骶骨部分切除四种脊柱-骨盆固定的生物力学比较  

A biomechanical comparison of four types of spinopelvic fixation secondary to partial sacral resection in cadaveric samples

作　　者：苏保辉[1] 李曰众 王炳武[1] 于明东[1] 史玉林[1] 孙良智[1] SU Bao-hui;LI Yue-zhong;WANG Bing-wu;YU Ming-dong;SHI Yu-lin;SUN Liang-zhi(Department of Spine Surgery,People's Hospital of Weifang City,Weifang 261041,China)

机构地区：[1]潍坊市人民医院脊柱外科,261041

出　　处：《中国矫形外科杂志》2021年第23期2173-2176,共4页Orthopedic Journal of China

基　　金：潍坊市卫生计生委科研计划项目(编号:wfwsjs-2018-00107)。

摘　　要：[目的]比较骶骨部分切除后四种脊柱-骨盆固定方式(spinopelvic fixation,SPF)的生物力学特点,为临床实际工作提供依据。[方法]4具L_(3)-骨盆成人尸体标本,行S_(1)以下骶骨部分切除,依次进行以下双侧L_(4)-L_(5)-髂骨SPF固定和力学测试,包括:(1)单钉单棒固定(single iliac screw and single rod,SISSR),(2)双钉单棒固定(dual iliac screws and single rod,DIS-SR),(3)双钉双棒固定(dual iliac screws and dual rods,DISDR),(4)双钉双棒连接固定+横连固定(dual iliac screws and dual rods plus transverse links,DISDR-TL)。施加5个循环的0〜500 N轴向压力,以及-7-7 N·m轴向扭转,记录第4个循环的数据,计算样本的压缩刚度和扭转刚度值。[结果]压缩刚度和扭转刚度由小至大依次为:SISSR组〈DISSR组〈DISDR组<DIS-DR-TL组,差异有统计学意义(P<0.05)。DISDR组和DISDR-TL组的压缩刚度高于SISSR组,差异均有统计学意义(P<0.05);而DISSR组,DISDR组和DISDR-TL组三组间的压缩刚度差异无统计学意义(P>0.05)。DISDR组和DISDR-TL组的扭转刚度均显著高于SISSR组和DISSR组(P<0.05);DISDR-TL组扭转刚度显著高于DISDR组,差异有统计学意义(P<0.05)。[结论]随着SPF结构复杂程度的提升,其结构压力刚度和扭转刚度显著增加。[Objective]To compare the biomechanical characteristics of four types of spinopelvic fixation(SPF)after partial sacral re section in cadaveric samples,and to provide a reference for clinical practice.[Methods]Four adult L_(3)-pelvis samples underwent partial sacral excision below Si,followed by bilateral L_(4)-L_(5)-iliac SPF and mechanical tests in following sequence:(1)bilateral SPF with single iliac screw and single rod(SISSR)on each side,(2)with dual screw and single rod(DISSR),(3)with dural screws and dual rods(DISDR),and(4)dual iliac screws and dual rods plus transverse links(DISDR-TL).Five cycles of 0-500N axial pressure,and-7-7 N·m axial torsion were loaded on the samples,and the data of the fourth cycle were recorded to calculate the compressive stiffness and torsional stiffness of the samples.[Results]Both the compression stiffness(CS)and torsion stiffness(TS)were ranked down-up in sequences of:SISSR group<DISSR group<DISDR group<DISDR-TL group,with a statistical significance among the 4 groups(P<0.05).In term of comparison among groups,the DISDR group and DISDR-TL group had significantly higher CS than the SISSR group(P<0.05),whereas there was no a significant difference in CS among DISSR group,DISDR group and DISDR-TL group(P>0.05).In addition,the DISDR group and DISDR-TL group had significantly higher TS than the SISSR group and DISSR group(P<0.05),while the DISDR-TL group had significantly higher TS than that of DISDR group(P<0.05).[Conclusion]With the upgrading SPF structure complexity,the structure has compressive stiffness and torsional stiffness increased considerably.

关 键 词：骶骨部分切除 脊柱-骨盆固定 髂骨钉 生物力学 

分 类 号：R687[医药卫生—骨科学]