经后路伤椎置钉对椎弓根劈裂后内固定生物力学稳定性的影响
发布时间：2018-07-22 20:02
【摘要】：本研究选用绵羊脊柱标本建造椎弓根劈裂模型,初步探讨椎弓根劈裂对脊柱椎体骨折椎弓根螺钉内固定稳定性的影响。在此实验研究基础上,采取不同伤椎置钉方式对椎弓根劈裂进行置钉,进一步探讨不同伤椎置钉方式对螺钉内固定稳定性的影响。椎弓根劈裂对脊柱椎体骨折椎弓根螺钉内固定稳定性影响的实验研究:选取新鲜(宰杀后6h内)绵羊脊柱标本20具,截取(T13~L3)脊柱段,在排除肿瘤、骨折及先天性脊柱畸形等情况后,对20具标本制作单椎体压缩骨折模型,然后将20具标本随机分为A、B两组,以A组标本模型作为单纯压缩骨折模型;再对B组标本T14胸椎的左侧椎弓根行外侧1/4切除,作为压缩骨折合并椎弓根劈裂椎体模型。然后对A、B两组模型分别置钉,进钉深度为钉道全长。然后在生物力学机上对标本进行模型行10000次疲劳实验,在疲劳实验后测定两组标本模型前屈、后伸、左侧弯、右侧弯4个方向运动范围(range of motion,ROM)的大小和螺钉拔出力大小,并比较两组差异[1]。在疲劳实验后,A、B两组实验标本模型活动度检测结果显示:A组(单纯压缩骨折模型组)各个方向活动范围大小:前屈(1.81±0.14)°、后伸(1.68±0.37)°、左侧弯(4.08±0.41)°、右侧弯(4.18±0.12)°;B组(压缩骨折合并椎弓根劈裂椎体模型组)各个方向活动范围大小:前屈(4.49±0.40)°、后伸(3.72±0.51)°、左侧弯(6.67±0.64)°、右侧弯(6.73±0.58)°。经统计分析显示,A组(单纯压缩骨折模型组)各个方向的活动范围均显著小于B组(压缩骨折合并椎弓根劈裂椎体模型组)(p0.01)。A、B两组标本模型螺钉最大拔出力检测结果显示:A、B组螺钉最大拔出力分别为(252.34±51.27)N;(115.50±36.74)N。经统计分析显示,A组(单纯压缩骨折模型组)螺钉最大拔出力显著大于B组(压缩骨折合并椎弓根劈裂椎体模型组)(p0.01)。不同伤椎置钉方式对螺钉内固定稳定性的影响的实验研究:选取新鲜(宰杀后6h内)绵羊脊柱标本36具,取(t13~l3)脊柱段,在排除肿瘤、骨折、及先天性脊柱畸形等情况后,将36具标本随机分为a、b、c、d四组,a、b两组标本处理同前;c、d两组处理同b组制作椎弓根劈裂椎体骨折模型,然后分别对四组标本行椎弓根置钉,进钉深度为钉道全长,a、b组标本置钉同前,c组标本置入四根椎弓根螺钉后,再在骨折椎体左侧椎弓根置入一根螺钉,d组置入四根椎弓根螺钉后,再在骨折椎体两侧椎弓根内均置入螺钉,即c组为置入5根螺钉组,d组为置入6根螺钉组。实验脊柱标本椎弓根置钉后,在生物力学机上以1.5hz的频率及(300±105)n的载荷对四组模型进行10000次循环加压,检测a、b、c、d四组标本模型的屈、伸及左右侧弯的活动范围,四组标本t14椎体左侧椎弓根螺钉的最大拔出力的大小及四组标本的轴向压缩刚度[1]。实验结果如下:四组标本模型的轴向压缩刚度结果显示:a(单纯压缩骨折模型组)、c(5钉组)、d(6钉组)三组的的轴向压缩刚度均显著大于b组(压缩骨折合并椎弓根劈裂椎体模型组),差异均具有统计学意义(p0.01);c(5钉组)、d(6钉组)两组的轴向压缩刚度均显著大于a组(单纯压缩骨折模型组),差异均有统计学意义(p0.01);c(5钉组)、d(6钉组)两组的轴向压缩刚度比较无明显差异(p0.05)。四组标本螺钉最大拔出力检测结果显示:b组(压缩骨折合并椎弓根劈裂椎体模型组)、c(5钉组)、d(6钉组)三组最大螺钉拔出力均显著低于a组(单纯压缩骨折模型组)(p0.01);b组(压缩骨折合并椎弓根劈裂椎体模型组)、c(5钉组)、d(6钉组)三组螺钉最大拔出力比较差异均无统计学意义(p0.05)。四组标本活动度检测结果显示:a(单纯压缩骨折模型组)、c(5钉组)、d(6钉组)三组在屈、伸及左、右侧弯4个方向上的活动度均小于b组(压缩骨折合并椎弓根劈裂椎体模型组)(p㩳0.01);c(5钉组)、d(6钉组)两组在屈伸、侧弯4个方向的运动范围均显著低于a组(单纯压缩骨折模型组)(p0.01);c(5钉组)、d(6钉组)两组在屈伸、侧弯4个方向的运动范围比较无明显差异(p0.05)。本研究结果提示,椎弓根皮质劈裂将会降低椎弓根螺钉内固定的稳定性,伤椎置钉能增加劈裂椎弓根内固定的稳定性,甚至稳定性优于椎弓根完整时的稳定性[2]。
[Abstract]:The effect of pedicle splitting on the stability of pedicle screw internal fixation of vertebral body fracture was preliminarily investigated by using a sheep spine specimen to build a pedicle split model. Effect of stability. An experimental study on the effect of pedicle screw fixation on vertebral pedicle fracture with pedicle split fracture: 20 specimens of fresh (after slaughtered 6h) sheep spinal column were selected to intercept (T13~L3) spinal segments. After removing tumors, fractures, and congenital spinal deformities, a single vertebral compression fracture model was made on 20 specimens, and then the model of single vertebral compression fracture was made. 20 specimens were randomly divided into A, B two, group A specimen model as simple compression fracture model, and then lateral 1/4 resection of the left pedicle of T14 thoracic vertebra in group B specimens as a compression fracture combined with pedicle splitting vertebral body model. Then A, B two models were nailed and the nail depth was the total length of the nail path. Then the biomechanical machine was used to mark the mark on the biomechanics machine. In this model, 10000 fatigue tests were carried out. After fatigue test, the size of range of motion, ROM and the size of screw pulling force were measured in 4 directions (of motion, ROM), and after fatigue test, after fatigue test, the activity degree detection results of A and B two group specimens showed A group (single). In the pure compression fracture model group, the range of movement in all directions: anterior flexion (1.81 + 0.14), extension (1.68 + 0.37), left bend (4.08 + 0.41), right bend (4.18 + 0.12) degrees, and group B (compression fracture combined with pedicle split vertebra model group) in