椎体后壁封堵加压器的设计及实验研究

发布时间：2018-01-25 07:27

本文关键词： 脊柱爆裂性骨折后壁缺损后壁封堵加压器修复　出处：《南华大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究目的：设计一种椎体后壁封堵加压器,用于治疗伴有后壁损伤脊柱爆裂性骨折及椎体后壁骨缺损的修复过程中,复位椎管内碎骨片；防止术中骨水泥渗漏及其引起的并发症。材料和方法：椎体后壁封堵加压器由横梁杆、U型加压器、螺杆、压片组成。取12具成年新鲜正常猪的脊柱标本,三个椎体为一个单元模型,分为A(爆裂性骨折组)、B(椎体后壁骨缺损组)两组,行影像学检查,排除骨病等干扰因素后,剔除标本所有附着肌肉组织,保留上下椎间盘、棘上韧带、棘间韧带的完整性。A组采用Panjabi[1]提出的“自由落体逐级撞击法”来制作标本中间椎体伴后壁损伤的爆裂性骨折。将制作成的模型椎弓根钉撑开复位固定后,行CT检查,测量椎管占位率。安装好椎体后壁封堵加压器实施椎体成型术,观察术中骨水泥是否渗漏及术后椎体后壁是否完整,再次行CT检查确认,测量椎管内骨块占位率及中间椎体前端、中缘、后端的高度。统计数据主要采用Spss18.0软件处理。B组使用钻头造成椎体后壁骨缺损模型,其中骨缺损的直径为10mm,深度为10mm。行X线、CT检查,证实造模成功,安装椎体后壁封堵加压器封堵椎体后壁后从椎管根入路注入骨水泥,观察骨水泥是否渗漏及术后椎体后壁是否完整,行CT检查确认。结果：1.实验一手术过程中出现1例骨水泥渗漏至椎旁,未出现骨水泥渗漏至椎管。减压彻底,椎管内无残留碎骨片,术后椎体后壁完整。2.椎体前缘高度造模成功后、撑开复位后、注射骨水泥后分别为63.5±10.6%、76.5±±7.6%、77.2±7.6%。椎体中缘高度由制造模成功后、恢复至撑开复位、椎体成形术后分别为60.1士9.8%、73.5±±6.2%、74.44±6.7%,椎体后缘高度造模成功后、撑开复位后、椎体成形术后分别为83.44±7.7%、94.5±±7.0%、95.2±±7.0%。椎管内骨块占位率造模成功后、撑开复位后、椎体成形术后分别为34.4±5.2%,9.1±3.1%,3.0±±0.8%。撑开复位后伤椎椎体前、中、后缘高度及椎管占位率较术前明显改善(P0.05)注射骨水泥后伤椎椎体前、中、后缘高度及椎管占位率较术前明显改善(P0.05)撑开复位后椎体前、中、后缘高度与注射骨水泥后比较无明显统计学意义(P0.05),注射骨水泥后椎管占位率(SOR)有明显改善(P0.05)。3.实验二过程中肉眼观未出现明显骨水泥渗漏,椎体后壁完整、光滑,CT显示椎体后壁完整,椎管内无占位。结论：椎体后壁封堵加压器,用于治疗伴有后壁损伤脊柱爆裂性骨折及椎体后壁骨缺损的修复过程中,可对椎管内骨折块进行复位；防止骨水泥渗漏；防止骨水泥对脊髓的热损伤。
[Abstract]:Objective: to design a kind of posterior wall plugging plus voltage regulator for the treatment of spinal burst fracture with posterior wall injury and the repair of posterior wall bone defect, and to reduce the bone fragments in the spinal canal. Materials and methods: the posterior wall of vertebra sealing and pressurizing was made up of U-type supercharger, screw and press slice. The spinal specimens of 12 adult fresh normal pigs were taken. The three vertebrae were divided into two groups: group A (burst fracture group) and group A (vertebral posterior wall bone defect group). Preservation of superior and inferior intervertebral discs, supraspinal ligaments and interspinous ligaments. Group A was treated with Panjabi. [1. The "free falling body step by step impact method" was put forward to make the burst fracture of the middle vertebra with posterior wall injury. After the pedicle nail was extended and fixed, CT was performed. Vertebral canal occupancy rate was measured. Vertebral body formation was performed by installing vertebral posterior wall plugging and pressurizer to observe the leakage of bone cement during operation and the integrity of posterior wall of vertebral body after operation. Ct examination was performed again to confirm it. The ratio of bone mass occupying in the spinal canal and the height of the front, middle and back end of the middle vertebral body were measured. The statistical data were mainly processed by Spss18.0 software. B group was used to make the model of bone defect in the posterior wall of the vertebral body. The bone defect was 10 mm in diameter and 10 mm in depth. X-ray and CT examinations were performed to confirm the success of the model. The posterior wall of the vertebral body was plugged and the posterior wall of the vertebral body was plugged by a pressure regulator. The bone cement was injected through the root of the spinal canal after plugging the posterior wall of the vertebral body. To observe whether the bone cement leakage and the integrity of the posterior wall of the vertebral body after operation, CT examination confirmed. Results 1. During the first operation, one case of bone cement leakage occurred to the paravertebral vertebrae. No bone cement leakage to the spinal canal. Decompression thoroughly, no residual bone fragments in the spinal canal, the posterior wall of the vertebral body is intact. 2. After the successful modeling of the anterior edge of the vertebral body, the vertebral body was extended and reduced. After injection of bone cement, it was 63.5 卤10.6 卤76.5 卤7.6 and 77.2 卤7.6, respectively. The height of the middle edge of vertebral body was restored to open reduction after the successful manufacture of the model. After vertebroplasty, it was 73.5 卤6.2and 74.44 卤6.7respectively after vertebroplasty. After vertebroplasty, it was 83.44 卤7.7and 94.5 卤7.0and 95.2 卤7.0. after the successful establishment of the model, the rate of bone mass in the vertebral canal was opened and reduced. After vertebroplasty, it was 34.4 卤5.2 and 9.1 卤3.1 卤3.0 卤0.8 respectively. The posterior edge height and spinal canal occupation rate were significantly improved after injection of bone cement (P 0.05). The posterior edge height and the spinal canal occupation rate were significantly improved compared with the preoperative P0.05). There was no significant difference in the anterior, middle and posterior height of the vertebral body between the posterior edge height and the bone cement injection group (P 0.05). The spinal canal occupation rate (SOR) after injection of bone cement was significantly improved (P 0.05). In experiment 2, there was no obvious leakage of bone cement, and the posterior wall of vertebral body was intact and smooth. Ct showed that the posterior wall of the vertebral body was intact and there was no space occupying in the vertebral canal. Conclusion: the posterior wall of the vertebral body is occluded and pressurized for the treatment of the burst fracture of the spine with injury of the posterior wall and the repair of the bone defect of the posterior wall of the vertebral body. The intraspinal fracture block can be reduced. Prevent bone cement leakage; Prevent thermal damage to the spinal cord caused by bone cement.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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