應(yīng)用聚甲基丙烯酸甲酯（PMMA）對新鮮尸體骨質(zhì)疏松標(biāo)本腰椎椎弓根釘?shù)赖膹娀芯?/H1>
發(fā)布時間：2018-03-10 06:07
本文選題：椎弓根螺釘 切入點：骨水泥強化 出處：《山東大學(xué)》2015年碩士論文 論文類型：學(xué)位論文
【摘要】：目的椎弓根螺釘內(nèi)固定系統(tǒng)普遍應(yīng)用于脊柱后路手術(shù)中,對脊柱的穩(wěn)定性起到重要的作用。在椎弓根螺釘對脊柱提供支撐穩(wěn)定作用時,臨床上普遍常見的一個并發(fā)癥是發(fā)生在“螺釘-骨質(zhì)”界面的松動,尤其是在骨質(zhì)疏松患者的人群中。新型設(shè)計的椎弓根螺釘在應(yīng)用于臨床前,對螺釘所進行的標(biāo)準(zhǔn)生物力學(xué)實驗方法為軸向拔出實驗,研究其力學(xué)性能。軸向拔出力學(xué)實驗數(shù)據(jù)與臨床實際應(yīng)用之間存在相關(guān)性。本實驗研究的主要目的是評價應(yīng)用聚甲基丙烯酸甲酯(PMMA)對新鮮人尸體骨質(zhì)疏松標(biāo)本的腰椎椎弓根釘?shù)廊N不同部位強化作用的差異性；進一步研究軸向拔出實驗的結(jié)果是否與椎弓根螺釘周期抗屈實驗的結(jié)果有直接的相關(guān)性。方法新鮮的人尸體骨質(zhì)疏松標(biāo)本腰椎椎弓根38個,每側(cè)椎弓根均植入椎弓根螺釘一枚,在置入椎弓根螺釘前通過骨水泥注射器向釘?shù)赖牟煌课蛔⑷牍撬唷８鶕?jù)骨水泥注入到釘?shù)赖牟煌课?將新鮮的人尸體骨質(zhì)疏松標(biāo)本腰椎分為4組：A組,釘?shù)牢磸娀M(空白對照組)；B組,椎弓根部位強化組；C組,椎體部位強化組；D組,全釘?shù)缽娀M。兩側(cè)的椎弓根內(nèi)骨水泥的注射部位不同,對其中一側(cè)的椎弓根進行周期抗屈實驗,對另一側(cè)進行椎弓根進行軸向拔出實驗。周期抗屈實驗的頻率為1.OHz,于螺釘釘頭位置加以正弦波形的應(yīng)力,應(yīng)力從25N開始逐步增加到75N。每個應(yīng)力進行250個周期,每隔250個周期應(yīng)力增加25N知道螺釘?shù)尼旑^部位的位移為5.4mm為止。軸向拔出實驗加載應(yīng)力時保持螺釘?shù)陌纬鏊俣葹?mm/min。結(jié)果1.周期抗屈實驗：在椎弓根螺釘釘頭產(chǎn)生相同位移的情況下,椎弓根強化組和全釘?shù)缽娀M相比,載荷差異無明顯統(tǒng)計學(xué)意義(P0.05)；椎體強化組和椎弓根強化組、全釘?shù)缽娀M相比,載荷差異有明顯統(tǒng)計學(xué)意義(P0.05)；各強化組與空白對照組相比,載荷的差異有明顯統(tǒng)計學(xué)意義(P0.05)。周期抗屈實驗中產(chǎn)生相同位移的情況下,與空白對照組相比,全釘?shù)缽娀M和椎弓根部位強化組均明顯增加載荷約27%,椎體部位強化組降低載荷約7%。椎弓根強化組載荷比椎體部位強化組相明顯增加37%。2.軸向拔出力實驗：與椎體部分強化組相比,釘?shù)雷倒课粡娀腿數(shù)缽娀M明顯增加軸向拔出力,差異有明顯統(tǒng)計學(xué)意義(P0.05)；椎弓根強化組與全釘?shù)缽娀M相比,最大軸向拔出力無明顯差別(P0.05)；螺釘各強化組均明顯高于空白對照組,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論1.對于骨質(zhì)疏松性椎體,椎弓根螺釘?shù)膹娀梢员憩F(xiàn)出很可靠地生物力學(xué)穩(wěn)定性,不僅軸向拔出實驗可以敏感的反應(yīng)螺釘?shù)纳锪W(xué)穩(wěn)定性,而且周期抗屈實驗也是評價生物力學(xué)穩(wěn)定性的重要實驗。周期抗屈實驗?zāi)M的是人體在行走時螺釘所承受載荷時的力學(xué)變化。2.通過軸向拔出實驗和周期抗屈實驗可知,椎弓根部位的強化可明顯提高螺釘?shù)纳锪W(xué)穩(wěn)定性,但是其強化作用還需要進一步經(jīng)過臨床試驗的驗證。全釘?shù)缽娀M雖然實驗生物力學(xué)穩(wěn)定性與椎弓根部位強化基本一致,但是由于其存在二次界面的原因,其遠(yuǎn)期穩(wěn)定性存在一定的風(fēng)險。因此臨床應(yīng)盡可能的在接近椎弓根部位進行強化。
[Abstract]:The purpose of pedicle screw fixation system is generally applied to the posterior spinal surgery, an important role for the stability of the spine. The pedicle screws provide support effect on the stability of the spine, a common clinical complications occurred in the "screw bone interface is loose, especially in patients with osteoporosis in the crowd. New design of pedicle screw in clinical application, the standard method of biomechanical experiment for screw pullout test, the mechanical properties of axial pullout. And there is a correlation between the clinical application of mechanical experimental data. The objective of this study is to evaluate the application of polymethylmethacrylate (PMMA) of fresh human cadaveric bone loose specimens of lumbar pedicle screw path difference of three different parts of the strengthening effect; further