all directions: anterior flexion (4.49 + 0.40) degrees, extension (3.72 + 0.51) degrees, left bend (6.67 + 1.68) degrees, Right bending (6.73 + 0.58) degrees. The statistical analysis showed that the range of activity in each direction of group A (simple compression fracture model group) was significantly smaller than that of group B (compression fracture combined with pedicle split vertebra model group) (P0.01).A. The maximum pulling force detection of model screws in B two groups showed: A, the maximum pulling force of B group screws was (252.34 + 51.27) N, respectively; (1) 15.50 + 36.74) N. showed that the maximum pulling force of screw in group A (simple compression fracture model group) was significantly greater than that of group B (compression fracture combined with pedicle split vertebra model group) (P0.01). The experimental study on the influence of different wound vertebra on the stability of internal fixation of screw fixation: 36 specimens of fresh (T1 after slaughtered 6h) sheep spinal column were selected (T1 3~l3) spinal segment, after removing the tumor, fracture, and congenital spinal deformities, 36 specimens were randomly divided into a, B, C, D four groups, a, B two groups were treated with the same before; C, D two groups were treated with the B group to make the vertebral arch fracture model of vertebral arch, and then the pedicle screws of the four groups were set respectively, the depth of the nail was the nailed length, a, B group specimens set the nail. At the same time, after four pedicle screws were placed in group C, a screw was inserted in the left pedicle of the fractured vertebral body. After four pedicle screws were placed in group D, the screws were inserted in the pedicle of the vertebral body, that is, group C was placed in 5 screws, and group D was placed in 6 screw groups. At the frequency of 1.5Hz and the load of (300 + 105) n, four groups of models were subjected to 10000 cyclic pressurization to detect the flexion of a, B, C, D four group specimens, the range of activity of the left and right side bending, the maximum pulling force of the left pedicle screw of the four groups of T14 vertebrae and the axial compression stiffness [1]. experimental results of the four groups of the four groups: four groups of specimens. The axial compression stiffness of the model showed that the axial compression stiffness of a (simple compression fracture model group), C (5 nail group) and D (6 nail group) was significantly greater than that of group B (compression fracture combined with pedicle split vertebra model group), the difference was statistically significant (P0.01), and C (5 nail group), and D (6 nail group) two groups were significantly greater than the a group (the group of 6 nails). The difference was statistically significant (P0.01), and there was no significant difference in axial compression stiffness between the two groups of C (5 nail group) and D (6 nail group). The maximum pulling force test of the four groups of specimens showed that the B group (compression fracture combined with pedicle split vertebra model group), C (5 nail group), and D (6 nail group) three groups of three groups of maximum screw pulling force were all Significantly lower than group A (simple compression fracture model group) (P0.01), group B (compression fracture combined with pedicle split vertebra model group), C (5 nail group), D (6 nail group) three groups of screw maximum pulling force difference was not statistically significant (P0.05). Four groups of specimens activity detection results showed: a (simple compression fracture model group), C (5 nail group), D (6 