钉道强化对颈椎前路椎间融合术式稳定性影响的生物力学研究  

BIOMECHANICAL STUDY ON EFFECT OF POLYMETHYLMETHACRYLATE AUGMENTATION ON CERVICAL STABILITY AFTER ANTERIOR CERVICAL INTERBODY FUSION

作　　者：陈春[1] 赵卫东[1] 孙培栋[1] 吴长福[1] 瞿东滨[2] 欧阳钧[1] 

机构地区：[1]南方医科大学人体解剖学教研室广东省医学生物力学重点实验室,广州510515 [2]南方医科大学附属南方医院脊柱外科

出　　处：《中国修复重建外科杂志》2010年第10期1174-1179,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：卫生部重大社会公益项目(200802017)~~

摘　　要：目的评价聚甲基丙烯酸甲酯(polymethylmethacrylate,PMMA)骨水泥对颈椎骨螺钉的强化作用,分析钉道强化前后、疲劳前后不同状态下颈椎前路椎间融合术(anterior cervical interbody fusion,ACIF)术后颈椎的稳定性。方法在12个猪颈椎(C3～7)标本上,利用Motion Analysis运动捕捉分析系统和MTS-858液压伺服材料试验机按以下分组顺序测试屈伸、左右侧弯、左右旋转6个方向的运动角位移参数,包括运动范围(range of motion,ROM)、中性区(neutral zone,NZ)和弹性区(elastic zone,EZ)。正常对照组(A组)为完整状态;钢板固定组(B组)行C4、5椎间盘切除植骨前路钢板固定术;钢板固定疲劳组(C组)对B组标本行屈伸、左右侧弯疲劳实验,各加载5000次;钉道强化钢板固定组(D组)对C组注入PMMA实施钉道强化;钉道强化钢板固定疲劳组(E组)对D组标本行屈伸、左右侧弯疲劳实验。结果 A组各运动方向ROM、NZ、EZ与其他各组比较差异均有统计学意义(P<0.05)。B组各运动方向ROM、NZ、EZ明显低于C组(P<0.05);但与D组比较差异均无统计学意义(P>0.05);其屈伸ROM、NZ及前屈EZ均明显低于E组(P<0.05),其他运动方向各指标与E组比较差异均无统计学意义(P>0.05)。C组各运动方向ROM、NZ、EZ均明显高于D、E组(P<0.05)。D组与E组比较,除屈伸、左右侧弯ROM和NZ,左右旋转ROM,及屈伸、右侧弯、左右旋转EZ明显低于E组(P<0.05)外,其他运动方向各指标与E组比较差异均无统计学意义(P>0.05)。结论 PMMA骨水泥强化钉道能明显增强ACIF内固定术式的稳定性,这为临床实施颈椎前路钢板螺钉内固定术提供生物力学依据。Objective To evaluate the effect of polymethylmethacrylate （PMMA） augmentation on cervical stability after anterior cervical interbody fusion （ACIF） before and after fatigue. Methods Twelve porcine cervical spines （C37） were subjected to testing angular displacement parameters, including the range of motion （ROM）, neutral zone （NZ）, and elastic zone （EZ）, in nondestructive flexion and extension, right/left lateral bending, and left/right rotation on Motion Analysis motion capture system and MTS-858 servo-hydraulic testing machine. Intact cervical spines served as control group （group A）; onelevel discectomy and fusion was performed with anterior plate fixation based on group A as group B; flexion and extension, left/right lateral bending （5 000 cycles） fatigue testing based on group B as group C; the augmentation screw channel was used based on group C as group D; and flexion and extension, left/right lateral bending fatigue testing were performed based on group D as group E. Results The ROM, NZ, and EZ in group A were significantly different from those in other groups （P 〈 0.05） at flexion/extension, left/right bending, and left/right rotation. The ROM, NZ, and EZ in group B were significantly smaller than those in group C （P 〈 0.05） in flexion/extension, left/right bending, and left/right rotation, but there was no significant difference when compared with group D （P 〉 0.05）. The ROM and NZ in flexion/extension and the EZ in flexion in group B were significant smaller than those in group E （P 〈 0.05）, but there was no significant difference in the other indexes （P 〉 0.05）. The ROM, NZ, and EZ in group C in flexion and extension, left/right lateral bending, and left/right rotation were significantly higher than those in groups D and E （P 〈 0.05）. The ROM and NZ in flexion and extension and left/right lateral bending, and the ROM in left/right rotation, and the EZ in flexion and extension, right bending, and left/right rotation in group D were si

关 键 词：骨水泥强化 颈椎前路椎间融合术 疲劳载荷 生物力学 

分 类 号：R687.3[医药卫生—骨科学]