脊柱不同节段固定对骶部影响的生物力学研究  

Biomechanical study of the stress on sacral region in spinal fixation and fusion with different length of segments

作　　者：张玉坤[1] 谢江[1] 李磊[1] 任军[1] ZHANG Yukun;XIE Jiang;LI Lei;Ren Jun(Department of Spinal Surgery,6th Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,China)

机构地区：[1]新疆医科大学第六附属医院脊柱外科,乌鲁木齐830002

出　　处：《中华骨与关节外科杂志》2020年第9期719-722,共4页Chinese Journal of Bone and Joint Surgery

基　　金：新疆维吾尔自治区自然科学基金项目(2017D01C262)。

摘　　要：背景:内固定融合术治疗退行性腰椎侧凸取得了良好的矫形效果。目前对不同节段固定对腰骶部生物力学研究较少,尚缺乏可靠的数据支持。目的:研究退行性腰椎侧凸手术采用不同节段固定融合术对S1螺钉应力分布的影响,为手术方式的选择提供依据。方法:抽取6具新鲜成人尸体按照三种不同固定方式分成L5-S1单节段组、L3-S1长节段组、T10-S1长节段组,分别采取8 Nm力矩的六自由度力学研究对S1螺钉所受应力进行测定,并采取统计学方法进行比较。结果:①前屈及后伸加载位时,L3-S1和T10-S1长节段固定的S1螺钉拔出力、横向力、弯矩较L5-S1单节段固定显著增加(P<0.05)。②双侧屈加载位时,L3-S1和T10-S1长节段固定的S1螺钉横向力、弯矩较L5-S1单节段固定显著增加(P<0.05)。③左、右旋加载位时,L3-S1和T10-S1长节段固定的S1螺钉所受弯矩较L5-S1单节段固定显著增加(P<0.05)。结论:L3-S1和T10-S1长节段固定时,S1螺钉所受的应力较L5-S1单节段固定增加,故跨胸腰段固定融合可考虑行髂骨螺钉固定或S2螺钉固定,以减少远端骶骨螺钉应力。Background:The internal fixation and fusion has achieved good orthopedic effect in treatment of degenerative lumbar scoliosis.At present,there are few studies on lumbosacral biomechanics with different segmental fixation,and there is a lack of reliable data.Objective:To investigate the effect of segmental fixation with different spinal lengths on stress distribution of sacrum 1 screw,and to provide basis for lumbar degenerative surgery.Methods:Six fresh adult cadavers were selected and divided into L5-S1 group,L3-S1 group and T10-S1 group according to three different fixing methods.The stress of sacrum 1 screw was measured with 8 Nm torque and six degrees of freedom force respectively,and compared with statistical methods.Results:The pull-out force,lateral force and bending moment of the sacrum 1 screw increased significantly with the extension in the forward flexion and backward extension loading positions in the L3-S1 and T10-S1 groups compared with L5-S1 group;the transverse force and bending moment of sacrum 1 screw significantly increased in L3-S1 group and T10-S1 group compared with L5-S1 group in bilateral flexion loading position(P<0.05).The bending moment of sacrum 1 screw in the rotation loading position significantly increased in L3-S1 group and T10-S1 group compared with L5-S1 group(P<0.05).Conclusions:The stresses on S1 screw significantly increased when the fixation and fusion at segments L3-S1 and T10-S1,compared with that on segment L5-S1.Therefore,iliac screw fixation or sacral 2 screw fixation can be considered to reduce the stress of distal sacral screw after fixation and fusion across thoracic and lumbar segments.

关 键 词：胸腰椎 生物力学 长节段固定 

分 类 号：R687.3[医药卫生—骨科学]