RTS自旋转撑开脊柱微创内固定系统的生物力学研究及临床疗效评价  

Biomechanic evaluation and clinical efficacy of RTS minimally invasive spine system

作　　者：赵泉来[1] 徐宏光[1] 沈祥[1] 王弘[1] 刘平[1] 王凌挺[1] 杨晓明[1] 陈学武[1] 张玙[1] 李逸峰[1] 俞宏星[1] 

机构地区：[1]皖南医学院第一附属医院弋矶山医院脊柱外科,安徽芜湖241001

出　　处：《中国骨与关节外科》2015年第6期472-477,481,共7页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金(项目编号:81272048);安徽省自然科学基金(项目编号:1308085MHl52)

摘　　要：背景:经皮万向钉椎弓根固定技术已应用于胸腰椎的微创手术治疗,但是万向钉不能随着棒的形状的改变与连接棒保持正交效应,缺少撑开装置,且存在微动效应,导致术后撑开、复位、矫正度的丢失。目的:评价RTS自旋转撑开脊柱微创内固定系统治疗胸腰椎骨折的生物力学稳定性和临床疗效。方法:取5具同种新鲜小牛的胸腰椎,制作前中柱损伤的骨折模型。另选择50例胸腰椎骨折的患者,分为RTS组(27例)和开放手术(23例),比较两组手术切口、手术时间、出血量以及后凸畸形矫正率。结果:后伸实验、扭转实验中骨折内固定组的位移与正常对照组相比,差异有统计学意义,而轴向压力、前屈实验中骨折内固定组的位移与正常对照组相比,差异无统计学意义。拔出实验中短螺钉(6.5 mm×30 mm)的最大轴向拔出力明显小于长螺钉(6.5 mm×50 mm),短螺钉的最大轴向拔出力为长螺钉的58.4%。RTS组和开放手术组切口长度、手术时间、术中出血量、术后引流、术后VAS评分比较,差异均有统计学意义(P<0.05)。各自组内手术前后Cobb角、伤椎前缘高度占正常椎体高度的百分比、VAS评分均有统计学差异(P<0.01),而伤椎后缘高度占正常椎体高度的百分比无统计学差异(P>0.05)。结论:采用新型RTS自旋转撑开脊柱微创内固定系统治疗胸腰椎骨折,能有效恢复椎体高度,纠正后凸畸形,明显缓解患者疼痛,有利于脊柱功能的恢复,创伤小,在临床上可推广应用。Background：Currently universal percutaneous pedicle screw fixation has been applied in thoracic and lumbar minimally in-vasive surgery. However, the screw cannot keep orthogonal effect with the change of the shape of connecting rod, and it lacks of distraction devices and will be fretting sometimes, which may lead to postoperative distraction, reset, loss of correc-tion. Objective：To assess the biomechanics and clinical efficacy of RTS minimally invasive spine system for thoracolumbar frac-ture. Methods：Mid-column thoracolumbar fracture was made in 5 fresh calves. Meanwhile, 52 patients with thoracolumbar frac-ture were enrolled in this study and divided into 2 groups：RTS group （n=27） and open surgery group （n=23）. Surgical inci-sion, operation time, blood loss and deformity correction were recorded and compared between two groups. Results：There were no significant differences in the slip distances of extension experiment or torsion experiment between internal fixation group and control group. However, there were no significant differences in the slip distances of axial com-pression experiment or flexion experiment between these two groups. The maximum axial pull output of short screw （6.5 mm±30 mm） was 58.4%of long screw （6.5 mm±50 mm）. There were significant differences in the incision size, operation duration, intraoperative blood loss, postoperative draining and postoperative VAS score between the RTS group and open surgery group （P〈0.01）. Postoperative Cobb angle, anterior height of fracture vertebral body and VAS score had statistical significance compared with preoperative ones in both groups （P〈0.01）. the pain and recover the spinal function. With its minor surgical trauma, the RTS minimally invasive spine system can be used in clinic further.

关 键 词：胸腰椎骨折 微创手术 骨折固定 内固定器 

分 类 号：R687.3[医药卫生—骨科学]