两种植骨法对胸腰椎爆裂骨折复位后骨缺损空隙残存率及压缩刚度的影响  

INFLUENCE OF TWO KINDS OF BONE GRAFTING METHODS ON BONE DEFECT GAP RESIDUAL RATES AND COMPRESSIVE STIFFNESS AFTER REDUCTION OF THORACOLUMBAR BURST FRACTURE

作　　者：敖俊[1] 辛志军[1] 陈方[1] 辛向军[2] 廖文波[1] 

机构地区：[1]遵义医学院附属医院脊柱外科,贵州遵义563003 [2]潍坊市中医院骨伤二科

出　　处：《中国修复重建外科杂志》2013年第8期974-979,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：贵州省科学技术基金课题资助项目(2010J2179);遵义医学院博士科研启动基金资助项目(201019)~~

摘　　要：目的研究胸腰椎爆裂骨折两种方法植骨后伤椎椎体的植骨量、骨缺损空隙残存率及生物力学稳定性。方法取18个4～6月龄新鲜小牛脊柱腰段(L1～5)离体标本,制备L3椎体爆裂骨折模型,模拟胸腰椎爆裂骨折行伤椎撑开复位、椎弓根螺钉内固定。将18个标本随机分为3组,每组6个,A组伤椎椎体内不植骨,B组行经双侧椎弓根伤椎椎体内植骨,C组行经单侧椎管伤椎椎体内植骨。记录B、C组植骨量;将3组标本行DR片及CT观察伤椎椎体骨缺损空隙大体情况;经CT扫描后采用数格子法计算伤椎椎体骨缺损空隙残存率;应用ElectreForce-3510高精度生物材料试验机测试标本压缩刚度。结果 B、C组植骨量分别为(4.58±0.66)g和(5.72±0.78)g,比较差异有统计学意义(t=2.707,P=0.022)。DR片及CT观察示:A组标本伤椎椎体内见较大骨缺损空隙;B组伤椎椎体的"蛋壳样"空隙内可见骨粒填充,多集中于伤椎椎体后半部,椎体前部填充不足;C组伤椎椎体内较多骨粒填充,分布均匀。A、B、C组标本骨缺损空隙残存率分别为52.0%±5.5%、39.7%±2.5%、19.5%±2.5%,C组显著低于A、B组,B组显著低于A组,差异均有统计学意义(P<0.05)。前屈压缩刚度C组显著高于A、B组(P<0.05),A、B组间比较差异无统计学意义(P>0.05);后伸压缩刚度C组显著高于A组(P<0.05),但A、B组间及B、C组间差异均无统计学意义(P>0.05);左侧弯及右侧弯压缩刚度3组间比较差异均无统计学意义(P>0.05)。结论胸腰椎爆裂骨折椎弓根钉棒系统固定结合经单侧椎管伤椎椎体内植骨较经双侧椎弓根伤椎椎体内植骨植入骨量更多,更充分,术后骨缺损空隙残存率更小,对恢复脊柱前屈-压缩刚度更好。Objective To investigate the amount of bone grafting,bone defect gap residual rates,and biomechanical stability of the injured vertebral body after reduction of thoracolumbar burst fractures,pedicle screw-rods fixation,and bone graft by bilateral pedicle or unilateral spinal canal. Methods Eighteen fresh lumbar spine（L1-5） specimens of calves（aged 4-6 months） were collected to establish the burst fracture model at L3 and divided into 3 groups randomly.After reduction and fixation with pedicle screws,no bone graft was given in group A（n=6）,and bone graft was performed by bilateral pedicles in group B（n=6） and by unilateral spinal canal in group C（n=6）.The amount of bone grafting in groups B and C was recorded.The general situation of bone defect gaps was observed by the DR films and CT scanning,and the defect gap residual rates of the injured vertebrae were calculated with counting of grids.The compression stiffness was measured by ElectreForce-3510 high precision biological material testing machines. Results The amount of bone grafting was（4.58 ± 0.66） g and（5.72 ± 0.78） g in groups B and C respectively,showing signficant difference（t=2.707,P=0.022）.DR films and CT scanning observation showed large bone defect gap was seen in injured vertebrae specimens of group A;however,the grafting bone grains was seen in the ＂eggshell＂ gap of the injured vertebral body,which were mainly located in the posterior part of the vertebral body,but insufficient filling of bone graft in the anterior part of the vertebral body in group B;better filling of the grafting bone grains was seen in injured vertebral body of group C,with uniform distribution.The bone defect gap residual rates were 52.0% ± 5.5%,39.7% ± 2.5%,and 19.5% ± 2.5% respectively in groups A,B,and C;group C was significantly lower than groups A and B（P 0.05）,and group B was significantly lower than group A（P 0.05）.Flexion compressive stiffness of group C was significantly higher than that of groups A and B（P 0.05）,but

关 键 词：胸腰椎爆裂骨折 植骨 生物力学 小牛 

分 类 号：R687.3[医药卫生—骨科学]