前路单节段内固定治疗不同爆裂程度Denis B型胸腰椎骨折的生物力学研究  

Anterior single segment interbody fixation in treatment of Denis B type thoracolumbar fracture with different burst degrees：a biomechanical study

作　　者：喻振兴[1] 丁真奇[1] 康两期[1] 沙漠[1] 梁勃威[1] 王江泽[1] 

机构地区：[1]漳州市医院骨科,福建漳州363000

出　　处：《中华生物医学工程杂志》2017年第2期100-105,共6页Chinese Journal of Biomedical Engineering

摘　　要：目的 探讨前路单节段融合固定治疗不同爆裂程度Denis B型骨折的脊椎生物力学稳定性,为临床扩大前路单节段固定治疗Denis B型骨折范围提供生物力学依据.方法 收集6具新鲜成人尸体脊柱标本（T11-L3）,采用椎体切除法建立L1 Denis B型不同爆裂程度骨折模型,根据损伤程度分为4组（n=6）,依次为A组（正常组）：无骨折;B组（轻度组）：椎体爆裂程度〈1/2单节固定;C组（中度组）：椎体爆裂程度〉1/2单节固定;D组（重度组）：椎体完全爆裂双节段固定,通过脊柱三维运动机加载8.0 Nm扭矩,依次测定各组屈伸、侧弯及旋转方向运动范围（ROM）.结果 C组屈伸、侧弯及旋转ROM与B组比较有一定程度升高,但差异无统计学意义（P〉0.05）;B、C组屈伸、侧弯及旋转ROM与A组相比差异有统计学意义（P〈0.05）,与D组相比旋转ROM值降低,下降范围约59%~81%,P〈0.05,而屈伸、侧弯ROM差异无统计学意义（P〉0.05）.结论 前路单节段内固定能为椎体爆裂程度〉1/2胸腰椎Denis B型骨折提供有效的初始生物力学稳定性,其屈伸、侧弯及旋转稳定性与爆裂程度有一定的正相关性;临床上对椎体爆裂程度〉1/2胸腰椎Denis B型骨折在能容纳螺钉的情况下,可考虑采用前路单节段固定.Objective To investigate the biomechanical stability of anterior single segment interbody fixation in the treatment of Denis B type thoracolumbar fracture with different burst degrees,and to provide a biomechanical basis for the wide-spread clinical use of single-segment interbody fixation for the treatment of Denis type B fracture. Methods Six fresh human cadaver spine specimens （T11-L3） were included. The fracture models of L1 Denis B type with different burst degrees was established by corpectomy. According to the degrees of injury,the models were divided into 4 groups（n=6 each）,followed by group A （normal group）：no fracture;group B（mild group）：vertebral burst degree 〈1/2 single segment fixation;group C（medium group）：vertebral burst degree〉1/2 single segment fixation;and group D（severe group）：completely broken vertebral body with double segment fixation. The flexion and extension,right/left lateral bending and axial rotation range of motion（ROM）were determined by the three-dimensional spinal motion measuring instrument loading with 8.0 Nm torque. Results The flexion and extension,right/left lateral bending and axial rotation ROM somehow increased in group C compared with those in group B,and there were no statistically significant differences （P〉0.05）. The flexion and extension,right/left lateral bending and axial rotation ROM in groups B and C were statistically significant different compared with those in group A（P〈0.05）. Compared with group D,the axial rotation ROM value decreased by 59%~81%,P〈0.05,but there was no statistically significant difference between flexion and extension and right/left lateral bending ROM（P〉0.05）. Conclusion The anterior single segment interbody fixation may provide effective initial biomechanical stability for vertebral burst degree〉1/2 in Denis B type thoracolumbar fracture. Its stability of flexion and extension,right/left lateral bending and axial rotation ROM is positively correlated with the degrees of burst. When

关 键 词：脊柱骨折 胸椎 腰椎 前路减压 脊柱生物力学 

分 类 号：R687.3[医药卫生—骨科学]