寰枢椎U型棒钛缆内固定系统的生物力学评价

发布时间：2018-03-14 17:22

本文选题：寰枢椎　切入点：内固定　出处：《第二军医大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的设计一种基于寰枢椎传统钉棒基础上的寰枢椎U型棒钛缆内固定技术,并通过影像学研究和离体人体标本的生物力学研究,评估其安全性及生物力学稳定性。研究方法1、获取从2016年6月至2016年8月门诊和病房所摄50例成年人(男女各25例)患者的颈椎CT薄层扫描及三维重建图像,利用Philips IntelliSpace Portal系统测定C1椎弓根的尺寸,包括高度和宽度,设计C1椎弓根螺钉的理想钉道,确定理想的进钉点及内倾角。2、选取6具新鲜成人的枕颈部标本(C0 3)节段,通过实验机器对其施加1.5Nm的纯力偶矩,产生前后屈伸、左右侧屈、轴向旋转六个方向的纯力偶矩,每次实验测试时加载3个循环,每次循环持续10秒,并按照以下实验顺序记录第3次循环的前屈后伸、左右侧屈、左右旋转6个方向上的三维运动范围(ROM):完整组(M1组)、Gallie组(M3组)、Bilateral cable组(M4组)、Unilateral cable组(M5组)、双侧PS组(M6组)、失稳组(M2组)。结果1、评价寰椎椎弓根螺钉相关测量数据的左侧和右侧之间没有统计学上的显著性差异(P0.05),在男性和女性之间的许多参数中存在统计学差异(P0.05),而两者的钉道内倾角,女性大于男性,但没有统计学差异(P0.05)(表1 3)。椎弓根高度4.0mm螺钉直径的比例为23%(23/100),而3.5mm螺钉直径的比例达到13.0%(13/100)。理想寰椎椎弓根螺钉钉道的进钉点与矢状面的垂直距离,男性为19.93±1.32mm,女性为18.01±1.24mm,螺钉的内倾角度,男性为7.07±2.19°,女性为7.20±1.65°,钉道长度,男性为28.52±1.70mm,女性为27.74±1.96mm。2、6具标本的失稳组较完整组均表现出明显活动度增加,所有标本分别加载4种不同内固定组合后,寰枢椎在不同工况下的活动度均有不同程度的显著性减少,稳定性增加。Unilateral cable组与其它内固定组ROM相比,在各个方向上均有所减少,特别是在左右侧屈及轴向旋转方向上有显著性差异。结论1、寰椎椎弓根螺钉置钉的安全性主要取决于椎动脉沟下方椎弓根的外壁高度和髓腔高度,通过患者术前的CT薄层扫描及三维重建片,评估寰椎椎弓根置钉的安全性至关重要,对于外壁高度3.5mm的患者应谨慎置钉,而对于无髓腔的患者避免选择椎弓根螺钉,而应选择替代方案。2、寰枢椎U型棒钛缆内固定系统手术操作简单、安全,稳定性好,可以作为寰枢椎椎弓根螺钉固定技术的替代方案和补救术式,从而有效治疗寰枢椎脱位,特别是难复性脱位。
[Abstract]:Objective to design an atlantoaxial U-bar titanium cable internal fixation technique based on the traditional atlantoaxial screw rod, and to study the biomechanics of human specimens by imaging and in vitro. Methods 1. From June 2016 to August 2016, 50 adult patients (25 males and 25 males) were examined with thin slice CT and 3D reconstruction images of cervical vertebrae. The size of C1 pedicle, including height and width, was measured by Philips IntelliSpace Portal system. The ideal nail passage of C1 pedicle screw was designed. The ideal point of entry and the angle of inclination were determined. The occipitocervical specimens of 6 fresh adults were selected. The pure force couple moment of 1.5 Nm is applied to it by the experimental machine, which produces the pure force couple moment in six directions of flexion and extension, left and right flexion, axial rotation. Three cycles are loaded in each experiment, and each cycle lasts 10 seconds. According to the following experimental sequence, the third cycle of forward flexion and extension, left and right flexion, The range of three dimensional motion in 6 directions of left and right rotation: complete group M 1, group M 3, cable group M 3, group M 4, group M 5, bilateral cable group M 5, bilateral PS group M 6, and unstable group M 2. Results 1. To evaluate the relevant measurement data of atlas pedicle screws. There was no statistically significant difference between the side and the right side (P 0.05). There was a statistical difference in many parameters between men and women (P 0.05). Women are larger than men, but there is no statistical difference (Table 13). The ratio of pedicle height 4.0mm screw diameter is 2323 / 100m, while 3.5mm screw diameter is 13.0mm / 1000.The ideal vertical distance between the point of entry and sagittal plane of the nail path of atlas pedicle screw is ideal. The angle of introversion of screw was 7.07 卤2.19 掳in male and 7.20 卤1.65 掳in female. The length of nail canal was 28.52 卤1.70 mm in male and 27.74 卤1.96 mm 路2mm in female. After all the specimens were loaded with four different internal fixation combinations, the motion of atlantoaxial vertebrae decreased significantly in different working conditions, and the stability increased. Compared with other internal fixation groups, ROM decreased in all directions in the cable group. Conclusion 1. The safety of atlas pedicle screw placement mainly depends on the height of the external wall and the medullary cavity of the pedicle below the vertebral artery sulcus. It is very important to evaluate the safety of atlas pedicle screw placement by CT thin slice scan and 3D reconstruction before operation. The patients with 3.5mm height of external wall should be careful with screw placement, while patients with unmyelinated cavity should avoid the choice of pedicle screw. It is suggested that the alternative should be .2. the internal fixation system of atlantoaxial U-bar titanium cable is simple, safe and stable. It can be used as an alternative and a remedy for atlantoaxial pedicle screw fixation, so as to effectively treat atlantoaxial dislocation. In particular, the dislocation is difficult to be refolded.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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