新型椎弓根钉应用骨水泥强化的相关研究

发布时间：2018-05-03 13:58

本文选题：动物模型 + 骨质疏松　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的:1、通过经椎弓根微量泵入脱钙液及椎体前缘浸泡脱钙液的方法模拟人体腰椎动态脱钙过程,从而建立快速、与人体腰椎近似、可控性高的骨质疏松模型。2、研究在何种骨质疏松程度下,PMI-NPPS(percutaneous minimally invasive novel perfusional pedicle screw,经皮长U形空心椎弓根钉钉孔骨水泥强化的新型椎弓根钉)加骨水泥强化系统在生物力学方面要优于单纯PMI-NPPS系统并达到正常骨质时的生物力学水平,从而为临床上不同骨质疏松的病人在使用PMI-NPPS时是否需要骨水泥强化提供理论依据。3、探索骨水泥剂量与PMI-NPPS加骨水泥强化系统生物力之间的关系,为临床上骨水泥剂量的使用提供一定的理论依据。方法:1、特别制作了专用的灌注固定器,并有一套系统的脱钙装置2、制作2.5-3岁羊的新鲜离体腰椎80个3、将标本按完全随机设计的方法随机分成4组,分别脱钙0小时、2小时、4小时、6小时,进行骨密度测试。(A组:不脱钙;B组:3%稀盐酸脱钙2小时;C组:3%稀盐酸脱钙4小时;D组:3%稀盐酸脱钙6小时)4、统计学分析各处理组的BMD(Bone Mineral Density,骨密度),并计算出B、C、D三组BMD降低的百分比;分别对4组椎体进行CT(Computed Tomography,计算机断层扫描)检查。5、B组中的椎体一半打入PMI-NPPS(B1组),一半打入PMI-NPPS+1.5ml PMMA(Polymethylmethacrylate,聚甲基丙烯酸甲酯)(B2组),并分别进行生物力学测试,统计学分析得出结论:后者的生物力学指标是否优于前者并且达到正常骨密度组(A组)的生物力学水平。6、C、D组同样进行步骤5的操作。7、重新制作50个C组椎体,随机分成5组,分别置入PMI-NPPS+PMMA,PMMA剂量分别为0ml、0.5ml、1ml、1.5ml、2ml,再分别进行生物力学测试,然后得出PMMA剂量与Fmax(the maximum pullout Force,最大拔出力)的关系。结果:1、脱钙处理2、4、6小时后的椎体其BMD分别下降18.3%、28.0%、40.8%。2、CT显示正常骨密度的椎体其密度均匀、图像清晰、密度较高,而脱钙后的椎体其密度降低,特别是横突和椎体中央最为明显,脱钙的时间越长,这种变化趋势更加明显。3、(1)B2组的Fmax和E(energy absorbed to failure,能量吸收值)分别为(936.60±70.16)N、(2.00±0.13)J,与B1组相比均具有显著性差异(P0.05),而与A组相比,均不具有显著性差异(P0.05)。(2)C2组的Fmax和E分别为(891.59±47.97)N、(1.89±0.07)J,与C1组相比均具有显著性差异(P0.05),而与A组相比,均不具有显著性差异(P0.05)。(3)D2组的Fmax和E分别为(531.50±35.61)N、(1.14±0.10)J,与D1组相比均具有显著性差异(P0.05),与A组相比,也均具有显著性差异(P0.05)。4、在C组中置入PMI-NPPS+PMMA,Fmax随骨水泥剂量的增大而增大。二者呈直线相关,线性回归方程为y=312.25x+418.75( R2=0.977)结论:1、应用椎体前缘浸泡稀盐酸和微量泵往椎弓根灌注稀盐酸的方法可以快速建立有效的骨质疏松模型,为生物力学的研究提供有效依据。2、在骨量减少、骨质疏松情况下,PMI-NPPS内注入PMMA可以提高螺钉的稳定性,并且达到正常骨密度时的生物力水平;在严重骨质疏松情况下,PMI-NPPS内注入PMMA可以提高螺钉的稳定性,但是不能达到正常骨密度时的生物力水平;此为临床应用PMI-NPPS时是否注入PMMA提供有效的理论依据。3、在骨质疏松条件下,往PMI-NPPS中注入PMMA,在一定剂量范围内,随着PMMA剂量的增加,PMI-NPPS+PMMA的Fmax越高,但需要考虑骨水泥渗漏的风险,此为临床骨水泥剂量的使用提供有效的理论依据。
[Abstract]:Objective: 1, the process of dynamic decalcification of the lumbar spine was simulated by the method of decalcification through the pedicle of the pedicle and the anterior edge of the vertebral body to simulate the process of dynamic decalcification of the lumbar spine, and to establish a rapid, similar and controllable osteoporosis model.2 with the human lumbar spine, and to study the degree of osteoporosis, PMI-NPPS (percutaneous minimally invasive novel perfusional PE). Dicle screw, a new type of pedicle bone cement strengthened by a skin long U shaped hollow pedicle nailed bone cement and a bone cement strengthening system is superior to the pure PMI-NPPS system in biomechanics and the biomechanical level of the normal bone, thus whether the bone cement should be strengthened for the patients with different osteoporosis in the clinical use of PMI-NPPS. The theoretical basis of.3 was provided to explore the relationship between the dosage of bone cement and the biological force of PMI-NPPS augmentation system, and to provide a certain theoretical basis for the use of clinical bone cement dosage. Method: 1, special perfusion fixator was made, and a system of decalcification was installed in a set of 2, 80 3 fresh isolated lumbar vertebrae of 2.5-3 year old sheep were made. The specimens were randomly divided into 4 groups according to the method of complete random design, which were decalcified for 0 hours, 2 hours, 4 hours and 6 hours. (group A: non decalcification; group B: 3% dilute hydrochloric decalcification for 2 hours; C