脊柱胸腰段骨折侧前方TSRH与Z-plate固定的生物力学研究
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摘要
目的
利用尸体标本制成胸腰段骨折生物力学模型，分别行侧前方TSRH(Texas Scotlish Rit Heospital)与Z-plate(Z型钛合金板)两种不同的内固定，进行生物力学测试。比较TSRH与Z-plate两种不同固定方法的可靠性及脊柱内固定后强度、刚度和稳定性等力学性能，为临床选择更佳的内固定方法提供科学依据。
方法
采用15具尸体胸腰段标本，5具为正常(NS)脊柱对照组，10具造成压缩性骨折后分两组(每组5具)，分别用TSRH和Z-plate行侧前方固定，应用实验应力分析法进行生物力学测试。
结果
应用TSRH内固定的脊柱应变、位移比正常脊柱对照组的应变、位移分别减小17—20％和8％；而其固定后的强度和刚度与Z-plate固定组相比仅小5％和5％，统计显示两种固定方法无显著性差异(P＞0.05)。
结论
采用TSRH侧前方内固定后的脊柱不但强度、刚度和稳定性得到满足，而且在承载能力、脊柱的稳定性上优于正常对照组，与Z-plate固定组相比，显示无显著性差异，说明采用TSRH器材进行脊柱骨折侧前方固定在生物力学性能方面具有一定的优越性，而且其操作相对简单便捷、便于多节段固定，亦能充分减压，其价格明显低于Z-plate。因此具有推广应用价值。
Objective
To establish Biomechanical model of fracture of thoracic and lumbar vertebra by cadaver specimen, and to undergo biomechanical test after lateral anterior internal fixation by TSRH(Texas Scotlish Rit Heospital) and Z-plate differently. To compare the reliability of the two lateral-anterior fixation systems-TSRH and Z-plate, and provide scientific evidence for clinical use.
Methods
15 fresh thoracolumbar specimen were used, 10 of them were made compressed fracture and divided into two groups (each contained 5 specimen),TSRH and Z-plate were used for lateral-anterior fixation respectively, Biomechanical detection was carried on by the experimental stress analysis.
Results
Compared with the control group normal spine, the strain and displacement of the spine decreased 17-20% and 8% respectively after TSRH fixation. Compared with Z-plate group, the intensity and rigidity decreased 5% and 5% respectively, which did not show significant difference (P>0. 05) .
Conclusion
Lateral-anterior fixation by the use of TSRH not only can give satisfactory effect on intensity, rigidity and stability of the spine, but also is superior to the control group in both loading-bearing capacity and stability. There is not significant difference between the TSRH group and Z-plate group, TSRH has superiority in biomechanics. It is relatively simple to operate and is suitable for multi-segment, it can also provide satisfactory decompression effect and is cheaper than Z-plate. So lateral-anterior fixation of TSRH is worth popularizing.
利用尸体标本制成胸腰段骨折生物力学模型，分别行侧前方TSRH(Texas Scotlish Rit Heospital)与Z-plate(Z型钛合金板)两种不同的内固定，进行生物力学测试。比较TSRH与Z-plate两种不同固定方法的可靠性及脊柱内固定后强度、刚度和稳定性等力学性能，为临床选择更佳的内固定方法提供科学依据。
方法
采用15具尸体胸腰段标本，5具为正常(NS)脊柱对照组，10具造成压缩性骨折后分两组(每组5具)，分别用TSRH和Z-plate行侧前方固定，应用实验应力分析法进行生物力学测试。
结果
应用TSRH内固定的脊柱应变、位移比正常脊柱对照组的应变、位移分别减小17—20％和8％；而其固定后的强度和刚度与Z-plate固定组相比仅小5％和5％，统计显示两种固定方法无显著性差异(P＞0.05)。
结论
采用TSRH侧前方内固定后的脊柱不但强度、刚度和稳定性得到满足，而且在承载能力、脊柱的稳定性上优于正常对照组，与Z-plate固定组相比，显示无显著性差异，说明采用TSRH器材进行脊柱骨折侧前方固定在生物力学性能方面具有一定的优越性，而且其操作相对简单便捷、便于多节段固定，亦能充分减压，其价格明显低于Z-plate。因此具有推广应用价值。
Objective
To establish Biomechanical model of fracture of thoracic and lumbar vertebra by cadaver specimen, and to undergo biomechanical test after lateral anterior internal fixation by TSRH(Texas Scotlish Rit Heospital) and Z-plate differently. To compare the reliability of the two lateral-anterior fixation systems-TSRH and Z-plate, and provide scientific evidence for clinical use.
Methods
15 fresh thoracolumbar specimen were used, 10 of them were made compressed fracture and divided into two groups (each contained 5 specimen),TSRH and Z-plate were used for lateral-anterior fixation respectively, Biomechanical detection was carried on by the experimental stress analysis.
Results
Compared with the control group normal spine, the strain and displacement of the spine decreased 17-20% and 8% respectively after TSRH fixation. Compared with Z-plate group, the intensity and rigidity decreased 5% and 5% respectively, which did not show significant difference (P>0. 05) .
Conclusion
Lateral-anterior fixation by the use of TSRH not only can give satisfactory effect on intensity, rigidity and stability of the spine, but also is superior to the control group in both loading-bearing capacity and stability. There is not significant difference between the TSRH group and Z-plate group, TSRH has superiority in biomechanics. It is relatively simple to operate and is suitable for multi-segment, it can also provide satisfactory decompression effect and is cheaper than Z-plate. So lateral-anterior fixation of TSRH is worth popularizing.
