胸椎弓根壁破裂3种补救置钉方法的生物力学研究
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摘要
目的对人体标本胸椎弓根壁破裂3种补救置钉方法进行生物力学对比。方法选取5具青壮年尸体共30个胸椎体60个椎弓根,分为强化空心钉(HSS)组(15个椎弓根)、皮质骨通道螺钉(CBTS)组(30个椎弓根)和椎弓根-肋骨单元钉(PRUS)组(15个椎弓根),制成椎弓根内侧壁破裂模型。完成置钉后分别进行螺钉轴向抗拔出力实验,比较最大轴向抗拔出力、刚度、能量吸收值。结果 HSS组、CBTS组、PRUS组螺钉最大轴向抗拔出力分别为(973. 00±23. 88) N、(647. 13±21. 89) N、(613. 00±23. 25) N,差异有统计学意义(P <0. 05)。HSS组、CBTS组、PRUS组刚度分别为(284. 61±14. 77) N/mm、(218. 82±11. 84) N/mm、(194. 72±13. 06) N/mm,差异有统计学意义(P <0. 05)。HSS组、CBTS组、PRUS组能量吸收值分别为(2. 77±0. 13) J、(1. 41±0. 40) J、(1. 31±0. 57) J,HSS组与CBTS组、PRUS组比较差异有统计学意义(P <0. 05),但CBTS组与PRUS组比较差异无统计学意义(P> 0. 05)。结论在胸椎弓根壁破裂情况下,HSS、CBTS、PRUS 3种补救置钉均能够提供内固定稳定,HSS内固定稳定性最大,CBTS次之,PRUS最小。
Objective To compare the biomechanical characteristics of three methods of remedial placement screw in rupture of the pedicle wall of the thoracic vertebra of human specimens. Methods Thirty vertebrae containing 60 vertebral pedicles were obtained from 5 human cadaveric spines,divided into the hollow strengthening screw group( HSS group,15 pedicles),cortical bone trajectory screw group( CBTS group,30 pedicles) and pedicle rib unit screw group( PRUS group,15 pedicles). Models of lateral wall rupture of all thoracic pedicles were produced. Three groups were conducted with axial pullout experiment,then maximum axial pullout strength,stiffness,energy absorption value were compared among three groups. Results Maximum axial pullout strength of HSS group,CBTS group and PRUS group was( 973. 00 ± 23. 88) N,( 647. 13 ± 21. 89) N,( 613. 00 ± 23. 25) N,respectively. There were significant differences in maximum axial pullout strength among three groups( P < 0. 05). The values of stiffness of HSS group,CBTS group and PRUS group was( 284. 61 ± 14. 77) N/mm,( 218. 82 ± 11. 84) N/mm,( 194. 72 ± 13. 06) N/mm respectively,and there were significant differences among three groups( P < 0. 05). Energy absorption values of HSS group,CBTS group and PRUS group was( 2. 77 ± 0. 13) J,( 1. 41 ± 0. 40) J and( 1. 31 ± 0. 57) J,respectively,and there were significant differences between HSS group and other two groups( P < 0. 05). But there was no significant difference between CBTS group and PRUS group( P > 0. 05). Conclusions Under the condition of rupture of the pedicle wall of the thoracic vertebra of human specimens,HSS,CBTS and PRUS can increase the stability of the internal fixation,but the biomechanical stability of HSS is optimum,CBTS second,and PRUS last.
Objective To compare the biomechanical characteristics of three methods of remedial placement screw in rupture of the pedicle wall of the thoracic vertebra of human specimens. Methods Thirty vertebrae containing 60 vertebral pedicles were obtained from 5 human cadaveric spines,divided into the hollow strengthening screw group( HSS group,15 pedicles),cortical bone trajectory screw group( CBTS group,30 pedicles) and pedicle rib unit screw group( PRUS group,15 pedicles). Models of lateral wall rupture of all thoracic pedicles were produced. Three groups were conducted with axial pullout experiment,then maximum axial pullout strength,stiffness,energy absorption value were compared among three groups. Results Maximum axial pullout strength of HSS group,CBTS group and PRUS group was( 973. 00 ± 23. 88) N,( 647. 13 ± 21. 89) N,( 613. 00 ± 23. 25) N,respectively. There were significant differences in maximum axial pullout strength among three groups( P < 0. 05). The values of stiffness of HSS group,CBTS group and PRUS group was( 284. 61 ± 14. 77) N/mm,( 218. 82 ± 11. 84) N/mm,( 194. 72 ± 13. 06) N/mm respectively,and there were significant differences among three groups( P < 0. 05). Energy absorption values of HSS group,CBTS group and PRUS group was( 2. 77 ± 0. 13) J,( 1. 41 ± 0. 40) J and( 1. 31 ± 0. 57) J,respectively,and there were significant differences between HSS group and other two groups( P < 0. 05). But there was no significant difference between CBTS group and PRUS group( P > 0. 05). Conclusions Under the condition of rupture of the pedicle wall of the thoracic vertebra of human specimens,HSS,CBTS and PRUS can increase the stability of the internal fixation,but the biomechanical stability of HSS is optimum,CBTS second,and PRUS last.
引文
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[7]董献成,荆鑫,张明建,等.胸椎椎弓根螺钉固定失败经椎弓根外入路补救的力学测试[J].临床骨科杂志,2008,11(6):564-566.
[2] Matsukawa K,Yato Y,Hynes R A,et al. Cortical bone trajectory for thoracic pedicle screws:a technical note[J]. Clin Spine Surg,2017,30(5):497-504.
[3] Sellin J N,Raskin J S,Staggers K A,et al. Feasibility and safety of using thoracic and lumbar cortical bone trajectory pedicle screws in spinal constructs in children:technical note[J]. J Neurosurg Pediatr,2017,21(2):1-7.
[4] Hu M H,Wu H T,Chang M C,et al. Polymethylmethacrylate augmentation of the pedicle screw:the cement distribution in the vertebral body[J]. Eur Spine J,2011,20(8):1281-1288.
[5] Matsukawa K,Taguchi E,Yato Y,et al. Evaluation of the fixation strength of pedicle screws using cortical bone trajectory:what is the ideal trajectory for optimal fixation?[J]. Spine,2015,40(15):873-878.
[6]周春峰,赵剑.经椎弓根皮质骨通道固定技术应用于胸腰段爆裂性骨折的有限元研究[J].南通大学学报(医学版),2015,35(2):117-121.
[7]董献成,荆鑫,张明建,等.胸椎椎弓根螺钉固定失败经椎弓根外入路补救的力学测试[J].临床骨科杂志,2008,11(6):564-566.