group: 3% dilute hydrochloric acid decalcification for 4 hours; 3% dilute hydrochloric acid decalcification for 6 hours), and statistically analyzed BMD (Bone Mineral Density, bone density) of each treatment group, and counted and counted The percentage of B, C, and D three groups was calculated. CT (Computed Tomography, computed tomography) was used to examine.5 in 4 groups of vertebrae, and half of the vertebrae in the B group entered PMI-NPPS (B1 group), and half of the vertebrae were introduced into the PMI-NPPS+1.5ml. The conclusion is: whether the biomechanical index of the latter is superior to the former and achieves the biomechanical level of the normal bone density group (group A).6, C, and the group D also carries out step 5 operation.7, and reproduces 50 groups of C vertebrae and randomly divide into 5 groups, and the PMMA dose are 0ml, 0.5ml, 1ml, 1.5ml, respectively, respectively. Then, the relationship between PMMA dose and Fmax (the maximum pullout Force, maximum pulling force) was obtained. Results: 1, the vertebral BMD decreased by 18.3%, 28%, 40.8%.2 after decalcification for 2,4,6 hours, and CT showed that the density of the vertebral body with normal bone density was uniform, the image was clear and the density was high, and the density of the vertebral body after decalcification was reduced, especially the transverse process and the transverse process. The center of the vertebral body is the most obvious, the longer the decalcification time, the trend is more obvious.3, (1) the Fmax and E in group B2 (energy absorbed to failure, energy absorption value) are respectively (936.60 + 70.16) N, (2 + 0.13) J, compared with B1 group (P0.05), and compared with the group, no significant difference (2) E (891.59 + 47.97) N and (1.89 + 0.07) J, respectively, had significant difference (P0.05) compared with that of the C1 group (P0.05). (3) Fmax and E of D2 group were (531.50 + 35.61) N and (1.14 + 0.10) J, and there were significant differences compared with those of the group. In the group, PMI-NPPS+PMMA and Fmax were increased with the increase of bone cement dosage. The two was linear correlation and linear regression equation was y=312.25x+418.75 (R2=0.977) conclusion: 1. The method of applying dilute hydrochloric acid and micropump to the pedicle by using the anterior edge of vertebral body can quickly build an effective osteoporosis model, which is a biomechanical study. To provide an effective basis for.2, in the case of bone mass reduction and osteoporosis, the injection of PMMA in PMI-NPPS can improve the stability of the screw and reach the level of the biological force when the bone density is normal. In the case of severe osteoporosis, the injection of PMMA in PMI-NPPS can improve the stability of the screw, but it can not reach the biological force level when the normal bone density is not reached. This provides an effective theoretical basis for the clinical application of PMI-NPPS to the injection of PMMA. Under the condition of osteoporosis, PMMA is injected into PMI-NPPS. Within a certain dose, the higher the PMMA dose, the higher the Fmax of PMI-NPPS+PMMA is, but the risk of bone cement leakage should be considered. This provides an effective reason for the use of clinical bone cement dosage. On the basis.

【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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