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作 者:王大鹏[1] 齐向北[1] 刘士昭[1] 李鸿翥 尹晓东[1]
机构地区:[1]河北医科大学第三医院骨科河北省骨科生物力学重点实验室,石家庄050051
出 处:《中华实验外科杂志》2017年第8期1374-1376,共3页Chinese Journal of Experimental Surgery
基 金:河北省自然科学基金(H2012206068);政府资助临床医学优秀人才培养项目基金
摘 要:目的 探讨防腐标本椎体成形术(PVP)后邻近椎体再骨折的原因.方法 选取防腐尸体4具,每具尸体取T9-L5椎体,每具胸腰椎标本分为T9-T11、T12-L2、L3-L5 3个脊柱节段(包括3个椎体,2个椎间盘).将12个脊柱节段,分为A、B两组,每组各有6个脊柱节段(T9-T11、T12-L2、L3-L5各两个).A组人为造成中间椎体骨折后行PVP;B组不做任何处理.A、B两组分别在生物力学机下行压缩力学实验.记录A、B两组脊柱节段的最大垂直载荷、刚度及邻近椎体再骨折的位置并进行比较与统计学分析.结果 A组与B组最大垂直载荷的差异有统计学意义(t=-2.267,P=0.047),注入骨水泥后,A组脊柱节段最大垂直载荷(3048±403)N比B组(3586±418)N低约15%;A、B两组刚度差异无统计学意义(t=-0.542,P=0.600).A组再发骨折的部位为T9、T12、L3椎体各两个,全部为上位邻近椎体.B组骨折的部位为T9、T10、T12、L1椎体各一个,L3椎体两个.结论 PVP后脊柱节段的最大垂直载荷下降,增加了邻近椎体(尤其是上位邻近椎体)发生再骨折的风险.Objective To study the causes of fractures in untreated adjacent vertebraes after vertebroplasty.Methods Twelve spinal segements (four T9-T10,four T12-L2,and four L3-L5) from four embalmed human cadavers were divided into groups A and B (n=6/group).In group A,experimental vertebral compression fractures were created at middle vertebraes (T10,L1,L4),and these middle vertebraes were augmented with polymethymethacryclate.Then all spinal segements were compressed until a new fracture occurred at any vertebrae,and the location of fractured vertebrae,maximum veritical load,and stiffness were investigated.Results There was statistically significant difference in the maximum vertical load between groups A and B (t=-2.267,P=0.047).The maximum veritical load in group A was,on average,15% lower than that in group B [(3 048±403),(3 586±418) N,respectively].There was no significant difference in stiffness between the two groups (t=-0.542,P=0.600).In the group A,new fractures following percutaneous verteoplasty (PVP) occurred at T9 in 2 specimens,T12 in 2,and L3 in 2.All new fractures occurred in the superior vertebrae in the group A.In the group B,the fractures occurred at T9 in 1 specimen,T10 in 1,T12 in 1,L1 in 1,and L3 in 2.Conclusion The failure strength of spinal segments can be decreased by vertebroplasty,which will increase the risk of adjacent vertebral body fracture,especially the superior vertebrae.
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