nailing group) three groups in three groups) Flexion, extension and left, right bend in 4 directions were less active than group B (compression fracture combined with pedicle split vertebra model group) (P? 0.01); C (5 nail group), D (6 nail group) two groups in flexion and extension and lateral bending were significantly lower than group A (pure compression bone fracture model group) (P0.01); C (5 nail group), D (6 nail group) two groups in flexion extension, side bend 4 directions There is no significant difference in the range of movement (P0.05). The results of this study suggest that pedicle cortical cleavage can reduce the stability of the pedicle screw internal fixation, and the injured vertebral placement can increase the stability of the pedicle internal fixation, and even the stability is better than the stability of the pedicle intact [2].
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2138410
[Abstract]:The effect of pedicle splitting on the stability of pedicle screw internal fixation of vertebral body fracture was preliminarily investigated by using a sheep spine specimen to build a pedicle split model. Effect of stability. An experimental study on the effect of pedicle screw fixation on vertebral pedicle fracture with pedicle split fracture: 20 specimens of fresh (after slaughtered 6h) sheep spinal column were selected to intercept (T13~L3) spinal segments. After removing tumors, fractures, and congenital spinal deformities, a single vertebral compression fracture model was made on 20 specimens, and then the model of single vertebral compression fracture was made. 20 specimens were randomly divided into A, B two, group A specimen model as simple compression fracture model, and then lateral 1/4 resection of the left pedicle of T14 thoracic vertebra in group B specimens as a compression fracture combined with pedicle splitting vertebral body model. Then A, B two models were nailed and the nail depth was the total length of the nail path. Then the biomechanical machine was used to mark the mark on the biomechanics machine. In this model, 10000 fatigue tests were carried out. After fatigue test, the size of range of motion, ROM and the size of screw pulling force were measured in 4 directions (of motion, ROM), and after fatigue test, after fatigue test, the activity degree detection results of A and B two group specimens showed A group (single). In the pure compression fracture model group, the range of movement in all directions: anterior flexion (1.81 + 0.14), extension (1.68 + 0.37), left bend (4.08 + 0.41), right bend (4.18 + 0.12) degrees, and group B (compression fracture combined with pedicle split vertebra model group) in all directions: anterior flexion (4.49 + 0.40) degrees, extension (3.72 + 0.51) degrees, left bend (6.67 + 1.68) degrees, Right bending (6.73 + 0.58) degrees. The statistical analysis showed that the range of activity in each direction of group A (simple compression fracture model group) was significantly smaller than that of group B (compression fracture combined with pedicle split vertebra model group) (P0.01).A. The maximum pulling force detection of model screws in B two groups showed: A, the maximum pulling force of B group screws was (252.34 + 51.27) N, respectively; (1) 15.50 + 36.74) N. showed that the maximum pulling force of screw in group A (simple compression fracture model group) was significantly greater than that of group B (compression fracture combined with pedicle split vertebra model group) (P0.01). The experimental study on the influence of different wound vertebra on the stability of internal fixation of screw fixation: 36 specimens