引文
1 Harrington PR. Technical details in relation to the successful use of instrumentation inscoliosis. Orthop Clin North Am 1972;3:499-567．
2 Luque ER. The anatomic basis and development of segmental spine instrumentation. Spine 1982;7:256-259．
3 Cotrel Y, Dubousset J. Nouvelle techniqued osteosynthese rachienne segmentoire par vole posterieure. Rev Chir Orthop 1984;70:494．
4 Steifee AD, Biscup RS, Stitkowski DJ. Segmental spine plates with pedicle screw fixation. Clin Orthop 1986;203:45-53．
5 Hall JE, Dwyer instrumentation in anterior fusion of the spine. J Bone Joint Surg 1981;63A:1188-1190．
6 Trammell TR, Benedict F, Reed D.Anterior spine fusion using Zielke instrumentation for adult thoracolumbar and lumbar scoliosis. Spine 1990;16:1378-1382．
7 Turi M, Johnston CE,Richards BS.Anterior correction of idiopathic scoliosis using TSRH instrumentation. Spine 1993; 18:417-422．
8 Brown LP,Bridwell K.H, Holt RJ, Jennings J. Aortic erosions and lacerations associated with the Dunn anterior spinal instrumentation. Paper presented at SRS 1985．
9 Panjabi MM, Biomechanical eraluation of spinal Fixation derices: I A conceptual franework. Spine 1988． 13:1129．
10王以进、王介鳞编著，骨科生物力学，北京，第一版，人民军医出版社，1989，99： 239。
11 Dunn HK, Anterior etabiligation of thoracolumbar injuries, Clin Orthog,
1984,189:116.
12 Kaneda K.Kostuik IP, Buret fractures with Neurologic Deficits of the thoracolumbar—lumbar spine, Spine, 1984,9:788.
13 杨礼庆，王海义，王欢，安春厚。侧前方入路椎体融合模型的建立及过伸活动影响的实验研究。中国医科大学学报 2000，04，20：29(2)：106-107。
14 徐一佳，郑祖根，董启榕，等。胸腰段椎体内压力分布与骨折的相关性研究。中华创伤杂志 2000，0815：16(8)：460-462。
15 王春，刘成招，郭卫中，刘文。三种内固定方法治疗胸腰椎骨折的疗效与生物力学评价。美国中华骨科杂志 2000，02，20：6(1)：55-56。
16 William T, Hardaker, Jr, M, D and William J, Richardson, M, D Textbook of surgery The biological basis of modem surgical practice fifteenth edition, Fractures of the spine 1999; 1401—1407.
17 An HS, Vaccaro AR, Coffer JM, Lin S. Burst fractures of the low lumbar spine. Comparison between body cast, Harrington rod, Luque rod and Steffee plate. Spine 1991; 16: 440S～444S.
18 La Grone MO, Bradfod DS, Moe JH, et al. Treatment of symptomatic flat back after spinal fusion. J Bone Joint Surg 1988; 70A: 569～580.
2 Luque ER. The anatomic basis and development of segmental spine instrumentation. Spine 1982;7:256-259．
3 Cotrel Y, Dubousset J. Nouvelle techniqued osteosynthese rachienne segmentoire par vole posterieure. Rev Chir Orthop 1984;70:494．
4 Steifee AD, Biscup RS, Stitkowski DJ. Segmental spine plates with pedicle screw fixation. Clin Orthop 1986;203:45-53．
5 Hall JE, Dwyer instrumentation in anterior fusion of the spine. J Bone Joint Surg 1981;63A:1188-1190．
6 Trammell TR, Benedict F, Reed D.Anterior spine fusion using Zielke instrumentation for adult thoracolumbar and lumbar scoliosis. Spine 1990;16:1378-1382．
7 Turi M, Johnston CE,Richards BS.Anterior correction of idiopathic scoliosis using TSRH instrumentation. Spine 1993; 18:417-422．
8 Brown LP,Bridwell K.H, Holt RJ, Jennings J. Aortic erosions and lacerations associated with the Dunn anterior spinal instrumentation. Paper presented at SRS 1985．
9 Panjabi MM, Biomechanical eraluation of spinal Fixation derices: I A conceptual franework. Spine 1988． 13:1129．
10王以进、王介鳞编著，骨科生物力学，北京，第一版，人民军医出版社，1989，99： 239。
11 Dunn HK, Anterior etabiligation of thoracolumbar injuries, Clin Orthog,
1984,189:116.
12 Kaneda K.Kostuik IP, Buret fractures with Neurologic Deficits of the thoracolumbar—lumbar spine, Spine, 1984,9:788.
13 杨礼庆，王海义，王欢，安春厚。侧前方入路椎体融合模型的建立及过伸活动影响的实验研究。中国医科大学学报 2000，04，20：29(2)：106-107。
14 徐一佳，郑祖根，董启榕，等。胸腰段椎体内压力分布与骨折的相关性研究。中华创伤杂志 2000，0815：16(8)：460-462。
15 王春，刘成招，郭卫中，刘文。三种内固定方法治疗胸腰椎骨折的疗效与生物力学评价。美国中华骨科杂志 2000，02，20：6(1)：55-56。
16 William T, Hardaker, Jr, M, D and William J, Richardson, M, D Textbook of surgery The biological basis of modem surgical practice fifteenth edition, Fractures of the spine 1999; 1401—1407.
17 An HS, Vaccaro AR, Coffer JM, Lin S. Burst fractures of the low lumbar spine. Comparison between body cast, Harrington rod, Luque rod and Steffee plate. Spine 1991; 16: 440S～444S.
18 La Grone MO, Bradfod DS, Moe JH, et al. Treatment of symptomatic flat back after spinal fusion. J Bone Joint Surg 1988; 70A: 569～580.