Th3～Th5前路逆向椎弓根—肋骨复合体螺钉内固定技术的影像学形态测量和生物力学研究

发布时间：2018-03-15 07:16

  本文选题：椎弓根-肋骨复合体　切入点：椎弓根　出处：《广西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：第一部分Th3-Th5前路逆向椎弓根-肋骨复合体螺钉内固定技术影像学形态测量目的：在Th3-Th5二维的CT平扫和三维的Mimics重建模型上对正常人的上胸椎进行观察和测量,为上胸椎(Th3～Th5)的前路逆向椎弓根-肋骨复合体螺钉的固定技术提供形态学的数据参考。方法：对30例患者的上胸椎(Th1～Th6)的薄层CT扫描数据进行重建,在横切面上测量椎弓根和椎弓根-肋骨复合体的横径、钉道长度和横切面的进钉角度,在冠状面上测量椎弓根纵径和椎弓根-肋骨复合体的有效纵径。选取上述的20例患者的CT扫描数据,采用Mimincs软件重建出Th1～Th6的椎弓根-肋骨复合体三维模型,然后用自带的模拟软件模拟出Th3～Th5椎弓根-肋骨复合体的最佳钉道和螺钉轴心,最后使用3-D测量工具测量螺钉的横切面和矢状面的进钉点距离,横切面和矢状面的的进钉角度和钉道长度。结果：Th3～Th5节段椎弓根-肋骨复合体的平均横径(5.03 mm)明显大于椎弓根的平均横径(12.73 mm),椎弓根-肋骨复合体的平均有效纵径(9.17 mm)明显小于椎弓根的平均纵径(11.72 mm)。椎弓根-肋骨复合体的进钉角度比椎弓根的进钉角度更大(31.43°VS 13.32°),钉道长度更长(56.48 mm VS 38.77mm)。 Th3-Th5节段的椎弓根纵径大于其横径,但是椎弓根-肋骨复合体的有效纵径小于其横径,而又大于同节段的椎弓根横径。前路逆向椎弓根-肋骨复合体螺钉的平均长度是57.25mm (46.1 mm～ 65.8 mm), Th3至Th5的螺钉长度逐渐变长,分别为55.03 mm,57.27 mm和59.45mm。螺钉进针点的平均横切面距离是-3.58 mm (0～-5.8 mm),从Th3到Th5螺钉进针点的距离依次增宽,分别为-2.82 mm,-3.69 mm和-4.26mm。螺钉的平均横切面角度是32.68°(21.3°～39.6°),Th3～Th5螺钉的角度逐渐减小,分别为34.82°,32.73°和30.48°。螺钉进针点的平均矢状面距离是5.68 mm (2.7～9.1 mm),从Th3到Th5螺钉进针点的位置逐渐降低,分别是4.58 mm,5.89 mm和6.56 mm。螺钉的平均矢状面角度是82.44° (71.1°～91.2°),从Th3到Th5螺钉的角度逐渐增大,分别为78.17°,83.30°和85.85°。结论：1.椎弓根螺钉直径的选择主要由其横径决定,椎弓根-肋骨复合体螺钉直径的选择主要由其有效纵径限制。2.与椎弓根螺钉相比,在Th3～Th5的椎弓根-肋骨复合体可以选择较粗、较长的螺钉。3.Th3～Th5经椎弓根-肋骨复合体途径置钉较经椎弓根置钉有更大的外倾角,可减少螺钉穿破椎弓根内侧壁而损伤脊髓风险。4.术中实施Th3～Th5的前路逆向椎弓根-肋骨复合体螺钉时,要充分考虑其立体结构的复杂性,尽量把螺钉位于重叠的骨性结构,要根据不同的节段选择不同的螺钉直径和长度,以及不同的进钉点和置钉方向。第二部分Th3～Th5前路逆向椎弓根-肋骨复合体螺钉内固定技术的生物力学研究目的：测定Th3～Th5前路逆向椎弓根-肋骨复合体螺钉的最大轴向拔出力来评价其生物力学性能,并与椎弓根螺钉进行比较。方法：取10具福尔马林固定的人体胸椎标本(T1～T6),保留标本及相连的一段长约5cm肋骨和肋间软组织及壁胸膜。在Th3～Th5椎体的一侧的经椎弓根-肋骨复合体逆向植入5.0 mm X 50 mm的螺钉,在对侧植入椎弓根螺钉(3.5 mm X 35 mm)。在岛津万能试验机上测量每颗螺钉的最大轴向拔出力。结果：前路逆向椎弓根-肋骨复合体螺钉的轴向最大拔出力的平均值是322.1±66.6 N,椎弓根螺钉轴向最大拔出力的平均值是340.6±55.0N,两者比较的差别没有统计学上的意义(P=0.254)。结论：选择较粗和较长的螺钉固定时,前路逆向椎弓根-肋骨复合体螺钉的生物力学性能与椎弓根螺钉的生物力学性能基本相似,前路逆向椎弓根-肋骨复合体螺钉固定技术可以为脊柱的重建提供坚强的固定。
[Abstract]:The purpose of the first part of the Th3-Th5 shape measurement of anterior transpedicular screw fixation of rib complex imaging in the Mimics reconstruction model of CT flat two-dimensional and three-dimensional Th3-Th5 scan on thoracic of normal people were observed and measured, for upper thoracic spine (Th3 ~ Th5) of the anterior reverse pedicle rib complex screw fixation technique to provide morphological data for reference. Methods: 30 patients with upper thoracic spine (Th1 ~ Th6) of the thin CT scan data reconstruction, measurement of pedicle and pedicle rib complex in the cross section of the nail into the angle of transverse diameter, screw path length and cross section, in the coronal plane measurement of pedicle longitudinal diameter and effective the longitudinal diameter of the pedicle rib complex. Select the CT scan data of 20 cases of the patients, using Mimincs software to reconstruct the Th1 ~ Th6 pedicle rib complex 3D model, and then use the built-in simulation software A simulation of Th3 ~ Th5 Shiumi Ne rib complex best screw and screw axis, and finally use the 3-D tool for measuring screw transverse and sagittal screw point distance, transverse and sagittal screw angle and the length of screws. Results: Th3 ~ Th5 segment Shiumi Ne rib bone complex the average diameter (5.03 mm) was significantly higher than Shiumi Ne's average diameter (12.73 mm), the average effective Shiumi Ne longitudinal rib complex size (9.17 mm) was significantly less than the average Shiumi Ne longitudinal diameter (11.72 mm). In view of the nail Shiumi Ne rib complex is greater than the nail angle (31.43 degrees of Shiumi Ne 13.32 ~ VS), screw length (56.48 mm VS 38.77mm). Shiumi Ne longitudinal segment Th3-Th5 diameter greater than the diameter, but the effective longitudinal Shiumi Ne rib complex size smaller than the transverse diameter, Shiumi Ne cross and larger segments of the same size. The anterior reverse Shiumi Ne ribs 澶嶅悎浣撹灪閽夌殑骞冲潎闀垮害鏄，

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