为(3.22±1.23)N·m/deg,A~E组重建结构的扭转刚度分别是完整状态组的105.4%±10.1%、89.8%±12.3%、75.9%±10.6%、71.2%±10.2%和109.1%±16.9%。A、B、E组与完整状态组比较差异无统计学意义(P>0.05),C、D组的扭转刚度显著低于A、E组和完整状态组(P<0.05),E组的扭转刚度显著高于B组(P<0.05)。结论1/2S1以下切除后,使用髂骨单钉技术可有效恢复局部稳定性;进一步切除单侧骶髂关节或全部骶骨时,髂骨单钉技术难以恢复局部初始稳定性。在骶骨肿瘤手术治疗中,对于骶骨全切或单侧骶髂关节切除所致的失稳,应采用髂骨双钉固定。Objective To evaluate the effects of sacrectomy extent on the stability of lumbo-iliac fixation using single or dual iliac screw technique,and to determine which conditions require the dual iliac screw technique.Methods Nine fresh L2 to pelvic specimens were harvested from donated adult cadavers.After testing the intact state simulated by L3-5 pedicle screw fixation,sequential partial sacrectomies and L3 to iliac fixation using bilateral single iliac screw(Single)were conducted on the same specimen as follows:in group A,under S1 partial sacrectomy and Single;in group B,under 1/2 S1 partial sacrectomy and Single;in group C,one-side(left)sacroiliac joint resection and Single;in group D,total sacrectomy and Single;and in group E,the single iliac screw was replaced by dual iliac screws based on group D.Biomechanical testing was performed on a material testing machine under 0-800 N compression and—7-7 N?m torsion loading modes for construct stiffness evaluation.Results The compressive stiffness of intact condition was(392±119)N/mm,groups A,B,C,D,and E obtained 106.4%±9.5%,102.7%±8.0%,92.2%±10.1%,72.7%±8.0%,and 107.7%±10.7%of intact condition,respectively.No significant differences were found among groups A,B,C,and the intact state(P0.05),however,the four groups showed significantly higher compressive stiffness than group D(P0.05).Although group E exhibited a comparable compressive stiffness with groups A,B,and intact state(P0.05),it displayed markedly higher compressive stiffness than groups C and D (P0.05).The torsional stiffness of intact state was(3.22±1.23)N?m/deg.Groups A,B,C,D,and E acquired 105.4%±10.1%,89.8%±12.3%,75.9%±10.6%,71.2%±10.2%,and 109.1%±16.9%of intact state,respectively.No significant differences were detected among groups A,B,E,and the intact state(P0.05).However,groups C and D showed remarkably lower torsional stiffness than groups A,E,and the intact state(P0.05).Importantly,group E offered remarkably higher torsional stiffness than grou

关 键 词:骶骨肿瘤 骶骨切除 髂骨钉 腰-髂固定 生物力学 

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

 

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