本文選題：椎弓根螺釘　切入點(diǎn)：骨水泥強(qiáng)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(duì)脊柱的穩(wěn)定性起到重要的作用。在椎弓根螺釘對(duì)脊柱提供支撐穩(wěn)定作用時(shí),臨床上普遍常見(jiàn)的一個(gè)并發(fā)癥是發(fā)生在“螺釘-骨質(zhì)”界面的松動(dòng),尤其是在骨質(zhì)疏松患者的人群中。新型設(shè)計(jì)的椎弓根螺釘在應(yīng)用于臨床前,對(duì)螺釘所進(jìn)行的標(biāo)準(zhǔn)生物力學(xué)實(shí)驗(yàn)方法為軸向拔出實(shí)驗(yàn),研究其力學(xué)性能。軸向拔出力學(xué)實(shí)驗(yàn)數(shù)據(jù)與臨床實(shí)際應(yīng)用之間存在相關(guān)性。本實(shí)驗(yàn)研究的主要目的是評(píng)價(jià)應(yīng)用聚甲基丙烯酸甲酯(PMMA)對(duì)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(qiáng)化作用的差異性；進(jìn)一步研究軸向拔出實(shí)驗(yàn)的結(jié)果是否與椎弓根螺釘周期抗屈實(shí)驗(yàn)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(gè),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(guò)骨水泥注射器向釘?shù)赖牟煌课蛔⑷牍撬�。根�?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?qiáng)化組(空白對(duì)照組)；B組,椎弓根部位強(qiáng)化組；C組,椎體部位強(qiáng)化組；D組,全釘?shù)缽?qiáng)化組。兩側(cè)的椎弓根內(nèi)骨水泥的注射部位不同,對(duì)其中一側(cè)的椎弓根進(jìn)行周期抗屈實(shí)驗(yàn),對(duì)另一側(cè)進(jìn)行椎弓根進(jìn)行軸向拔出實(shí)驗(yàn)。周期抗屈實(shí)驗(yàn)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(kāi)始逐步增加到75N。每個(gè)應(yīng)力進(jìn)行250個(gè)周期,每隔250個(gè)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(shí)驗(yàn)加載應(yīng)力時(shí)保持螺釘?shù)陌纬鏊俣葹?mm/min。結(jié)果1.周期抗屈實(shí)驗(yàn)：在椎弓根螺釘釘頭產(chǎn)生相同位移的情況下,椎弓根強(qiáng)化組和全釘?shù)缽?qiáng)化組相比,載荷差異無(wú)明顯統(tǒng)計(jì)學(xué)意義(P0.05)；椎體強(qiáng)化組和椎弓根強(qiáng)化組、全釘?shù)缽?qiáng)化組相比,載荷差異有明顯統(tǒng)計(jì)學(xué)意義(P0.05)；各強(qiáng)化組與空白對(duì)照組相比,載荷的差異有明顯統(tǒng)計(jì)學(xué)意義(P0.05)。周期抗屈實(shí)驗(yàn)中產(chǎn)生相同位移的情況下,與空白對(duì)照組相比,全釘?shù)缽?qiáng)化組和椎弓根部位強(qiáng)化組均明顯增加載荷約27%,椎體部位強(qiáng)化組降低載荷約7%。椎弓根強(qiáng)化組載荷比椎體部位強(qiáng)化組相明顯增加37%。2.軸向拔出力實(shí)驗(yàn)：與椎體部分強(qiáng)化組相比,釘?shù)雷倒课粡?qiáng)化和全釘?shù)缽?qiáng)化組明顯增加軸向拔出力,差異有明顯統(tǒng)計(jì)學(xué)意義(P0.05)；椎弓根強(qiáng)化組與全釘?shù)缽?qiáng)化組相比,最大軸向拔出力無(wú)明顯差別(P0.05)；螺釘各強(qiáng)化組均明顯高于空白對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.對(duì)于骨質(zhì)疏松性椎體,椎弓根螺釘?shù)膹?qiáng)化可以表現(xiàn)出很可靠地生物力學(xué)穩(wěn)定性,不僅軸向拔出實(shí)驗(yàn)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(shí)驗(yàn)也是評(píng)價(jià)生物力學(xué)穩(wěn)定性的重要實(shí)驗(yàn)。周期抗屈實(shí)驗(yàn)?zāi)M的是人體在行走時(shí)螺釘所承受載荷時(shí)的力學(xué)變化。2.通過(guò)軸向拔出實(shí)驗(yàn)和周期抗屈實(shí)驗(yàn)可知,椎弓根部位的強(qiáng)化可明顯提高螺釘?shù)纳锪W(xué)穩(wěn)定性,但是其強(qiáng)化作用還需要進(jìn)一步經(jīng)過(guò)臨床試驗(yàn)的驗(yàn)證。全釘?shù)缽?qiáng)化組雖然實(shí)驗(yàn)生物力學(xué)穩(wěn)定性與椎弓根部位強(qiáng)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(xiǎn)。因此臨床應(yīng)盡可能的在接近椎弓根部位進(jìn)行強(qiáng)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(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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本文編號(hào)：1592081