后路椎体次全切除和钛网加钉棒重建术的生物力学研究  

Study on the biomechanics of posterior subtotal corpectomy,titanium mesh support with pedicle screw internal fixation

作　　者：林慰光[1] 胡奕山[1] 郑干轩[1] 林本丹[1] 赵卫东[2] 

机构地区：[1]广东省汕头市中心医院外七科,515031 [2]南方医科大学解剖教研室,广州510515

出　　处：《广东医学》2012年第19期2878-2880,共3页Guangdong Medical Journal

基　　金：广东省医学科研基金立项项目(编号:B2011299)

摘　　要：目的通过比较正常状态、前路单钛网支撑+钉棒内固定、后路椎管减压、单钛网和双钛网加椎弓根钉内固定术式的稳定性,分析各术式之间的生物力学差异。方法选用6具成年家猪T11～L3脊柱标本,建立L1椎体次全切除模型,进行3种不同的重建术:术1:经前路单钛网支撑+钉棒内固定术;术2:经后路椎管270°减压+单钛网+椎弓根钉内固定术;术3:经后路椎管360°减压+双钛网+椎弓根钉内固定术。采用非损伤性加载对每个标本的完整状态以及3种重建方式下的固定状态的稳定性进行测试。结果采用术2、术3重建后,在4.0Nm载荷下T12～L2各运动方向的运动范围均较完整标本小(P<0.05),在后伸运动中,术3的运动范围小于术1,差异有统计学意义(P<0.05),其他运动中,3种重建方式之间差异无统计学意义(P>0.05)。结论对比正常状态及前路钛网支撑+钉棒内固定术,后路椎管减压+单钛网+椎弓根钉内固定术和后路椎管减压+双钛网+椎弓根钉内固定术均能重建脊柱的即刻稳定性;在后伸运动中,后路双钛网术式的脊柱即刻稳定性优于前路术式。Objective To investigate the biomechanics of subtotal corpectomy with different internal fixations in pigs.Methods Fresh T11-L3 spine specimens were adopted from 6 adult pigs.L1 subtotal corpectomy model was established and three reconstruction operations were performed：（1） Operation 1： anterior approach with single titanium mesh＋screw plate internal fixation;（2） Operation 2： posterior approach with 270° decompression of spinal canal＋single titanium mesh＋pedicle screw internal fixation;（3） Operation 3： posterior approach with 360° decompression of spinal canal＋double titanium meshes＋pedicle screw internal fixation.Non-invasive loading test was adopted for assessment of the stability of integration condition and fixation condition under three reconstruction methods.Results The range of motions（ROM） of T12~L2 in each direction was significantly reduced in reconstruction with Operation 2 or 3 than intact state（P0.05）.In extension motion,the ROM in Operation 3 was significantly less than that in Operation 1（P0.05）,whereas in other the other directions,there was no significant difference in ROM among three reconstruction methods（P0.05）.Conclusion All the three reconstruction systems provide rigid stability in subtotal corpectomy,in which the posterior approach with 360° decompression of spinal canal＋double titanium meshes＋pedicle screw internal fixation provides more convenient stability than anterior surgery.

关 键 词：椎体次全切除 钛网 椎弓根钉 生物力学 

分 类 号：R683.2[医药卫生—骨科学]