一期侧前路双钉棒固定腰骶段脊柱的生物力学研究  

Biomechanical study of lumbosacral spine fixation with double pedicle crew system by anterolateral approach in one stage

作　　者：杨寅[1,2] 贺西京[2] 曹军军[1] 张延平[1] 郭华[1] 王立省 刘俭涛 Yang Yin;He Xijing;Cao Junjun;Zhang Yanping;Guo Hua;Wang Lisheng;Liu Jiantao(The Second Department of Orthopedics,Xi＇an Central Hospital,Xi＇an 710004,China;Department of Orthopedics,Second Affiliated Hospital of Xi＇an Jiaotong University,Xi＇an 710003,Chin;Xi＇an First Aid Center,Xi＇an 710018,Chin;Department of Spineand,Spinal Cord Surgery,He＇nan Provincial People＇s Hospital,Zhengzhou 450003,China)

机构地区：[1]西安市中心医院骨二科,710004 [2]西安交通大学第二附属医院骨科,710003 [3]西安市急救中心,710018 [4]河南省人民医院脊柱脊髓外科,郑州450003

出　　处：《中华骨科杂志》2018年第22期1374-1383,共10页Chinese Journal of Orthopaedics

基　　金：陕西省重点研发计划项目（2017SF-287）

摘　　要：目的对一期侧前路病灶清除钛笼植骨融合联合双钉棒系统内固定在重建腰骶段脊柱稳定性的效果进行生物力学评价，为其在临床上的推广提供生物力学支持。方法于西安交通大学医学部解剖教研室获取腰骶段脊柱标本15具，通过CT扫描及骨密度检查剔除骨折、畸形及骨质疏松的标本，剩余标本随机分为生理组、前固定组与后固定组。对前固定组与后固定组中的所有标本行L5椎体及邻近椎间盘次全切除术，通过钛笼与双钉棒前路固定前固定组标本；单纯利用双钉棒后路固定后固定组标本；生理组标本不作处理。所有标本术后摄X线片，并行薄层CT扫描等影像学检查以判断假体植入位置是否合适，有无脊髓压迫等不良现象。对3组腰骶段脊柱标本进行屈伸、侧弯、轴向扭转以及轴向压缩等状态下的力学测试，以评估前路双钉棒系统联合钛笼在固定腰骶段脊柱的力学效果。结果所有腰骶段脊柱标本均无骨折、畸形、骨质疏松等疾患。术后影像学检查显示植入的假体位置均正常，未见椎弓根钉刺入椎管及脊髓压迫等不良现象。体外力学测试结果显示在屈伸、侧弯、轴向压缩及扭转方向上，生理组标本达到最大加载位移（5 mm）或转角（5°）时所需的载荷均明显小于前固定组与后固定组标本，差异均有统计学意义（F前屈=1335.989，P前屈=0.000；F背伸=166.688，P背伸=0.000；F左侧弯=258.872，P左侧弯=0.000；F右侧弯=335.766，P右侧弯=0.000；F轴向压缩=481.444，P轴向压缩=0.000；F左扭转=21.682，P左扭转=0.000；F右扭转=34.990，P右扭转=0.000）。前固定组标本在前屈、左右侧弯、轴向压缩方向上达到最大加载位移（5 mm）时所需的载荷明显大于与后固定组标本，差异均有统计学意义（P前屈=0.000；P左侧弯=0.006；P右侧弯=0.016；P轴向压缩=0.000），而在背伸方向上达到最大加�ObjectiveTo conduct the biomechanical evaluation of the effect of the new operative method, one stageanterior debridement and fusion combined withtitanium cage and dual screw-rod anterior instrumentation inter-fixation on the reconstruction of lumbosacral spine stability and provide biomechanical support for its further promotion in clinical practice.MethodsFifteen lumbosacral spine specimens were obtained from the department of anatomy, Xi＇an Jiaotong University Health Science Center. Fracture, deformity and osteoporosis were removed by CT and bone density examination. The remaining specimens were randomly divided into intact group, anterior fixation group and posterior fixation group. L5 vertebral body and adjacent intervertebraldisc subtotal resection were performed on all specimens in the anterior fixation group and the posterior fixation group. The specimens in the anterior fixation group were fixed through titanium cage and dual screw-rod from front approach and the specimens inthe posterior group were fixed by dual screw-rod from posterior approach. Specimens in the intact group were not treated. All specimens were examined by X-ray and thin-slice CT after surgery to determine whether implant placement was appropriate andwhether there was spinal cord compression or not. Three groups of lumbosacral spine specimens were subjected to mechanical testsunder the conditions of flexion and extension, lateral bending, axial torsion and axial compression to evaluate the mechanical effect of anterior dual screw-rod system combined with titanium cage on the fixation of lumbosacral spine.ResultsAll lumbosacralspine specimens were free of fractures, deformities, osteoporosis and other diseases. Postoperative imaging examination showed thatthe implant was in normal position and no adverse phenomena such as pedicle screw insertion into the spinal canal and spinalcord compression were observed. Mechanical test results in vitro showed that the load required for maximum loading displacement （5 mm） or rotation angle （

关 键 词：腰椎 骶椎 脊柱融合术 生物力学 

分 类 号：R687[医药卫生—骨科学]