study of axial pullout experiment results The Shiumi Ne screw cyclic bending resistance test has a direct relationship. Methods fresh human cadaver specimens of lumbar osteoporosis Shiumi Ne 38, Shiumi Ne Shiumi Ne screws were implanted on each side of a syringe through bone cement implantation of bone cement to different parts of the screw placement in Shiumi Ne screw. According to bone cement injected into different parts of the nail the fresh human cadaveric lumbar osteoporosis were divided into 4 groups: A group, no screw augmentation group (control group); B group, Shiumi Ne group C group, part of strengthening; vertebral body augmentation group; group D, the strong nail group. Bone cement injection site on both sides of the Shiumi Ne the different, on one side of the Shiumi Ne cycle bending resistance test, on the other side of Shiumi Ne axial pullout experiment. Cyclic bending resistance test frequency is 1.OHz, the stress on the screw head position to sinusoidal waveform, stress from 25N began to stress the 250 cycle increased gradually to 75N. each, every 250 cycles of stress increased 25N know parts of the screw nail head displacement is 5.4mm. Keep the screw pull-out speed of 5mm/min. results of the 1. periodical anti bending experiment of axial pull-out test loaded stress: the nail head in pedicle screw have the same displacement situation, to strengthen Shiumi Ne group and augmentation group, there was no significant difference of load (P0.05); vertebroplasty group and Shiumi Ne group strengthened, all augmentation group, there was significant difference of load (P0.05); the strengthening group compared with the control group, there is obvious significant differences in load (P0.05). Cyclic bending resistance produces the same displacement in the experiment condition, compared with the control group, the augmentation group and Shiumi Ne group significantly increased the load strengthening parts of about 27%, vertebral body strong Group to reduce the load of about 7%. Shiumi Ne strengthened group load vertebral body augmentation group significantly increased 37%.2. phase axial pull-out experiment: compared with vertebral partial reinforcement group, screw position and strengthen the whole Shiumi Ne augmentation group significantly increased the axial pull-out, difference has obvious statistical significance (P0.05); Shiumi Ne strengthened group and the entire nail augmentation group compared with the maximum axial pull-out strength has no obvious difference (P0.05); the strengthening screw group were significantly higher than the blank control group, the difference was statistically significant (P0.05). Conclusion: 1. for osteoporotic vertebral strengthening can exhibit very reliable biomechanical