椎板回植椎管重建内固定术的生物力学研究  

A biomechanical study on lamina reimplantation fastened by different plates for canal reconstruction

作　　者：陈建民 刘国印[2] 贾小宝[2] 张勇[2] 曾达[3] 张二来 练仲华 蔡达威 赵建宁 

机构地区：[1]南京医科大学金陵临床医院 [2]南京中医药大学附属81医院 [3]厦门医疗器械研发检测中心有限公司 [4]faculty of Engineering and the Environment, University of Southampton, Southampton, United Kingdom

出　　处：《中国矫形外科杂志》2017年第24期2262-2268,共7页Orthopedic Journal of China

基　　金：南京市科技计划项目(编号:201503007);南京军区科技创新项目(编号:15ZD020)

摘　　要：[目的]比较椎板回植椎管重建术不同内固定方式的生物力学稳定性,为临床应用提供依据。[方法]采用3D打印技术打造正常人的L4椎体模型,对L4椎体模型实施全椎板切除术,根据椎板回植椎管重建内固定方式的不同分成H型椎板钢板组、L型钢板组和两孔钢板组。分别通过静态压缩试验和动态疲劳压缩试验对三组模型进行加载直至钢板失效、椎板钢板断裂或回植的椎板塌陷。静态压缩试验采用速度控制模式(5 mm/min),动态疲劳压缩试验采用载荷控制模式(加载的波形为正弦波,加载频率为5 Hz,载荷比为R=10,循环极限次数为5 000 000次)。[结果]静态压缩时,H型椎板钢板失效时均未出现椎板原位还纳或"关门"现象,而L型和两孔钢板均出现椎板关闭和"关门"现象;H型椎板钢板可承受的屈服载荷远大于L型和两孔钢板(P<0.01),而L型钢板与两孔钢板较为接近,差异无统计学意义(P>0.05);H型椎板钢板的屈服位移与L型钢板较为接近(P>0.05),却远小于两孔钢板(P<0.01);压缩刚度:H型椎板钢板>L型钢板>两孔钢板(P<0.01);H型椎板钢板与L型和两孔钢板比较,在相同的静态轴向载荷下位移明显减少(P<0.01)。动态压缩时,L型与两孔钢板的疲劳稳定性能和极限载荷相近(P>0.05),分别为H型椎板钢板的46.88%和46.59%(P<0.01)。[结论]H型椎板钢板的疲劳稳定性能和极限载荷及其在维持椎管扩大、腰椎的轴向稳定和压缩刚度方面要明显优于L型和两孔钢板,具有较好的临床应用前景。[Objective] To compare the biomechanical stability of different plates to fasten lamina reimplantation for canal reconstruction, and to provide the basis for clinical application. [Methods] Normal human models of the fourth lumbar vertebra were made using 3D printing. Reimplantation of the resected lamina after total laminectomy was conducted on the models, sub-sequently, the reimplanted lamina was fastened. In term of different lamina plates used for fastening, the samples were divided into the H-shaped plate group, L-shaped plate group, and two-hole plate group. Compression loads were ap- plied on the samples until failure of the plate or the collapse of the reimplanted lamina by the static compression test atspeed of 5 mm/min, and the dynamic compression test in sine wave of 5Hz with load ratio of 10 and limited of 5 000 000 cycles. [Results] At the failure point of static compression, no reimplanted lamina collapse in situ or shut down＂ phenomenon hap- pened in any sample of the H-shaped plate group, whereas those did occur in the L-shaped plate group and two-hole plate group. The yield strength in the H-shaped plate group was significantly greater than that in the L-shaped plate group and two- hole plate group （P〈0.01）, while this strength in the L-shaped plate group was relatively close to the two-hole plate group （P〉 0.05） . No significant difference in yield displacement was found between the H-shaped plate group and L-shaped plate group （P〉0.05）, while that in the 2 aforesaid groups were significantly less than the two-hole plate group （P〈0.01）. The compressive stiffness was graded in sequence of the H-shaped plate group 〉 the L-shaped plate group 〉 the two-hole plate group （P〈0.01）. Compared with the L-shaped plate group and the two-hole plate group, the H-shaped plate group has significantly decreased displacement under the same static axial load （P〈0.01）. At the dynamic test, the fatigue performance and extreme loading of the L-shaped plate group and the two-h

关 键 词：椎管重建术 椎板回植 椎板钢板 3D打印 生物力学 

分 类 号：R687.3[医药卫生—骨科学]