可动人工腰椎的研制及体外即刻固定的生物力学研究  

The movable artificial lumbar vertebralbody:development and biomechanical study

作　　者：刘俭涛 贺西京[2] 高延征[1] 王宏博 吕东波 余正红[1] 高坤[1] 杨寅[3] Liu Jiantao;He Xijing;Gao Yanzheng;Wang Hongbo;Lyu Dongbo;Yu Zhenghong;Gao Kun;Yang Yin(Department of Spine and Spinal Cord Surgery, Henan Provincial People's Hospital, Zhengzhou 450003, China;Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710003, China;Department of Orthopaedics, Xi'an Central Hospital, Xi'an 710004, China)

机构地区：[1]河南省人民医院脊柱脊髓外科,郑州450003 [2]西安交通大学第二附属医院骨科,710003 [3]西安市中心医院骨科,710004

出　　处：《中华骨科杂志》2019年第3期152-159,共8页Chinese Journal of Orthopaedics

基　　金：2016年河南省科技攻关项目(162102310018);河南省科技创新杰出人才项目(154200510027);陕西省重点研发计划项目(2017SF-287).

摘　　要：目的 探讨一种新型腰椎假体——可动人工腰椎的稳定性及活动度。方法 取15具成人新鲜腰椎标本,随机分为生理组、融合组、非融合组。应用计算机辅助软件采集L2椎体及邻近椎间盘的解剖参数,利用3D打印与机械加工技术个性化制作假体。融合组与非融合组行L2椎体及邻近椎间盘部分切除术后分别植入钛笼、钛板与可动人工腰椎,生理组标本不做处理。术后行影像学检查,判断假体位置及脊髓情况。对三组标本在前屈、背伸、左右侧弯及左右旋转方向上进行7.5 N·m载荷的生物力学测试,测量手术部位及邻近椎间盘的活动度。结果 个性化制作的假体由椎体部件、椎间盘部件、复合材料球三部分构成。术后影像学检查均未发现假体移位、脊髓压迫等情况。非融合组T12L1椎间隙在前屈、背伸、左侧弯、右侧弯状态下的ROM(分别为3.68°±0.86°、3.52°±0.86°、2.64°±0.93°、2.58°±0.76°)与生理组(分别为3.98°±0.90°、3.74°±0.91°、2.94°±1.10°、2.96°±0.86°)比较差异无统计学意义;融合组ROM(分别为5.28°±0.83°、5.32°±0.42°、4.72°±1.10°、4.94°±1.17°)较生理组与非融合组增大。非融合组L1,2与L2,3椎间隙在前屈、背伸、左侧弯、右侧弯状态下的活动度(L1,2分别为4.62°±0.51°、4.34°±0.67°、3.16°±0.55°、3.28°±0.41°,L2,3分别为4.54°±0.58°、4.36°±0.65°、3.26°±0.21°、3.42°±0.37°)与生理组(L1,2分别为4.10°±0.53°、3.72°±0.42°、2.74°±0.50°、3.04°±0.40°,L2,3分别为4.26°±0.72°、4.08°±0.77°、3.00°±0.36°、3.20°±0.31°)比较差异无统计学意义,两组均大于融合组(L1,2分别为1.10°±0.35°、1.28°±0.31°、0.84°±0.34°、0.80°±0.43°,L2,3分别为1.14°±0.30°、1.18°±0.28°、0.94°±0.36°、1.06±0.32°)。生理组T12~L3全节段左、右旋转活动度分别为4.47°±0.99°、4.40°±0.70°,非融合组分别为4.60°±0.90°、4.50°±0.77°,融Objective To develop a new type of lumbar prosthesis, movable artificial lumbar vertebral body (MALV) and evaluate the stability and activity of the prosthesis by in vitro biomechanical test. Methods Fifteen adult fresh lumbar spine specimens were randomly divided into three groups: intact group, fusion group and non-fusion group. The anatomical parameters of L2 vertebral body and adjacent intervertebral discs were collected by software (Mimics 16.0, Materialise Company, USA) and the new prosthesis was personalized by 3D printing and mechanical processing. All specimens in fusion group and in non-fusion group were implanted with titanium cage, titanium plate and MALV respectively after partial resection of L2 vertebra and adjacent intervertebral disc. No other intervention was conducted on physiological specimens. All specimens were examined by imaging to determine the position of the prosthesis and the condition of the spinal cord. Specimens in all groups were subjected to a 7.5 N·m load biomechanical test in flexion, extension, left and right lateral bending, left and right rotation aiming to evaluate the mobility of operative site and adjacent discs. Results The new prosthesis consists of three parts, vertebral body, intervertebral disc and composite material ball. All 15 cadavers were free of spinal deformity, fracture and osteoporosis. Postoperative radiographic examination indicated no prosthesis displacement and spinal compression without adverse phenomena. The results in vitro mechanical test were as followed. There was no statistical difference in ROM of the T12L1 intervertebral in non-fusion group (3.68°±0.86°, 3.52°±0.86°, 2.64°±0.93°, 2.58°±0.76° respectively) and in intact group (3.98°±0.90°, 3.74°±0.91°, 2.94°±1.10°, 2.96°±0.86° respectively) in flexion, extension, left and right lateral bending (P>0.05). The ROM of the T12L1 intervertebral in fusion group (5.28°±0.83°, 5.32°±0.42°, 4.72°±1.10°, 4.94°±1.17° respectively) was significantly larger than that in inta

关 键 词：腰椎 假体设计 生物力学 活动范围 关节 

分 类 号：R687[医药卫生—骨科学]