stability of Shiumi Ne screw, not only the axial pullout experiment biomechanical stability sensitive reaction screw, and cyclic bending resistance experiment is important to evaluate the biomechanical stability. The cyclic bending resistance test is simulated in human walking screw The mechanical changes of.2. load through the axial pull-out test and cyclic bending resistance test shows that the reinforcement can significantly improve the biomechanical stability of screw parts of Shiumi Ne, but the strengthening effect still needs to be further validated in clinical trials. The augmentation group although the biomechanical stability and strengthening the basic parts of Shiumi Ne, but because of the there are two reasons for the long-term stability of the interface, there is a certain risk. Therefore, the clinical should as far as possible in parts of close to Shiumi Ne for strengthening.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
【參考文獻】
相關(guān)期刊論文 前3條
1 劉達(dá);吳子祥;高明暄;雷偉;;改進螺釘設(shè)計提高骨質(zhì)疏松條件下椎弓根螺釘穩(wěn)定性的研究進展[J];臨床骨科雜志;2009年05期
2 王春,劉衛(wèi)軍;脊柱椎弓根螺釘內(nèi)固定效果的生物力學(xué)評價[J];醫(yī)用生物力學(xué);1998年03期
3 趙政軍,孟平,李小川,高偉;治療骨質(zhì)疏松防止椎弓根釘松動[J];中國骨質(zhì)疏松雜志;2003年02期
相關(guān)博士學(xué)位論文 前1條
1 劉國民;細(xì)胞外基質(zhì)成份涂層椎弓根螺釘在負(fù)荷與非負(fù)荷狀態(tài)下誘導(dǎo)、傳導(dǎo)骨生成的研究[D];吉林大學(xué);2010年
，
本文編號：1592081
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/1592081.html
本文選題：椎弓根螺釘 切入點：骨水泥強化 出處：《山東大學(xué)》2015年碩士論文 論文類型：學(xué)位論文
【摘要】：目的椎弓根螺釘內(nèi)固定系統(tǒng)普遍應(yīng)用于脊柱后路手術(shù)中,對脊柱的穩(wěn)定性起到重要的作用。在椎弓根螺釘對脊柱提供支撐穩(wěn)定作用時,臨床上普遍常見的一個并發(fā)癥是發(fā)生在“螺釘-骨質(zhì)”界面的松動,尤其是在骨質(zhì)疏松患者的人群中。新型設(shè)計的椎弓根螺釘在應(yīng)用于臨床前,對螺釘所進行的標(biāo)準(zhǔn)生物力學(xué)實驗方法為軸向拔出實驗,研究其力學(xué)性能。軸向拔出力學(xué)實驗數(shù)據(jù)與臨床實際應(yīng)用之間存在相關(guān)性。本實驗研究的主要目的是評價應(yīng)用聚甲基丙烯酸甲酯(PMMA)對新鮮人尸體骨質(zhì)疏松標(biāo)本的腰椎椎弓根釘?shù)廊N不同部位強化作用的差異性；進一步研究軸向拔出實驗的結(jié)果是否與椎弓根螺釘周期抗屈實驗的結(jié)果有直接的相關(guān)性。方法新鮮的人尸體骨質(zhì)疏松標(biāo)本腰椎椎弓根38個,每側(cè)椎弓根均植入椎弓根螺釘一枚,在置入椎弓根螺釘前通過骨水泥注射器向釘?shù)赖牟煌课蛔⑷牍撬唷８鶕?jù)骨水泥注入到釘?shù)赖牟煌课?將新鮮的人尸體骨質(zhì)疏松標(biāo)本腰椎分為4組：A組,釘?shù)牢磸娀M(空白對照組)；B組,椎弓根部位強化組；C組,椎體部位強化組；D組,全釘?shù)缽娀M。兩側(cè)的椎弓根內(nèi)骨水泥的注射部位不同,對其中一側(cè)的椎弓根進行周期抗屈實驗,對另一側(cè)進行椎弓根進行軸向拔出實驗。周期抗屈實驗的頻率為1.OHz,于螺釘釘頭位置加以正弦波形的應(yīng)力,應(yīng)力從25N開始逐步增加到75N。每個應(yīng)力進行250個周期,每隔250個周期應(yīng)力增加25N知道螺釘?shù)尼旑^部位的位移為5.4mm為止。軸向拔出實驗加載應(yīng)力時保持螺釘?shù)陌纬鏊俣葹?mm/min。結(jié)果1.周期抗屈實驗：在椎弓根螺釘釘頭產(chǎn)生相同位移的情況下,椎弓根強化組和全釘?shù)缽娀M相比,載荷差異無明顯統(tǒng)計學(xué)意義(P0.05)；椎體強化組和椎弓根強化組、全釘?shù)缽娀M相比,載荷差異有明顯統(tǒng)計學(xué)意義(P0.05)；各強化組與空白對照組相比,載荷的差異有明顯統(tǒng)計學(xué)意義(P0.05)。周期抗屈實驗中產(chǎn)生相同位移的情況下,與空白對照組相比,全釘?shù)缽娀M和椎弓根部位強化組均明顯增加載荷約27%,椎體部位強化組降低載荷約7%。椎弓根強化組載荷比椎體部位強化組相明顯增加37%。2.軸向拔出力實驗：與椎體部分強化組相比,釘?shù)雷倒课粡娀腿數(shù)缽娀M明顯增加軸向拔出力,差異有明顯統(tǒng)計學(xué)意義(P0.05)；椎弓根強化組與全釘?shù)缽娀M相比,最大軸向拔出力無明顯差別(P0.05)；螺釘各強化組均明顯高于空白對照組,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論1.