不同骨密度下腰椎椎弓根螺钉固定在疲劳实验前后的生物力学比较
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摘要
目的研究不同骨密度下腰椎椎弓根螺钉固定在疲劳试验前后的生物力学比较,为临床工作提供生物力学参考。方法取新鲜成年绵羊胸腰椎脊柱标本(T12~L5)27具,采用随机数字表法分为3组,分别为A组(盐酸脱钙0h,骨量正常)、B组(盐酸脱钙2h,骨量减少)、C组(盐酸脱钙4h,骨质疏松),每组9具。3组均采用在L4~L5上置入椎弓根钉棒系统。以(300±105)N的载荷对3组模型进行250 000次循环4个方向(前屈、后伸、左侧弯、右侧弯)加载,比较4组模型疲劳试验前后的脊柱活动范围、螺钉的最大拔出力、轴向压缩刚度。结果与疲劳试验前相比,A组脊柱的运动范围值、轴向压缩刚度、螺钉的最大拔出力较试验前未见明显改变,差异无统计学意义(P>0.05),B、C组脊柱的运动范围值、轴向压缩刚度明显增大,螺钉的最大拔出力明显减小,组内组间差异均有统计学意义(P<0.05)。结论疲劳试验后,骨量减少及骨质疏松对腰椎椎弓根螺钉固定影响较大,临床医师在该条件下不应行单纯椎弓根螺钉内固定。
Objective To explore the biomechanis with different bone density by the pedicle screws fixation before and after fatigue test.Thus provide biomechanical basis for the clinical work.Methods A total of 27 fresh lumbar vertebrae samples of adult sheep(L1-L5)were equally divided into three groups,such as group A of decalcified with HCL 0h,group B of decalcified with HCL 2hand group C of decalcified with HCL 4h,by using the random number table method,every groups was 9 models.Four screws was performed on the L4-L5 pedicle of vertebral arch of the three groups.Three groups were performed fatigue test of250 000 times in 4direction(flexion,extension,left lateral bending,right lateral bending)by(300+105)N load.The range of motion(ROM),the axial compressive stiffness were measured and the results in every group were compared before and after fatigue test.Results After fatigue test,ROM and the axial compressive stiffness had no significant change in group A(P>0.05),but ROM of B group and C group were both increased and the axial compressive stiffness were decreased,Significance was found with and between groups.Conclusion The stability of people who are performed pedicle screws simplly may be decrease when the spine of osteopenia.
Objective To explore the biomechanis with different bone density by the pedicle screws fixation before and after fatigue test.Thus provide biomechanical basis for the clinical work.Methods A total of 27 fresh lumbar vertebrae samples of adult sheep(L1-L5)were equally divided into three groups,such as group A of decalcified with HCL 0h,group B of decalcified with HCL 2hand group C of decalcified with HCL 4h,by using the random number table method,every groups was 9 models.Four screws was performed on the L4-L5 pedicle of vertebral arch of the three groups.Three groups were performed fatigue test of250 000 times in 4direction(flexion,extension,left lateral bending,right lateral bending)by(300+105)N load.The range of motion(ROM),the axial compressive stiffness were measured and the results in every group were compared before and after fatigue test.Results After fatigue test,ROM and the axial compressive stiffness had no significant change in group A(P>0.05),but ROM of B group and C group were both increased and the axial compressive stiffness were decreased,Significance was found with and between groups.Conclusion The stability of people who are performed pedicle screws simplly may be decrease when the spine of osteopenia.
引文
[1]林周胜,陈建庭,朱青安.脊柱后路经椎弓根螺钉动态固定系统的临床应用及生物力学研究进展[J].医用生物力学,2013,28(6):684-689.
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[3]De Iure F,Bosco G,Cappuccio M,et al.Posterior lumbar fusion by peek rods in degenerative spine:preliminary report on 30cases[J].Eur Spine J,2012,21(Suppl 1):S50-54.
[4]王瑞臣,李岩,董军.双能X射线骨密度仪不同测量方式检测大鼠骨密度的准确性[J].中国组织工程研究,2012,16,16(30):5600-5603.
[5]刘达,张译,蒋凯,等.骨质疏松人工骨模块中膨胀式椎弓根螺钉与骨水泥强化螺钉稳定性的比较研究[J].重庆医科大学学报,2015,40(2):176-180.
[6]刘瑶瑶,孙东,张泽华,等.用于骨质疏松椎体固定的椎弓根螺钉进展[J].中国矫形外科杂志,2011,19(23):1982-1986.
[7]Paxinos O,Tsitsopoulos PP,Zindrick MR,et al.Evaluation of pullout strength and failure mechanism of posterior instrumentation in normal and osteopenic thoracic vertebrae[J].J Neurosurg Spine,2010,13(4):469-476.
[8]Becker S,Chavanne A,Spitaler R,et al.Assessment of different screw augmentation techniques and screw designs in osteoporotic spines[J].Eur Spine J,2008,17(11):1462-1469.
[9]尚庆,刘宗超,鲁晓波.快速制备骨质疏松体外模型的实验研究[J].中国修复重建外科杂志,2013,27(3):326-329.
