模拟猪颈椎C5/6椎间盘摘除椎弓根螺钉后路固定联合不同融合器融合的即刻应力应变分析  

Immediate stress and strain analysis of posterior pedicle screw fixation combined with different fusion cages in C5/6 discectomy of simulated pig cervical vertebrae

作　　者：冯涛[1] 张宏[1] 任虎[1] 李熙明[1] 潘铄[1] 王晓静[1] 于大海[1] Feng Tao;Zhang Hong;Ren Hu;Li Ximing;Pan Shuo;Wang Xiaojing;Yu Dahai(First Ward,Department of Orthopedics,Shijiazhuang First Hospital,Shijiazhuang 050000,Hebei Province,China)

机构地区：[1]石家庄市第一医院骨科一病区

出　　处：《中国组织工程研究》2020年第12期1810-1816,共7页Chinese Journal of Tissue Engineering Research

基　　金：石家庄市科学技术研究与发展计划项目(161460703)，项目负责人：冯涛~~

摘　　要：背景:后路减压椎弓根螺钉固定结合椎间植骨融合是治疗颈椎间盘突出的重要方法,模拟C5/6椎间盘摘除椎弓根螺钉后路固定椎间融合即刻的应变电测量鲜有报道。目的:对比分析颈椎C5/6椎间盘摘除、椎弓根螺钉后路固定联合不同融合器椎间融合即刻产生的应力及应变。方法:18个猪颈椎标本按随机数字表法分为3组,分别为骨笼融合组、PEEK融合组及钛网融合组(n=6)。各组均模拟C5/6椎间盘摘除、椎弓根螺钉后路固定,之后分别应用不同融合器进行椎间融合。融合前、后分别在椎弓根螺钉固定部位椎体下方、融合器融合部位椎体边缘、相邻椎体边缘粘贴电阻应变片,以静态电阻应变仪测量各组标本在压缩状态下各测点的应变值,由应力公式计算出各组颈椎标本椎弓根螺钉后路固定融合器融合前、后各测点的应力值。结果与结论:①在相同载荷作用下,融合后钛网融合组各测点的应变和应力均小于骨笼融合组和PEEK融合组,差异有显著性意义(P<0.05);②在相同载荷作用下,融合后骨笼融合组各测点的应变和应力均大于PEEK融合组,差异有显著性意义(P<0.05);③提示体外模拟C5/6椎间盘摘除、椎弓根螺钉后路固定,置入不同的融合器后应力、应变均发生了变化,因此选择合适的椎间融合器可降低应力集中对邻近节段产生的影响。BACKGROUND:Posterior decompression and pedicle screw fixation combined with interbody fusion is a method for the treatment of cervical vertebral degenerative lesions.There are few reports on the measurement of strain electricity in simulating C5/6 intervertebral disc fusion after pedicle screw removal.OBJECTIVE:To analyze stress and strain immediately after C5/6discectomy,pedicle screw fixation combined with interbody fusion.METHODS:Eighteen fresh pig cervical specimens were randomly divided into three groups:bone cage fusion group,PEEK fusion group,and titanium mesh fusion group(n=6).Each group simulated C5/6 discectomy and pedicle screw fixation,and then different fusion cages were used for interbody fusion.Before and after fusion,the resistance strain gauges were attached under the vertebral body at the position of pedicle screw fixation,at the edge of vertebral body at the fusion position of fusion cage,at the edge of adjacent vertebral body.The strain values of each sample were measured under the compression state by static resistance strain gauge.The stress values at each measurement point before and after fusion in posterior fixation with pedicle screws for cervical vertebrae in each group were calculated by material mechanics formula.RESULTS AND CONCLUSION:(1)Under the same load,the strain and stress of each measurement point in the titanium mesh fusion group were smaller than those in the bone cage fusion group and the PEEK fusion group,and the difference was significant(P<0.05).(2)Under the same load,the strain and stress of each test point in the bone cage fusion group were larger than those in the PEEK fusion group,and the difference was significant(P<0.05).(3)These results confirm that simulated C5 discectomy in vitro,posterior pedicle screw fixation and implantation of different fusion cages have different changes of stress and strain.The selection of appropriate interbody fusion cage can reduce the effect of stress concentration on adjacent segments.

关 键 词：椎间盘摘除 椎弓根螺钉 后路固定 钛网 骨笼 PEEK 椎间融合 应变电测量 应力分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]