椎弓根钉棒系统联合椎体支柱块治疗胸腰椎骨折的生物力学试验及临床应用  

Biomechanical experiments study on thoracolumbar fracture treated with vertebral pillar combined with posterior pedicle screw system and clinical application

作　　者：方钧[1] 郑季南[1] 杨培伟[1] 

机构地区：[1]解放军第180医院骨三科,福建泉州362000

出　　处：《颈腰痛杂志》2016年第3期176-181,共6页The Journal of Cervicodynia and Lumbodynia

基　　金：军区医药卫生科研基金(编号:12MA071)

摘　　要：目的探讨经椎体支柱块联合椎弓根钉棒系统治疗胸腰椎骨折的生物力学及临床应用效果。方法 (1)收集18具人胸腰段尸体标本(T_(11)-L_3),保留标本后方韧带复合体完整,采用目标椎体钻孔结合Panjabi等[1]提出的逐级撞击法制作L_1椎体骨折模型,用牙脱粉包埋T_(11)和L_3椎体,随机分三组并模拟三种手术方式;A组伤椎两侧置入支柱块+上下椎体4钉2棒系统;B组经伤椎6钉2棒系统;C组伤椎骨水泥置入+上下椎体4钉2棒系统;应用三维运动测试仪对标本进行前屈、后伸、侧弯及旋转6个方位运动范围的测试;(2)自2012年4月-2015年2月将胸腰椎骨折患者分为3组,A组,22例,椎弓根钉棒系统联合椎体支柱块固定;B组,34例,经伤椎椎弓根钉棒固定;C组,26例,球囊扩张椎体成形治疗。比较3组病例术前及术后1周、术后6个月伤椎椎体中部高度和脊柱Cobb角,按疼痛视觉模拟(VAS)评分法评价临床疗效。结果 (1)三种固定方式固定后的标本在屈伸、侧弯及旋转上的稳定性与对照组比较差异有统计学意义(P<0.05)。三组间比较差异无统计学意义(P>0.05);(2)A、B组在术后1周、6个月椎体中部高度的组间比较差异有统计学意义(P<0.05),VAS评分在术后1周比较差异有统计学意义(P<0.05)。A、C组在术后1周、6个月椎体中部高度和脊柱Cobb角组间比较差异有统计学意义(P<0.05),VAS评分在术后1周、术后6个月比较差异无统计学意义(P>0.05)。结论椎体支柱块联合钉棒系统治疗胸腰椎骨折具有力学稳定性好、早期缓解疼痛、适用范围广等特点,是一种安全有效的治疗方法。Objective To study the biomechanical stability of vertebral pillar combined with posterior pedicle screw system in the treatment of thoracolumbar burst fracture and discuss its clinical application Methods （1）18 thoracolumbar spine specimens （Tll-L3） were collected from cadavers and the posterior ligamentous complex were reserved. The L1 fracture models were manip- ulated by boring of aimed vertebra combine and according to Panjabi＇s method. TI1 and L3 were em- bedded in polyester resin. The specimens were randomly divided into three groups： group A, treat- ed with vertebral pillar combined with posterior pedicle screw system; group B, treated with the injured vertebra transpedicular fixation; group C,treated with balloon dilatation vertebroplasty com- bined with posterior pedicle screw system. The Rang Of Motion （ROM） of flexion-extension was measured by bilateral bending and anial rotation with machine; （2） All cases of the thoraeolumbar fracture patients were divided into 3 groups：A, 22 cases, treated with vertebral pillar combined with posterior pedicle screw system; B, 34 cases, treated with posterior pedicle screw system; C,26 cases, treated with balloon vertebroplasty. The central vertebral height of injured vertebra and Cobb angle in all the three groups were measured and compared in the time of pre-opera- tion, one week after post-operation, 6 months after post-operation. Clinical treatment effects were estimated according to the method of visual analogue scale （VAS） scores. Results （1） The stability of flexion-extension, bilateral bending and anial rotation in three groups exist sig- nificant statistical differences （P〈0.05） as compared to control group, and no significant differ- ences among three groups;（2） There＇s statistical differences （P〈0.05） in central vertebral height between group A and B in the time of post-operation one week and 6 months. VAS score exist statistical differences （P〈0.05） when compared after one week. There＇s statistical

关 键 词：胸腰椎骨折 椎体支柱块 椎弓根钉棒 生物力学 

分 类 号：R683.2[医药卫生—骨科学]