本文關(guān)鍵詞： 脊柱爆裂性骨折 后壁缺損 后壁封堵加壓器 修復(fù)　出處：《南華大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的：設(shè)計一種椎體后壁封堵加壓器,用于治療伴有后壁損傷脊柱爆裂性骨折及椎體后壁骨缺損的修復(fù)過程中,復(fù)位椎管內(nèi)碎骨片；防止術(shù)中骨水泥滲漏及其引起的并發(fā)癥。材料和方法：椎體后壁封堵加壓器由橫梁桿、U型加壓器、螺桿、壓片組成。取12具成年新鮮正常豬的脊柱標(biāo)本,三個椎體為一個單元模型,分為A(爆裂性骨折組)、B(椎體后壁骨缺損組)兩組,行影像學(xué)檢查,排除骨病等干擾因素后,剔除標(biāo)本所有附著肌肉組織,保留上下椎間盤、棘上韌帶、棘間韌帶的完整性。A組采用Panjabi[1]提出的“自由落體逐級撞擊法”來制作標(biāo)本中間椎體伴后壁損傷的爆裂性骨折。將制作成的模型椎弓根釘撐開復(fù)位固定后,行CT檢查,測量椎管占位率。安裝好椎體后壁封堵加壓器實施椎體成型術(shù),觀察術(shù)中骨水泥是否滲漏及術(shù)后椎體后壁是否完整,再次行CT檢查確認(rèn),測量椎管內(nèi)骨塊占位率及中間椎體前端、中緣、后端的高度。統(tǒng)計數(shù)據(jù)主要采用Spss18.0軟件處理。B組使用鉆頭造成椎體后壁骨缺損模型,其中骨缺損的直徑為10mm,深度為10mm。行X線、CT檢查,證實造模成功,安裝椎體后壁封堵加壓器封堵椎體后壁后從椎管根入路注入骨水泥,觀察骨水泥是否滲漏及術(shù)后椎體后壁是否完整,行CT檢查確認(rèn)。結(jié)果：1.實驗一手術(shù)過程中出現(xiàn)1例骨水泥滲漏至椎旁,未出現(xiàn)骨水泥滲漏至椎管。減壓徹底,椎管內(nèi)無殘留碎骨片,術(shù)后椎體后壁完整。2.椎體前緣高度造模成功后、撐開復(fù)位后、注射骨水泥后分別為63.5±10.6%、76.5±±7.6%、77.2±7.6%。椎體中緣高度由制造模成功后、恢復(fù)至撐開復(fù)位、椎體成形術(shù)后分別為60.1士9.8%、73.5±±6.2%、74.44±6.7%,椎體后緣高度造模成功后、撐開復(fù)位后、椎體成形術(shù)后分別為83.44±7.7%、94.5±±7.0%、95.2±±7.0%。椎管內(nèi)骨塊占位率造模成功后、撐開復(fù)位后、椎體成形術(shù)后分別為34.4±5.2%,9.1±3.1%,3.0±±0.8%。撐開復(fù)位后傷椎椎體前、中、后緣高度及椎管占位率較術(shù)前明顯改善(P0.05)注射骨水泥后傷椎椎體前、中、后緣高度及椎管占位率較術(shù)前明顯改善(P0.05)撐開復(fù)位后椎體前、中、后緣高度與注射骨水泥后比較無明顯統(tǒng)計學(xué)意義(P0.05),注射骨水泥后椎管占位率(SOR)有明顯改善(P0.05)。3.實驗二過程中肉眼觀未出現(xiàn)明顯骨水泥滲漏,椎體后壁完整、光滑,CT顯示椎體后壁完整,椎管內(nèi)無占位。結(jié)論：椎體后壁封堵加壓器,用于治療伴有后壁損傷脊柱爆裂性骨折及椎體后壁骨缺損的修復(fù)過程中,可對椎管內(nèi)骨折塊進(jìn)行復(fù)位；防止骨水泥滲漏；防止骨水泥對脊髓的熱損傷。
[Abstract]:Objective: to design a kind of posterior wall plugging plus voltage regulator for the treatment of spinal burst fracture with posterior wall injury and the repair of posterior wall bone defect, and to reduce the bone fragments in the spinal canal. Materials and methods: the posterior wall of vertebra sealing and pressurizing was made up of U-type supercharger, screw and press slice. The spinal specimens of 12 adult fresh normal pigs were taken. The three vertebrae were divided into two groups: group A (burst fracture group) and group A (vertebral posterior wall bone defect group). Preservation of superior and inferior intervertebral discs, supraspinal ligaments and interspinous ligaments. Group A was treated with Panjabi. [1. The "free falling body step by step impact method" was put forward to make the burst fracture of the middle vertebra with posterior wall injury. After the pedicle nail was extended and fixed, CT was performed. Vertebral canal occupancy rate was measured. Vertebral body formation was performed by installing vertebral posterior wall plugging and pressurizer to observe the leakage of bone cement during operation and the integrity of posterior wall of vertebral body after operation. Ct examination was performed again to confirm it. The ratio of bone mass occupying in the spinal canal and the height of the front, middle and back end of the middle vertebral body were measured. The statistical data were mainly processed by Spss18.0 software. B group was used to make the model of bone defect in the posterior wall of the vertebral body. The bone defect was 10 mm in diameter and 10 mm in depth. X-ray and CT examinations were performed to confirm the success of the model. The posterior wall of the vertebral body was plugged and the posterior wall of the vertebral body was plugged by a pressure regulator. The bone cement was injected through the root of the spinal canal after plugging the posterior wall of the vertebral body. To observe whether the bone cement leakage and the integrity of the posterior wall of the vertebral body after operation, CT examination confirmed. Results 1. During the first operation, one case of bone cement leakage occurred to the paravertebral vertebrae. No bone cement leakage to the spinal canal. Decompression thoroughly, no residual bone fragments in the spinal canal, the posterior wall of the vertebral body is intact. 2. After the successful modeling of the anterior edge of the vertebral body, the vertebral body was extended and reduced. After injection of bone cement, it was 63.5 鹵10.6 鹵76.5 鹵7.6 and 77.2 鹵7.6, respectively. The height of the middle edge of vertebral body was restored to open reduction after the successful manufacture of the model. After vertebroplasty, it was 73.5 鹵6.2and 74.44 鹵6.7respectively after vertebroplasty. After vertebroplasty, it was 83.44 鹵7.7and 94.5 鹵7.0and 95.2 鹵7.0. after the successful establishment of the model, the rate of bone mass in the vertebral canal was opened and reduced. After vertebroplasty, it was 34.4 鹵5.2 and 9.1 鹵3.1 鹵3.0 鹵0.8 respectively. The posterior edge height and spinal canal occupation rate were significantly improved after injection of bone cement (P 0.05). The posterior edge height and the spinal canal occupation rate were significantly improved compared with the preoperative P0.05). There was no significant difference in the anterior, middle and posterior height of the vertebral body between the posterior edge height and the bone cement injection group (P 0.05). The spinal canal occupation rate (SOR) after injection of bone cement was significantly improved (P 0.05). In experiment 2, there was no obvious leakage of bone cement, and the posterior wall of vertebral body was intact and smooth. Ct showed that the posterior wall of the vertebral body was intact and there was no space occupying in the vertebral canal. Conclusion: the posterior wall of the vertebral body is occluded and pressurized for the treatment of the burst fracture of the spine with injury of the posterior wall and the repair of the bone defect of the posterior wall of the vertebral body. The intraspinal fracture block can be reduced. Prevent bone cement leakage; Prevent thermal damage to the spinal cord caused by bone cement.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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