髂骨钉垫片对腰-髂固定结构稳定性的生物力学影响  

BIOMECHANICAL EFFECTS OF ILIAC SCREW PLATES ON STABILITY OF LUMBO-ILIAC FIXATION CONSTRUCT

作　　者：王丽冰[1] 潘鹤海[1] 于滨生[1] 谢超凡[1] 许银峰[1] 郑召民[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》2013年第5期606-611,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金面上项目(31170902)~~

摘　　要：目的评价一种自主设计的髂骨钉垫片对腰-髂固定结构疲劳载荷前、后稳定性的影响。方法取自愿捐献的12具成人防腐尸体腰椎-骨盆标本,根据是否使用髂骨钉垫片随机分成A组(使用垫片)和B组(不使用垫片),每组6具。使用双能X线骨密度仪测定L1～4骨密度(bone mineral density,BMD)后,行双侧L3、L4、L5椎弓根钉和髂骨钉固定,并且切除L5、S1双侧关节突关节及椎间盘制作椎间失稳模型。在MTS材料试验机上,向标本施加0～600 N轴向压缩和—7～7 N.m轴向扭转载荷,测试固定结构初始压缩及扭转刚度。然后给标本施加2万次40～400 N循环压力载荷,重复刚度测试。最后,对所有螺钉进行轴向拔出测试,记录最大拔出力。植钉及加载过程中行大体及影像学观察。结果 A、B组BMD值分别为(1.15±0.13)g/cm2和(1.12±0.11)g/cm2,差异无统计学意义(t=0.428,P=0.678)。所有螺钉植入位置良好,加载过程中无钉棒松动及断裂。疲劳载荷后X线片示A、B组分别有1具(16.7%)和3具(50.0%)标本髂骨钉周围出现"骨透亮带"。A、B组疲劳载荷后压缩刚度和扭转刚度均低于疲劳载荷前(P<0.05)。疲劳载荷前,A、B组间压缩刚度和扭转刚度比较差异均无统计学意义(P>0.05);疲劳载荷后A组压缩刚度显著高于B组(t=2.664,P=0.024),而两组扭转刚度差异无统计学意义(t=0.410,P=0.690)。A、B组L3、L4、L5椎弓根钉的最大拔出力比较差异均无统计学意义(P>0.05);但A组的髂骨钉最大拔出力显著高于B组(t=3.398,P=0.007)。组内比较:A、B组L3椎弓根钉的最大拔出力均显著低于L4、L5椎弓根钉(P<0.05)。A组髂骨钉最大拔出力显著高于其他3个节段椎弓根钉(P<0.05);而B组髂骨钉拔出力显著低于L4、L5椎弓根钉(P<0.05)。结论在腰-髂重建中,髂骨钉垫片可以预防髂骨钉松动,有效保持固定结构的稳定性。Objective To evaluate the biomechanical effect of a self-made iliac screw plate on the stability oflumbo- iliac fixation construct before and after fatigue loading. Methods Twelve fresh lumbo-pelvic specimens from donated adult cadavers with formalin embalm were used in the study. According to whether use the iliac screw plate or not, the specimens were randomly assigned into group A （with iliac screw plate, n=6） and group B （without iliac screw plate, n=6）. The bone mineral density （BMD） of L1-4 was measured using dual-energy radiograph absorptiometry. The pedicle screw and lilac screw fixation were given at L3-5, and bilateral facetectomy and diskectomy at L5, S1 level were performed to prepare the model of the intervertebral destabilization. The biomechanical testing was conducted on a material testing machine under 0-600 N compression and -7-7 N-m torsion loading modes for the initial compressive stiffness and torsional stiffness evaluation. And then 20 000 cyclic compressive loading of 40-400 N was given to the specimen, the stiffness evaluation was repeated. Then the maximum pull-out strength of screws at every level was measured and compared. Gross observation and radiological observation were performed during experiment. Results The BMD values of groups A and B were （1.15 ± 0.13） g/cm2 and （1.12 ± 0.11） g/cm2 respectively, showing no significant difference between 2 groups （t=0.428, P=0.678）. All pedicle screws and iliac screws were inserted in good position; no loosening or breaking of screw was observed during loading. After fatigue loading, the incidence of halo ring around the iliac screws of groups A and B was 16.7% （1/6） and 50.0% （3/6）, respectively. The compressive stiffness and torsional stiffness after fatigue loading were significantly lower than those in initial state in groups A and B （P 〈 0.05）; there was no significant difference in compressive stiffness and torsional stiffness between groups A and B before fatigue loading （P 〉 0.05）. However, g

关 键 词：髂骨钉垫片 腰-髂重建 髂骨钉技术 内固定 生物力学 

分 类 号：R687.3[医药卫生—骨科学]