[10]Burval DJ,Mclain RF,Milks R,et al.Primary pedicle screw augmentation in osteoporotic lumbar vertebrae:biomechanical analysis of pedicle fixation strength[J].Spine(Phila Pa 1976),2007,32(10):1077-1083.
[11]Li G,Patil CG,Lad SP,et al.Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients[J].Spine(Phila Pa 1976),2008,33(11):1250-1255.
[12]盛孙仁,徐华梓,王向阳,等.猪、小牛与人颈椎的生物力学比较[J].医用生物力学,2010,25(5):380-384.
[13]闫石,苏峰,张志敏.经伤椎置钉对椎弓根皮质劈裂合并椎体骨折的生物力学稳定性的影响[J].中国医学科学院学报,2014,36(4):415-419.
[14]崔轶,雷伟.吴子详等绵羊椎体骨质疏松性生物力学模型的建立及评价[J].中国骨质疏松杂志,2010,16(1):13-18.
[15]张志敏,苏峰,张春林,等.腰椎不同节段固定对腰椎活动度及椎间压力的影响[J].重庆医学,2013,42(28):3403-3404,3407.
[16]Ramaswamy R,Evans S,Kosashvili Y.Holding power of variable pitch screws in osteoporotic,osteopenic and normal bone:are all screws created equal?[J].Injury,2010,41(2):179-183.
[17]Ashman RB,Bechtold JE,Edwards WT,et al.In vitro spinal arthrodesis implant mechanical testing protocols[J].J Spinal Disord,1989,2(4):274-281.
[18]李现令,李现今,张学军,等.脊柱椎弓根螺钉应用的生物力学特征[J].中国组织工程研究与临床康复,2011,15(30):5640-5645.
[2]Shea TM,Laun J,Gonzalez-Blohm SA,et al.Designs and techniques that improve the pullout strength of pedicle screws in osteoporotic vertebrae:current status[J].Biomed Res Int,2014,2014:748393.
[3]De Iure F,Bosco G,Cappuccio M,et al.Posterior lumbar fusion by peek rods in degenerative spine:preliminary report on 30cases[J].Eur Spine J,2012,21(Suppl 1):S50-54.
[4]王瑞臣,李岩,董军.双能X射线骨密度仪不同测量方式检测大鼠骨密度的准确性[J].中国组织工程研究,2012,16,16(30):5600-5603.
[5]刘达,张译,蒋凯,等.骨质疏松人工骨模块中膨胀式椎弓根螺钉与骨水泥强化螺钉稳定性的比较研究[J].重庆医科大学学报,2015,40(2):176-180.
[6]刘瑶瑶,孙东,张泽华,等.用于骨质疏松椎体固定的椎弓根螺钉进展[J].中国矫形外科杂志,2011,19(23):1982-1986.
[7]Paxinos O,Tsitsopoulos PP,Zindrick MR,et al.Evaluation of pullout strength and failure mechanism of posterior instrumentation in normal and osteopenic thoracic vertebrae[J].J Neurosurg Spine,2010,13(4):469-476.
[8]Becker S,Chavanne A,Spitaler R,et al.Assessment of different screw augmentation techniques and screw designs in osteoporotic spines[J].Eur Spine J,2008,17(11):1462-1469.
[9]尚庆,刘宗超,鲁晓波.快速制备骨质疏松体外模型的实验研究[J].中国修复重建外科杂志,2013,27(3):326-329.
[10]Burval DJ,Mclain RF,Milks R,et al.Primary pedicle screw augmentation in osteoporotic lumbar vertebrae:biomechanical analysis of pedicle fixation strength[J].Spine(Phila Pa 1976),2007,32(10):1077-1083.
[11]Li G,Patil CG,Lad SP,et al.Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients[J].Spine(Phila Pa 1976),2008,33(11):1250-1255.
[12]盛孙仁,徐华梓,王向阳,等.猪、小牛与人颈椎的生物力学比较[J].医用生物力学,2010,25(5):380-384.
[13]闫石,苏峰,张志敏.经伤椎置钉对椎弓根皮质劈裂合并椎体骨折的生物力学稳定性的影响[J].中国医学科学院学报,2014,36(4):415-419.
[14]崔轶,雷伟.吴子详等绵羊椎体骨质疏松性生物力学模型的建立及评价[J].中国骨质疏松杂志,2010,16(1):13-18.
[15]张志敏,苏峰,张春林,等.腰椎不同节段固定对腰椎活动度及椎间压力的影响[J].重庆医学,2013,42(28):3403-3404,3407.
[16]Ramaswamy R,Evans S,Kosashvili Y.Holding power of variable pitch screws in osteoporotic,osteopenic and normal bone:are all screws created equal?[J].Injury,2010,41(2):179-183.
[17]Ashman RB,Bechtold JE,Edwards WT,et al.In vitro spinal arthrodesis implant mechanical testing protocols[J].J Spinal Disord,1989,2(4):274-281.
[18]李现令,李现今,张学军,等.脊柱椎弓根螺钉应用的生物力学特征[J].中国组织工程研究与临床康复,2011,15(30):5640-5645.