传统与改良皮质骨轨迹置钉技术的生物力学性能比较  

Comparison of biomechanical properties between traditional and modified cortical bone trajectory technique

作　　者：周志豪 居来提·买提肉孜[2] 王水泉[3] 阿拉法特·卡哈尔 帕尔哈提·热西提[1] ZHOU Zhihao;Julaiti Maitirouzi;WANG Shuiquan;Alafate Kahaer;Paerhati Rexiti(Department of Spine Surgery,the First Affiliated Hospital,Xinjiang Medical University,Urumqi 830054,China;College of Mechanical Engineering,Xinjiang University,Urumqi 830046,China;College of Basic Medicine,Xinjiang Medical University,Urumqi 830017,China)

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054 [2]新疆大学机械工程学院,乌鲁木齐830046 [3]新疆医科大学基础医学院,乌鲁木齐830017

出　　处：《新疆医科大学学报》2022年第10期1129-1133,共5页Journal of Xinjiang Medical University

基　　金：国家自然科学基金(81960415);新疆维吾尔自治区研究生创新项目基金(XJ2021G206)。

摘　　要：目的采用有限元方法比较传统和改良皮质骨轨迹置钉技术的生物力学性能。方法选取2019年11月新疆医科大学解剖实验室骨质疏松标本4具,平均年龄(70.5±6.5)岁,男性2名,女性2名,骨密度T值均<-2.5 SD。使用Mimics和Abaqus6.9建立L4椎体模型,传统皮质骨轨迹置钉技术选用螺钉直径为5.0 mm、长度为35 mm,改良皮质骨轨迹置钉技术选用直径为5.0 mm、长度为40 mm的螺钉进行置钉。为消除椎体骨质对力学性能的影响,在同一椎体的两侧椎弓根分别插入两种不同技术要求的螺钉,采用有限元方法测定两种螺钉的轴向抗拔出力,上下左右载荷情况下螺钉稳定性及前屈,后伸,轴向及侧屈旋转工况下椎体稳定性并比较其固定性能。结果改良皮质骨轨迹置钉技术组的拔出力(1822±83)N显著大于传统皮质骨轨迹置钉技术组拔出力(1624±44)N,差异有统计学意义(P<0.05);改良皮质骨轨迹置钉技术组在受到上、下、右侧应力时载荷位移比明显大于传统皮质骨轨迹置钉技术组,差异有统计学意义(P=0.007;P=0.031;P=0.047);两种技术在左侧应力时载荷位移比差异无统计学意义(P>0.05)。改良皮质骨轨迹置钉技术组的椎体前屈、后伸、旋转、侧屈载荷位移比大于传统皮质骨轨迹置钉技术组,差异有统计学意义(P=0.003;P=0.03;P=0.019;P=0.014)。结论改良皮质骨轨迹置钉技术在抗拔出力、螺钉稳定性方面,椎体稳定性要优于传统皮质骨轨迹置钉技术。改良皮质骨轨迹置钉技术可能是比传统皮质骨轨迹置钉技术更佳的脊柱外科内固定技术。Objective The biomechanical properties of the traditional and modified cortical bone trajectory techniques were compared by finite element method.Methods 4 osteoporotic specimens were selected from the anatomy laboratory of Xinjiang Medical University,aged 70.5±6.5 years.The sex was 2 males and 2 females,and BMD T values were<2.5 SD.Using Mimics and Abaqus6.9,L4 vertebral body model was established.The traditional cortical bone trajectory technology used screws with a diameter of 5.0 mm and a length of 35 mm,and the modified cortical bone trajectory technology used screws with a diameter of 5.0 mm and a length of 40 mm.In order to eliminate the influence of vertebral bone on mechanical properties,2 screws with different technical requirements were inserted into the pedicle of both sides of the same vertebral body.The pull-out strength,screw stability and vertebral body stability were analyzed and compared.Results The pull-out force(1822±83)N of the modified cortical bone trajectory technique group was significantly higher than that of the traditional cortical bone trajectory technique group(1624±44)N(P<0.05);The load-displacement ratio of the modified cortical bone trajectory group was significantly higher than that of the traditional cortical bone trajectory group(P=0.007;P=0.031;P=0.047);There was no significant difference in load-displacement ratio between the two techniques under left stress(P>0.05).The load-displacement ratios of vertebral body flexion,extension,rotation and lateral flexion in the modified cortical bone trajectory group were greater than those in the traditional cortical bone trajectory group(P=0.003;P=0.03;P=0.019;P=0.014).Conclusion The modified cortical bone trajectory technique is better than the traditional cortical bone trajectory technique in terms of pullout resistance and screw stability.The modified cortical bone trajectory technique may be a better spinal surgical internal fixation technique than the traditional cortical bone trajectory technique.

关 键 词：改良皮质骨轨迹置钉技术 生物力学 有限元分析 骨质疏松 

分 类 号：R687[医药卫生—骨科学]