對于骨質(zhì)疏松性椎體,椎弓根螺釘?shù)膹娀梢员憩F(xiàn)出很可靠地生物力學(xué)穩(wěn)定性,不僅軸向拔出實驗可以敏感的反應(yīng)螺釘?shù)纳锪W(xué)穩(wěn)定性,而且周期抗屈實驗也是評價生物力學(xué)穩(wěn)定性的重要實驗。周期抗屈實驗?zāi)M的是人體在行走時螺釘所承受載荷時的力學(xué)變化。2.通過軸向拔出實驗和周期抗屈實驗可知,椎弓根部位的強化可明顯提高螺釘?shù)纳锪W(xué)穩(wěn)定性,但是其強化作用還需要進一步經(jīng)過臨床試驗的驗證。全釘?shù)缽娀M雖然實驗生物力學(xué)穩(wěn)定性與椎弓根部位強化基本一致,但是由于其存在二次界面的原因,其遠(yuǎn)期穩(wěn)定性存在一定的風(fēng)險。因此臨床應(yīng)盡可能的在接近椎弓根部位進行強化。
[Abstract]:The purpose of pedicle screw fixation system is generally applied to the posterior spinal surgery, an important role for the stability of the spine. The pedicle screws provide support effect on the stability of the spine, a common clinical complications occurred in the "screw bone interface is loose, especially in patients with osteoporosis in the crowd. New design of pedicle screw in clinical application, the standard method of biomechanical experiment for screw pullout test, the mechanical properties of axial pullout. And there is a correlation between the clinical application of mechanical experimental data. The objective of this study is to evaluate the application of polymethylmethacrylate (PMMA) of fresh human cadaveric bone loose specimens of lumbar pedicle screw path difference of three different parts of the strengthening effect; further study of axial pullout experiment results The Shiumi Ne screw cyclic bending resistance test has a direct relationship. Methods fresh human cadaver specimens of lumbar osteoporosis Shiumi Ne 38, Shiumi Ne Shiumi Ne screws were implanted on each side of a syringe through bone cement implantation of bone cement to different parts of the screw placement in Shiumi Ne screw. According to bone cement injected into different parts of the nail the fresh human cadaveric lumbar osteoporosis were divided into 4 groups: A group, no screw augmentation group (control group); B group, Shiumi Ne group C group, part of strengthening; vertebral body augmentation group; group D, the strong nail group. Bone cement injection site on both sides of the Shiumi Ne the different, on one side of the Shiumi Ne cycle bending resistance test, on the other side of Shiumi Ne axial pullout experiment. Cyclic bending resistance test frequency is 1.OHz, the stress on the screw head position to sinusoidal waveform, stress from 25N began to stress the 250 cycle increased gradually to 75N. each, every 250 cycles of stress increased 25N know parts of the screw nail head displacement is 5.4mm. Keep the screw pull-out speed of 5mm/min. results of the 1. periodical anti bending experiment of axial pull-out test loaded stress: the nail head in pedicle screw have the same displacement situation, to strengthen Shiumi Ne group and augmentation group, there was no