经皮质骨轨迹螺钉在腰椎结核病椎间固定的生物力学研究  

Biomechanical study of cortical bone trajectory screw in lumbar spine tuberculosis intervertebral fixation

作　　者：费骏[1] 石仕元[1] 胡胜平[1] 胡德新[1] 张晨威 FEI Jun;SHI Shi-yuan;HU Sheng-ping;HU De-xin;ZHANG Chen-wei(Zhejiang Provincial Integrated Chinese and Western Medicine Hospital,Zhejiang Provincial Clinical Center for Tuberculosis Diagnosis and Treatment,Hangzhou 310003,China)

机构地区：[1]浙江省中西医结合医院浙江省结核病诊疗中心,杭州310003

出　　处：《中国防痨杂志》2021年第2期171-177,共7页Chinese Journal of Antituberculosis

基　　金：2018年浙江省医药卫生科技项目(2018KY606);杭州市农业与社会发展科研主动设计项目(20180417A04)。

摘　　要：目的探究经皮质骨轨迹(cortical bone trajectory,CBT)螺钉病椎间固定在治疗腰椎结核的生物力学稳定性及其优势,为临床固定方式的选择提供生物力学依据。方法选取猪脊柱标本(T12~L5)16具,模拟体外(L2~L3)腰椎结核骨质破坏模型,通过随机数字表法分为4组,每组4具,分别予以短节段(病椎椎弓根钉)固定(A组)、短节段(病椎CBT钉)固定(B组),病椎间椎弓根螺钉固定(C组)、病椎间CBT螺钉固定(D组)。各组每具标本依次进行完整状态(状态1)和L2~L3脊柱结核造模植骨融合并内固定状态(状态2)下的生物力学测试。将各标本装载到脊柱三维运动机上,分别施予2N·m、2.5N·m、1N·m、3N·m纯力矩,记录标本在前屈、后伸、侧弯、扭转4个方向上的活动度,比较并分析各组活动度。结果A组在状态1和状态2模式下前屈、后伸、侧弯和扭转运动的活动度分别为(8.47±1.76)°、(7.01±1.10)°、(5.03±0.92)°和(4.48±0.41)°;(4.78±0.07)°、(2.91±0.16)°、(2.66±0.09)°和(2.23±0.05)°;B组在状态1和状态2模式下前屈、后伸、侧弯和扭转运动的活动度分别为(7.32±0.75)°、(5.35±0.69)°、(3.44±0.51)°和(3.36±1.02)°;(3.51±0.29)°、(1.74±0.04)°、(1.53±0.31)°和(1.23±0.08)°;C组在状态1和状态2模式下前屈、后伸、侧弯、扭转运动的活动度分别为(10.01±0.39)°、(9.05±0.25)°、(7.42±1.06)°和(6.92±1.15)°;(7.21±0.17)°、(5.07±0.02)°、(5.12±0.74)°和(4.58±0.01)°;D组在状态1和状态2模式下前屈、后伸、侧弯、扭转运动的活动度分别为(9.20±1.37)°、(7.38±0.88)°、(6.89±1.22)°和(6.00±0.52)°;(6.06±0.16)°、(3.99±0.02)°、(3.85±0.08)°和(3.47±0.10)°。各固定模式组状态2的活动度均较状态1减小,差异均有统计学意义(A组t值分别为4.531、5.346、6.008、4.149,P值分别为0.020、0.013、0.009、0.025;B组t值分别为9.481、16.181、11.814、4.769,P值分别为0.002、0.001、0.001、0.018;C组t值分别为4.349、8Objective To explore the biomechanical stability and advantages of cortical bone trajectory(CBT)screws in the treatment of lumbar spine tuberculosis and provide biomechanical evidence for the choice of clinical fixation methods.Methods Sixteen pig spine specimens(T12-L5)were selected to simulate the in vitro(L2-L3)lumbar spine tuberculosis bone destruction.The 16 specimens were randomly divided into 4 groups(shortsegment(vertebra pedicle screw)fixation(group A),short-segment(spine CBT screw)fixation(group B),intervertebral pedicle screw fixation(group C),vertebrae fixation with CBT screw(group D)),4 specimens in each group,each specimen in each group was subjected to biomechanical testing in the state of complete specimen(state 1)and L2-L3 spinal tuberculosis model bone graft fusion and internal fixation(state 2).We loaded each specimen on the spine 3 Dexercise machine,applied moments of 2 N·m,2.5 N·m,1 N·m,3 N·m,respectively,then recorded the range of movement(ROM)of the specimens in the four directions of flexion,extension,lateral bending and torsion,compared and analyzed each group of ROM.Results The ROMs of flexion,extension,lateral bending,and torsion in group A in state 1 and state 2 modes were(8.47±1.76)°,(7.01±1.10)°,(5.03±0.92)°,(4.48±0.41)°and(4.78±0.07)°,(2.91±0.16)°,(2.66±0.09)°,(2.23±0.05)°;the ROMs of flexion,extension,lateral bending and torsion in group B in state 1 and state 2 modes were(7.32±0.75)°,(5.35±0.69)°,(3.44±0.51)°,(3.36±1.02)°and(3.51±0.29)°,(1.74±0.04)°,(1.53±0.31)°,(1.23±0.08)°;the ROMs of flexion,extension,lateral bending,and torsion in group C in state 1 and state 2 modes were(10.01±0.39)°,(9.05±0.25)°,(7.42±1.06)°,(6.92±1.15)°and(7.21±0.17)°,(5.07±0.02)°,(5.12±0.74)°,(4.58±0.01)°;the ROMs of flexion,extension,lateral bending,and torsion in group D in state 1 and state 2 modes were(9.20±1.37)°,(7.38±0.88)°,(6.89±1.22)°,(6.00±0.52)°and(6.06±0.16)°,(3.99±0.02)°,(3.85±0.08)°,(3.47±0.10)°.The ROM value of each fixed mo

关 键 词：结核 脊柱 内固定器 脊柱融合术 疾病模型 动物 对比研究 

分 类 号：R687.3[医药卫生—骨科学]