of fresh (T1 after slaughtered 6h) sheep spinal column were selected (T1 3~l3) spinal segment, after removing the tumor, fracture, and congenital spinal deformities, 36 specimens were randomly divided into a, B, C, D four groups, a, B two groups were treated with the same before; C, D two groups were treated with the B group to make the vertebral arch fracture model of vertebral arch, and then the pedicle screws of the four groups were set respectively, the depth of the nail was the nailed length, a, B group specimens set the nail. At the same time, after four pedicle screws were placed in group C, a screw was inserted in the left pedicle of the fractured vertebral body. After four pedicle screws were placed in group D, the screws were inserted in the pedicle of the vertebral body, that is, group C was placed in 5 screws, and group D was placed in 6 screw groups. At the frequency of 1.5Hz and the load of (300 + 105) n, four groups of models were subjected to 10000 cyclic pressurization to detect the flexion of a, B, C, D four group specimens, the range of activity of the left and right side bending, the maximum pulling force of the left pedicle screw of the four groups of T14 vertebrae and the axial compression stiffness [1]. experimental results of the four groups of the four groups: four groups of specimens. The axial compression stiffness of the model showed that the axial compression stiffness of a (simple compression fracture model group), C (5 nail group) and D (6 nail group) was significantly greater than that of group B (compression fracture combined with pedicle split vertebra model group), the difference was statistically significant (P0.01), and C (5 nail group), and D (6 nail group) two groups were significantly greater than the a group (the group of 6 nails). The difference was statistically significant (P0.01), and there was no significant difference in axial compression stiffness between the two groups of C (5 nail group) and D (6 nail group). The maximum pulling force test of the four groups of specimens showed that the B group (compression fracture combined with pedicle split vertebra model group), C (5 nail group), and D (6 nail group) three groups of three groups of maximum screw pulling force were all Significantly lower than group A (simple compression fracture model group) (P0.01), group B (compression fracture combined with pedicle split vertebra model group), C (5 nail group), D (6 nail group) three groups of screw maximum pulling force difference was not statistically significant (P0.05). Four groups of specimens activity detection results showed: a (simple compression fracture model group), C (5 nail group), D (6 nailing group) three groups in three groups) Flexion, extension and left, right bend in 4 directions were less active than group B (compression fracture combined with pedicle split vertebra model group) (P? 0.01); C (5 nail group), D (6 nail group) two groups in flexion and extension and lateral bending were significantly lower than group A (pure compression bone fracture model group) (P0.01); C (5 nail group), D (6 nail group) two groups in flexion extension, side bend 4 directions There is no significant difference in the range of movement (P0.05). The results of this study suggest that pedicle cortical cleavage can reduce the stability of the pedicle screw internal fixation, and the injured vertebral placement can increase the stability of the pedicle internal fixation, and even the stability is better than the stability of the pedicle intact [2].
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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