significant difference of load (P0.05); vertebroplasty group and Shiumi Ne group strengthened, all augmentation group, there was significant difference of load (P0.05); the strengthening group compared with the control group, there is obvious significant differences in load (P0.05). Cyclic bending resistance produces the same displacement in the experiment condition, compared with the control group, the augmentation group and Shiumi Ne group significantly increased the load strengthening parts of about 27%, vertebral body strong Group to reduce the load of about 7%. Shiumi Ne strengthened group load vertebral body augmentation group significantly increased 37%.2. phase axial pull-out experiment: compared with vertebral partial reinforcement group, screw position and strengthen the whole Shiumi Ne augmentation group significantly increased the axial pull-out, difference has obvious statistical significance (P0.05); Shiumi Ne strengthened group and the entire nail augmentation group compared with the maximum axial pull-out strength has no obvious difference (P0.05); the strengthening screw group were significantly higher than the blank control group, the difference was statistically significant (P0.05). Conclusion: 1. for osteoporotic vertebral strengthening can exhibit very reliable biomechanical stability of Shiumi Ne screw, not only the axial pullout experiment biomechanical stability sensitive reaction screw, and cyclic bending resistance experiment is important to evaluate the biomechanical stability. The cyclic bending resistance test is simulated in human walking screw The mechanical changes of.2. load through the axial pull-out test and cyclic bending resistance test shows that the reinforcement can significantly improve the biomechanical stability of screw parts of Shiumi Ne, but the strengthening effect still needs to be further validated in clinical trials. The augmentation group although the biomechanical stability and strengthening the basic parts of Shiumi Ne, but because of the there are two reasons for the long-term stability of the interface, there is a certain risk. Therefore, the clinical should as far as possible in parts of close to Shiumi Ne for strengthening.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
【參考文獻】
相關(guān)期刊論文 前3條
1 劉達(dá);吳子祥;高明暄;雷偉;;改進螺釘設(shè)計提高骨質(zhì)疏松條件下椎弓根螺釘穩(wěn)定性的研究進展[J];臨床骨科雜志;2009年05期
2 王春,劉衛(wèi)軍;脊柱椎弓根螺釘內(nèi)固定效果的生物力學(xué)評價[J];醫(yī)用生物力學(xué);1998年03期
3 趙政軍,孟平,李小川,高偉;治療骨質(zhì)疏松防止椎弓根釘松動[J];中國骨質(zhì)疏松雜志;2003年02期
相關(guān)博士學(xué)位論文 前1條
1 劉國民;細(xì)胞外基質(zhì)成份涂層椎弓根螺釘在負(fù)荷與非負(fù)荷狀態(tài)下誘導(dǎo)、傳導(dǎo)骨生成的研究[D];吉林大學(xué);2010年
，本文編號：1592081
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/1592081.html
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