山羊可动腰椎复合体的设计及体外生物力学研究

发布时间：2018-06-27 12:34

本文选题：人工椎体 + 腰椎　；参考：《中国脊柱脊髓杂志》2017年04期

【摘要】：目的 :研制一种既能重建腰椎椎体高度又能保留相应椎间隙运动功能的山羊可动腰椎复合体并进行体外生物力学测试,从而为人工腰椎假体动物模型的建立及体内研究奠定基础。方法:26个新鲜山羊腰椎标本行薄层CT检查以排除存在脊柱畸形、骨折的标本,其中2个标本因椎体骨折被排除,24个标本纳入研究。应用计算机辅助软件对山羊腰椎拟手术区解剖参数进行采集(对L4椎体及邻近的椎间盘进行解剖测量)以及可动假体模型优化设计,根据24个标本的腰椎解剖参数将假体大小设计成5种规格,并利用3D打印与机械加工技术将其制作而成。将24个标本随机分为生理、融合与非融合3组,每组8个,术前行骨密度检查。生理组标本不进行手术操作,融合组与非融合组标本行L4椎体及邻近椎间盘部分切除,融合组标本置入钛笼、钛板,非融合组标本置入山羊腰椎复合体(假体置入在L4)。术后所有标本行影像学检查以判断假体位置及脊髓受压情况,然后对3组标本在4Nm的载荷下进行生物力学活动度测试以评估可动假体的活动度及稳定性。结果:3组标本骨密度检查无统计学差异(P0.05)。山羊L4椎体的前、中、后高分别为38.8±2.7mm、39.7±2.1mm、40.9±1.1mm;其上、中、下平面正中矢状径与正中冠状径分别为16.5±0.8mm、12.5±2.0mm、16.6±0.5mm与22.9±2.6mm、14.3±1.3mm、23.6±2.9mm;L3/4与L4/5椎间隙前、中、后高分别为4.9±1.0mm、3.0±0.5mm、1.9±1.0mm与5.0±0.4mm、3.6±0.9mm、2.4±0.9mm。山羊可动腰椎复合体由椎体部件与椎间盘部件构成,两者通过防脱球窝关节连接。术后影像学检查未发现假体位置异常及脊髓受压。与融合组相比,非融合组标本能显著保留L3/4和L4/5的运动范围、降低L2/3的运动范围(P0.05);与生理组相比,非融合组各椎间隙的运动范围无显著性差异(P0.05)。结论 :根据山羊腰椎解剖结构设计的山羊可动腰椎复合体不但可重建手术节段的椎体高度与稳定性,而且能保留相应节段的活动度。
[Abstract]:Objective: to develop a kind of goat movable lumbar complex which can reestablish the height of the lumbar vertebra and retain the motion function of the intervertebral space, and carry out a biomechanical test in vitro, so as to lay the foundation for the establishment of animal model of artificial lumbar prosthesis and in vivo research. Method: the thin layer CT examination of the lumbar vertebra standard of 26 fresh goat is excluded. Specimens of spinal deformity and fracture, of which 2 specimens were excluded because of vertebral fracture, 24 specimens were included in the study. Computer aided software was used to collect the anatomical parameters of the goats' lumbar pseudo operation area (the L4 vertebral and adjacent intervertebral discs were dissected) and the optimal design of the movable prosthesis pattern, according to the anatomical parameters of the lumbar vertebrae of 24 specimens. The size of the prosthesis was designed into 5 specifications and made up of 3D printing and machining technology. The 24 specimens were randomly divided into 3 groups, including physiological, fusion and non fusion, 8 in each group. The bone mineral density was examined before operation. The physiological group specimens were not operated on, the fusion group and the non fusion group were partially excised by the L4 vertebral body and adjacent intervertebral disc. The specimens were implanted in the titanium cage, titanium plate and non fusion group into the goat lumbar vertebra complex (implant in L4). All specimens were examined to determine the position of the prosthesis and the compression of the spinal cord after the operation. Then the biomechanical activity of the 3 groups was tested under the load of 4Nm to evaluate the mobility and stability of the prosthesis. Results: 3 There was no statistical difference in the bone mineral density of the group specimens (P0.05). The anterior, middle and posterior height of the goat L4 vertebral body were 38.8 + 2.7mm, 39.7 + 2.1mm, 40.9 + 1.1mm respectively. In the upper, middle and lower plane median sagittal diameter and median coronal diameter were 16.5 + 0.8mm, 12.5 + 2.0mm, 16.6 + 0.5mm and 22.9 + 2.6mm, 14.3 + 1.3mm, 23.6 + 2.9mm, before and before the intervertebral space. Don't be 4.9 + 1.0mm, 3 + 0.5mm, 1.9 + 1.0mm and 5 + 0.4mm, 3.6 + 0.9mm, and 2.4 + 0.9mm. goat's movable lumbar complex composed of vertebral body parts and intervertebral disc parts. The range of movement of L4/5 and the range of movement of L2/3 (P0.05); there was no significant difference in the range of motion between the intervertebral spaces of the non fusion group compared with the physiological group (P0.05). Conclusion: the goat movable lumbar complex designed according to the anatomical structure of the goat's lumbar vertebra can not only reconstruct the vertebral height and stability of the surgical segment, but also retain the corresponding segment. Activity degree.
【作者单位】：西安交通大学第二附属医院骨科;陕西省西安市第四医院骨科;
【基金】：2014年度西安交通大学综合交叉重点项目(编号:xjtc2014001)
【分类号】：R318.17

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