新型设计可灌注骨水泥椎弓根螺钉的生物力学特性  

Biological characteristics of a novel pourable pedicle bone cement

作　　者：马江卫[1] 刘烈东 杜耿[1] 高光明[1] 刘育[2] 

机构地区：[1]陕西省榆林市第一医院骨科,陕西省榆林市719000 [2]西安交通大学医学院西安市红会医院骨科,陕西省西安市710000

出　　处：《中国组织工程研究》2015年第34期5423-5427,共5页Chinese Journal of Tissue Engineering Research

基　　金：陕西省社会发展攻关计划项目(2014K13-04)~~

摘　　要：背景:老年性骨质疏松症患者由于骨质相对比较脆弱,使得椎弓根螺钉固定能力相对较差。当前,临床上使用骨水泥强化椎弓螺钉的方法能够提高螺钉固定能力,但是患者治疗时水泥渗漏以及螺钉取出困难成为其解决问题。目的:研制新型可灌注骨水泥椎弓根螺钉,探讨其生物力学特性和安全性及实用性,为临床骨质疏松脊柱疾病患者治疗提供依据。方法:选取南京中医大学附属医院2013年12月至2015年1月采集的6具73例完整湿润脊柱标本资料进行分析,标本中共有42个椎体。入选椎体在一侧椎弓根置入可灌注骨水泥椎弓根螺钉后采用骨水泥推杆和灌注筒在X射线辅助下向其内灌注2 mL骨水泥设为实验组,对侧椎弓根置入常规螺钉作为对照组,观察骨水泥弥散情况。结果与结论:骨水泥由稀糊状期进入团状初期的时间为三四分钟;糊状期骨水泥采用注射器抽取注入灌注筒中更为方便;灌注筒和螺钉尾部的螺纹连接方便、紧密,无渗漏;推杆可以提供足够的灌注力;骨水泥在中空和侧孔处弥散出螺钉,侧孔排列规律性强,且各侧孔间距相等;常规椎弓根螺钉极限强度、极限位移显著高于新型可灌注骨水泥椎弓根螺钉(P<0.05);常规椎弓根螺钉屈服载荷以及屈服位移显著低于新型可灌注骨水泥椎弓根螺钉(P<0.05);骨水泥在可灌注骨水泥螺钉周围弥散分布规则,骨水泥由4排侧孔向不同的方向弥散入周围骨松质,且与相邻骨水泥团融合;新型可灌注骨水泥螺钉轴向拔出力较对照组增加了114%(P<0.05);新型可灌注骨水泥螺钉最大旋出力矩,显著高于对照组(P<0.05)。结果证实,新型设计的可灌注骨水泥椎弓根螺钉,结合骨水泥推杆和灌注筒应用更加方便,能够有效控制骨水泥渗漏,提高椎弓根的稳定性且能在骨质疏松患者中广为使用。BACKGROUND： In senile osteoporosis patients, capacity of pedicle screw fixation is relatively poor due tO fragile bone substance. Currently, augmentation of pedicle screw fixation with bone cement can improve the ability of screw fixation, but bone cement leakage and difficulties in screw removal become the problem to be solved. OBJECTIVE： To develop a novel pourable pedicle bone cement and to investigate its biomechanical properties, safety and practicality, thus providing the basis for clinical treatment of osteoporosis and spinal diseases.METHODS： Six cases of complete wetting spines were collected at the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from December 2013 to January 20t 5, including 42 vertebrae. Pedicle screw fixation with X-ray assisted bone cement injection （2 mL） was performed unilaterally as experimental group, and conventional pedicle screw fixation was done contralaterally as control group. Bone cement dispersion was observed in the two groups. RESULTS AND CONCLUSION： It was 3-4 minutes for bone cement to agglomerate. Injection of bone cement paste into the infusion cylinder using a syringe was more convenient. The cylinder was connected tightly with the tail-end of the screw with no leakage. The push bar could provide sufficient perfusion force. Bone cement dispersion was found in the hollow part and side holes of the screw. Side holes arranged regularly, and the hole pitch was equal. Compared with the control group, the yield load and yield displacement were significantly higher in the experimental group （P 〈 0.05）, but the ultimate strength and ultimate displacement were significantly lower in the experimental group （P 〈 0.05）. Bone cement around the pourable cement screw dispersed regularly, which was diffused into the surround cancellous bone and integrated with adjacent bone cement mass. The axial withdrawal force was increased by 114% in the experimental group compared with the control group （P 〈 0.05）. The maximum rotary tor

关 键 词：组织工程 骨质疏松 生物力学 生物材料 骨生物材料 椎弓根螺钉内固定系统 生物力学特性 脊柱标本 安全性 实用性 骨水泥推杆 灌注筒 旋出力矩 抗屈实验 轴向拔出力 

分 类 号：R318[医药卫生—生物医学工程]