后路长节段固定不同置钉密度下脊柱三维运动的稳定性  

Stability of three-dimensional motion of spine with long-segment posterior fixation at different screw densities

作　　者：薛静波[1] 李昃鹏 王程[1] 欧阳智华[1] 李学林[1] 晏怡果[1] 王文军[1] Xue jingbo;Li Zepeng;Wang Cheng;Ouyang Zhihua;Li Xuelin;Yan Yiguo;Wang Wenjun(Department of Spine Surgery,The First Affiliated Hospital of University of South China,Hengyang 421001,Hunan Province,China)

机构地区：[1]南华大学附属第一医院脊柱外科,湖南省衡阳市421001

出　　处：《中国组织工程研究》2021年第12期1858-1863,共6页Chinese Journal of Tissue Engineering Research

基　　金：湖南省临床医疗技术创新引导项目(2017SK50202),项目负责人:薛静波;湖南省卫生计生委B类课题(20180154),项目负责人:薛静波;湖南省卫生计生委科研计划课题重点项目(A2017016),项目负责人:晏怡果;湖南省科技厅计划项目(2017SK4004),项目负责人:王文军。

摘　　要：背景:脊柱后路矫形椎弓根螺钉内固定已成为青少年特发性脊柱侧凸最为常见的临床治疗方法,但使用高密度的置钉方式会对患者造成更大的创伤且增加医疗成本。目的:利用六自由度关节机器人对后路不同置钉密度固定的猪脊柱进行生物力学测试,探讨不同置钉密度对后路长节段固定脊柱三维运动稳定性的影响。方法:在8具猪脊柱标本中,首先制备全椎弓根螺钉固定模型(100%固定),之后依次减少椎弓根螺钉,制备不同密度的椎弓根螺钉固定模型(82%,64%,36%),最后无椎弓根螺钉固定的脊柱作为空白对照组。采用六自由度关节机器人测试各组猪脊柱标本在屈伸位、侧弯位及轴向旋转位的稳定性。结果与结论:(1)在屈伸位、侧弯位的测试中,全椎弓根螺钉固定组(100%)与部分椎弓根螺钉固定组(82%,64%,36%)脊柱标本的活动度相比差异无显著性意义(P>0.05);(2)在轴向旋转位测试中,36%椎弓根螺钉固定组相比于全椎弓根螺钉固定组以及82%、64%椎弓根螺钉固定组,轴向旋转的稳定性显著降低(P<0.001);(3)在64%椎弓根螺钉固定组加入横向连接杆固定时,可以显著降低脊柱标本轴向旋转的活动度(P<0.05);(4)提示有限降低椎弓根螺钉的置钉密度,不会对脊柱后路长节段固定的稳定性造成不利影响。BACKGROUND:Spinal posterior orthopedic pedicle screw internal fixation has become the most common clinical treatment for adolescent idiopathic scoliosis,but the use of high density nail placement can cause greater trauma and increase medical costs.OBJECTIVE:Using the six-degree-of-freedom joint robot,the biomechanical test of the pig spine with different posterior nail density was carried out to investigate the effect of different posterior nail density on the three-dimensional motion stability of the spine.METHODS:In eight pig spine specimens,the model of total pedicle screw fixation(100%fixation)was first prepared.Afterwards,the pedicle screws were reduced in turn.Pedicle screws of different densities were placed in turn(82%,64%,and 36%).Finally,the spine without pedicle screw fixation was used as the blank control group.A six-degree-of-freedom joint robot was used to test the flexibility of each group of pig spine specimens in flexion position,lateral bending position and axial rotation position.RESULTS AND CONCLUSION:(1)In flexion position and lateral bending position,there was no significant difference in range of motion of the spine specimens between the whole screw internal fixation group(100%)and the partial pedicle screw density group(82%,64%,and 36%)(P>0.05).(2)In the axial rotation test,the stability of axial rotation was significantly reduced in the 36%pedicle screw group compared to the total screw fixation group and the 82%and 64%pedicle screw fixation groups(P<0.001).(3)When the 64%pedicle screw fixation group was added to the transverse connecting rod fixation,the range of motion of axial rotation of the spine specimen was significantly reduced(P<0.05).(4)It is indicated that limited reduction of nail density of pedicle screws does not adversely affect the stability of posterior segment fixation.

关 键 词：脊柱 后路 矫形 置钉密度 长节段固定 内固定 生物力学 

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