内固定结合伤椎骨水泥增强治疗骨质疏松性胸腰椎爆裂骨折的生物力学评价  

Biomechanical evaluation of internal fixation combined with injured vertebrae cement reinforcement in the treatment of osteoporotic thoracolumbar burst fractures

作　　者：翟伟峰 贾永伟 颜昊 倪明 张建坡 魏礼成 黄正 金浪 ZHAI Weifeng;JIA Yongwei;YAN Hao;NI Ming;ZHANG Jianpo;WEI Licheng;HUANG Zheng;JIN Lang(Department of Spine Surgery,Guanghua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;Department of Orthopaedics,Pudong New Area People’s Hospital,Shanghai University of Medicine and Health Sciences,Shanghai 201299,China)

机构地区：[1]上海中医药大学附属光华医院脊柱外科,上海200052 [2]上海健康医学院附属浦东新区人民医院骨科,上海201299

出　　处：《中国医药导报》2021年第30期96-100,共5页China Medical Herald

基　　金：国家自然科学基金面上项目(81972118);上海市科学技术委员会科研计划项目(18401904500);上海市卫生和计划生育委员会面上项目(201840361);上海市卫生健康委员会三年行动计划中医优势病种培育建设项目[ZY(2018-2020)-ZYBZ-04];上海市长宁区科学技术委员会重点项目(CNKW2017Z05)。

摘　　要：目的评估内固定结合伤椎骨水泥增强治疗骨质疏松性胸腰椎爆裂骨折的稳定性,为临床应用提供参考。方法2018年1月至2019年6月通过上海中医药大学收集6具老年胸腰段(T_(11)~L_(3))脊柱标本,用于制备L1椎体爆裂骨折模型。然后按照完整状态(空白组)、骨折状态(骨折组)、6钉内固定状态(6钉组)、6钉内固定结合伤椎骨水泥增强状态(6钉+骨水泥组)、4钉内固定结合伤椎骨水泥增强状态(4钉+骨水泥组)的顺序进行生物力学测试,各组标本在不同阶段分别完成前屈,后伸,左、右侧屈及轴向加压测试,CCD摄像机采集标本形变图像,基于Image J软件,采用数字标记点质心跟踪法测量冠状面上T12的垂直位移来反映固定节段的刚度,并进行比较。结果在轴向加压、前屈、后伸、左右侧屈加载模式下,骨折组的标本刚度均显著低于空白组、6钉组、4钉+骨水泥组、6钉+骨水泥组,差异有统计学意义(P<0.05)。在后伸、左右侧屈加载模式下,6钉组的标本刚度高于空白组,在轴向加压和前屈加载模式下,6钉组的标本刚度低于空白组,差异有统计学意义(P<0.05)。在轴向加压、后伸、左右侧屈加载模式下,4钉+骨水泥组与6钉+骨水泥组的标本刚度高于空白组和6钉组,且6钉+骨水泥组高于4钉+骨水泥组,差异有统计学意义(P<0.05)。在前屈加载模式下,4钉+骨水泥组的标本刚度低于空白组但高于6钉组,6钉+骨水泥组高于空白组和6钉组,差异有统计学意义(P<0.05)。结论三种固定方式均能达到固定节段的稳定,但6钉内固定结合伤椎骨水泥增强的手术方式稳定性最强,生物力学性能最佳。Objective To evaluate the stability of internal fixation combined with injured vertebrae cement reinforcement in the treatment of osteoporotic thoracolumbar burst fracture,and to provide reference for clinical application.Methods Six elderly thoracolumbral(T_(11)-L_(3))spinal specimens were collected by Shanghai University of Traditional Chinese Medicine from January 2018 to June 2019 to prepare L1 vertebral body burst fracture model.Then biomechanical tests were performed in the order of complete state(blank group),fracture state(fracture group),6-screw internal fixation state(6-screw group),6-screw internal fixation combined with injured vertebrae cement reinforcement state(6-screw+cement group),and 4-screw internal fixation combined with injured vertebrae cement reinforcement state(4-screw+cement group).The specimens in each group were tested in different stages of flexion,extension,left and right bending and axial compression respectively.The deformation images of the specimens were collected by CCD camera.Based on Image J software,digital marker point centroid tracking method was used to measure the vertical displacement of T12 on the coronal plane to reflect the stiffness of the fixed segment,and the comparison was made.Results Under axial compression,flexion,extension,and left and right bending loading modes,the specimen stiffness of fracture group was significantly lower than that of blank group,6-screw group,4-screw+cement group,and 6-screw+cement group,with statistically significant differences(P<0.05).The stiffness of specimens in the 6-screw group was higher than that in the blank group under extension and left and right bending loading modes,and the stiffness of speci mens in the 6-screw group was lower than that in the blank group under axial compression and forward bending loading modes,with statistical significance(P<0.05).Under axial compression,extension,and left and right bending loading modes,the stiffness of specimens in the 4 screw+cement group and 6 screw+cement group were higher than those

关 键 词：骨质疏松 胸腰椎爆裂骨折 骨水泥 内固定 生物力学 

分 类 号：R683.1[医药卫生—骨科学]