骶髂关节不同固定方式对骶部影响的生物力学研究  

Biomechanical study of the influence of different fixation methods on the sacroiliac joint

作　　者：张玉坤[1] 李磊[1] 任军[1] ZHANG Yukun;LI Lei;REN Jun(Department of Spinal Surgery,6th Affiliated Hospital of Xinjiang Medical Unsiversity,Urumqi 830002,Chin)

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》2021年第2期92-96,共5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:长节段固定治疗腰椎退变性侧凸取得了良好的矫形效果。目前对于骶髂关节不同固定方式对骶部影响的生物力学研究尚少。目的:研究骶髂关节不同固定方式对S1螺钉应力分布的影响,为腰椎退变性手术方式的选择提供依据。方法:抽取6具成人新鲜尸体按照三种不同固定方式分成T12-S1组(T12-S1固定)、T12-S2组(T12-S2固定)、T12-髂骨组(T12-S1-髂骨固定),分别采取8 Nm力矩的六自由度力对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:①T12-髂骨固定在前屈及后伸加载位时S1螺钉的拔出力为(15.32±5.31/-7.98±3.09)N、横向力为(41.40±14.61/-30.11±11.21)N、弯矩为(0.38±0.10/-0.42±0.11)Nm,均较T12-S1、T12-S2低(P<0.05);②T12-髂骨固定在左、右旋加载位时S1螺钉的弯矩为(左-0.34±0.25、右0.36±0.15)Nm,均较T12-S1、T12-S2低(P<0.05)。结论:T12-髂骨固定时S1螺钉的拔出力、横向力、弯矩较T12-S1、T12-S2低,可考虑行髂骨固定以达到提高手术效果的目的。Background:Long-segment fixation has achieved good orthopedic outcomes in treatment of lumbar degenerative scoliosis.Currently,there are few biomechanical studies on the influences of different fixation methods on sacrum.Objective:To explore the influences of different fixation methods on the stress distribution of screws,and to provide basis for the selection of surgical methods for lumbar degenerative diseases.Methods:Six fresh adult cadavers were selected and divided into T12-S1 group,T12-S2 group and T12-ilium group according to three different fixation methods.The stress of screws was measured by 6 degrees of freedom force with 8 Nm torque.Statistical method was adopted to compare among three groups.Results:The pull-out force was(15.32±5.31)N and(-7.98±3.09)N,transverse force was(41.40±14.61)N and(-30.11±11.21)N,and bending moment was(0.38±0.10)Nm and(-0.42±0.11)Nm of sacral screw at forward bend and extension loading positions,which were lower in T12-ilium fixation group than in T12-S1 and T12-S2 groups(P<0.05);the transverse force was(-0.34±0.25)Nm and(0.36±0.15)Nm of the sacral screw at left and right rotation loading position,which were lower in T12-ilium fixation group than in T12-S1 and T12-S2 groups(P<0.05).Conclusions:The pull-out force,transverse force and bending moment of sacral screw are lower in T12-ilium fixation than those in T12-S1 and T12-S2 fixations.Iliac screw fixation can be considered after thoracolumbar fixation and fusion to improve the surgical effect.

关 键 词：T12-S1-髂骨 生物力学 长节段固定 

分 类 号：R687.4[医药卫生—骨科学]