经腋中线胸腔入路上胸椎侧方内固定与传统前方钢板内固定：生物力学稳定性的对照分析  

Comparative analysis on biomechanical stability of the lateral fixation of the upper thoracic vertebrae through the middle axillary approach and the traditional anterior plate fixation

作　　者：施冬冬 李晓峰[1] 熊货杰 胡峰[1] 赵劲民[2] 陈前芬[1] Shi Dongdong;Li Xiaofeng;Xiong Huojie;Hu Feng;Zhao Jinmin;Chen Qianfen(Department of Orthopedics,Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,Guangxi Zhuang Autonomous Region,China;Regenerative Medicine Research Center,Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学第二附属医院骨科,广西壮族自治区南宁市530007 [2]广西医科大学再生生物研究中心,广西壮族自治区南宁市530021

出　　处：《中国组织工程研究》2020年第15期2349-2354,共6页Chinese Journal of Tissue Engineering Research

基　　金：2017广西自然科学基金(面上项目)(2017GXNSFAA198300)，项目名称：经腋中线胸腔入路手术治疗T2-5椎体病损的解剖及生物力学研究，项目负责人：陈前芬~~

摘　　要：背景:随着脊柱内固定技术的全面推广,重塑脊柱力学稳定越来越引起人们的关注,经腋中线胸腔入路侧方内固定治疗上胸椎病损是一种新的手术入路,目前有关其固定后上胸椎生物力学的研究较为少见。目的:对比侧方和前方钢板内固定模型的上胸椎三维运动稳定性和负重载荷强度,评估经腋中线胸腔入路侧方钢板内固定重建上胸椎是否可以达到符合脊柱生物力学稳定。方法:从12具人尸体获取C7-T6脊柱并双侧肋椎关节标本,进行完整上胸椎模型三维运动稳定性测试,记录为完整椎体组。随后将标本随机分为2组,分别建立传统前方钢板内固定(前方内固定组)与经腋中线入胸腔路侧方钢板内固定模型(侧方内固定组),每组6例标本,先后进行三维运动实验、垂直加压实验与垂直加压破坏实验。实验通过广西医科大学第二附属医院伦理委员会批准,批准号:NO.伦审2017(KY-0080)号。结果与结论:①完整椎体组左/右侧屈、前屈/后伸、左/右旋转运动下的载荷均小于侧方内固定组、前方内固定组(P<0.01),前方内固定组左/右旋转运动下的载荷均小于侧方内固定组(P<0.05),前方内固定组左/右侧屈、前屈/后伸运动下的载荷与侧方内固定组比较差异无显著性意义(P>0.05);②当载荷到达600 N时,前方内固定组椎体下沉位移小于侧方内固定组[(1.39±0.20),(2.15±0.17)mm,P<0.01];③前方内固定组与侧方内固定组最大强度载荷比较差异无显著性意义[(1839.70±122.45),(1798.65±120.21)N,P=0.571];④结果表明,经腋中线胸腔入路侧方钢板内固定方式是稳定的,它能够满足脊柱重建生物力学需要。BACKGROUND:With the comprehensive promotion of spinal internal fixation technology,the remodeling of spinal mechanical stability has attracted more and more attention.Lateral internal fixation via axillary midline transthoracic approach for the treatment of upper thoracic vertebra lesion is a new surgical approach.Currently,the research on the biomechanics of upper thoracic vertebra after fixation is relatively rare.OBJECTIVE:To evaluate whether the reconstruction of upper thoracic vertebrae via axillary midline transthoracic approach can achieve the requirements of biomechanical stability by biomechanical analysis of three-dimensional motion stability and load-bearing strength of upper thoracic vertebrae in lateral and anterior internal fixation models.METHODS:The C7-T6 spine and bilateral rib cage joint specimens were obtained from 12 human cadaveric bodies,and the three-dimensional motion stability test of the complete upper thoracic vertebrae model was performed and recorded as a complete vertebral body group.Subsequently,the specimens were randomly divided into two groups,and the traditional front plate internal fixation(front internal fixation group)and the axillary line into the thoracic cavity side plate internal fixation models(lateral internal fixation group)were established,respectively,with six specimens in each group.Three-dimensional motion test,vertical pressure test and vertical pressure failure test were performed.This study was approved by the Ethics Committee of Second Affiliated Hospital of Guangxi Medical University(approval No.2017(KY-0080)).RESULTS AND CONCLUSION:(1)The load of left vertebral body group under left/right flexion,flexion/posterior extension and left/right rotational motion was smaller than that of lateral internal fixation group and anterior internal fixation group(P<0.01).The load in the front internal fixation group under left/right rotational motion was smaller than that in the lateral internal fixation group(P<0.05).There was no significant difference between the left/rig

关 键 词：上胸椎 腋中线胸腔入路 前路 植骨 内固定 三维运动 载荷 强度 生物力学 

分 类 号：R459.9[医药卫生—治疗学] R312[医药卫生—临床医学]