本文選題：椎弓根-肋骨復(fù)合體　切入點(diǎn)：椎弓根　出處：《廣西醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分Th3-Th5前路逆向椎弓根-肋骨復(fù)合體螺釘內(nèi)固定技術(shù)影像學(xué)形態(tài)測(cè)量目的：在Th3-Th5二維的CT平掃和三維的Mimics重建模型上對(duì)正常人的上胸椎進(jìn)行觀察和測(cè)量,為上胸椎(Th3～Th5)的前路逆向椎弓根-肋骨復(fù)合體螺釘?shù)墓潭夹g(shù)提供形態(tài)學(xué)的數(shù)據(jù)參考。方法：對(duì)30例患者的上胸椎(Th1～Th6)的薄層CT掃描數(shù)據(jù)進(jìn)行重建,在橫切面上測(cè)量椎弓根和椎弓根-肋骨復(fù)合體的橫徑、釘?shù)篱L(zhǎng)度和橫切面的進(jìn)釘角度,在冠狀面上測(cè)量椎弓根縱徑和椎弓根-肋骨復(fù)合體的有效縱徑。選取上述的20例患者的CT掃描數(shù)據(jù),采用Mimincs軟件重建出Th1～Th6的椎弓根-肋骨復(fù)合體三維模型,然后用自帶的模擬軟件模擬出Th3～Th5椎弓根-肋骨復(fù)合體的最佳釘?shù)篮吐葆斴S心,最后使用3-D測(cè)量工具測(cè)量螺釘?shù)臋M切面和矢狀面的進(jìn)釘點(diǎn)距離,橫切面和矢狀面的的進(jìn)釘角度和釘?shù)篱L(zhǎng)度。結(jié)果：Th3～Th5節(jié)段椎弓根-肋骨復(fù)合體的平均橫徑(5.03 mm)明顯大于椎弓根的平均橫徑(12.73 mm),椎弓根-肋骨復(fù)合體的平均有效縱徑(9.17 mm)明顯小于椎弓根的平均縱徑(11.72 mm)。椎弓根-肋骨復(fù)合體的進(jìn)釘角度比椎弓根的進(jìn)釘角度更大(31.43°VS 13.32°),釘?shù)篱L(zhǎng)度更長(zhǎng)(56.48 mm VS 38.77mm)。 Th3-Th5節(jié)段的椎弓根縱徑大于其橫徑,但是椎弓根-肋骨復(fù)合體的有效縱徑小于其橫徑,而又大于同節(jié)段的椎弓根橫徑。前路逆向椎弓根-肋骨復(fù)合體螺釘?shù)钠骄L(zhǎng)度是57.25mm (46.1 mm～ 65.8 mm), Th3至Th5的螺釘長(zhǎng)度逐漸變長(zhǎng),分別為55.03 mm,57.27 mm和59.45mm。螺釘進(jìn)針點(diǎn)的平均橫切面距離是-3.58 mm (0～-5.8 mm),從Th3到Th5螺釘進(jìn)針點(diǎn)的距離依次增寬,分別為-2.82 mm,-3.69 mm和-4.26mm。螺釘?shù)钠骄鶛M切面角度是32.68°(21.3°～39.6°),Th3～Th5螺釘?shù)慕嵌戎饾u減小,分別為34.82°,32.73°和30.48°。螺釘進(jìn)針點(diǎn)的平均矢狀面距離是5.68 mm (2.7～9.1 mm),從Th3到Th5螺釘進(jìn)針點(diǎn)的位置逐漸降低,分別是4.58 mm,5.89 mm和6.56 mm。螺釘?shù)钠骄笭蠲娼嵌仁?2.44° (71.1°～91.2°),從Th3到Th5螺釘?shù)慕嵌戎饾u增大,分別為78.17°,83.30°和85.85°。結(jié)論：1.椎弓根螺釘直徑的選擇主要由其橫徑?jīng)Q定,椎弓根-肋骨復(fù)合體螺釘直徑的選擇主要由其有效縱徑限制。2.與椎弓根螺釘相比,在Th3～Th5的椎弓根-肋骨復(fù)合體可以選擇較粗、較長(zhǎng)的螺釘。3.Th3～Th5經(jīng)椎弓根-肋骨復(fù)合體途徑置釘較經(jīng)椎弓根置釘有更大的外傾角,可減少螺釘穿破椎弓根內(nèi)側(cè)壁而損傷脊髓風(fēng)險(xiǎn)。4.術(shù)中實(shí)施Th3～Th5的前路逆向椎弓根-肋骨復(fù)合體螺釘時(shí),要充分考慮其立體結(jié)構(gòu)的復(fù)雜性,盡量把螺釘位于重疊的骨性結(jié)構(gòu),要根據(jù)不同的節(jié)段選擇不同的螺釘直徑和長(zhǎng)度,以及不同的進(jìn)釘點(diǎn)和置釘方向。第二部分Th3～Th5前路逆向椎弓根-肋骨復(fù)合體螺釘內(nèi)固定技術(shù)的生物力學(xué)研究目的：測(cè)定Th3～Th5前路逆向椎弓根-肋骨復(fù)合體螺釘?shù)淖畲筝S向拔出力來評(píng)價(jià)其生物力學(xué)性能,并與椎弓根螺釘進(jìn)行比較。方法：取10具福爾馬林固定的人體胸椎標(biāo)本(T1～T6),保留標(biāo)本及相連的一段長(zhǎng)約5cm肋骨和肋間軟組織及壁胸膜。在Th3～Th5椎體的一側(cè)的經(jīng)椎弓根-肋骨復(fù)合體逆向植入5.0 mm X 50 mm的螺釘,在對(duì)側(cè)植入椎弓根螺釘(3.5 mm X 35 mm)。在島津萬能試驗(yàn)機(jī)上測(cè)量每顆螺釘?shù)淖畲筝S向拔出力。結(jié)果：前路逆向椎弓根-肋骨復(fù)合體螺釘?shù)妮S向最大拔出力的平均值是322.1±66.6 N,椎弓根螺釘軸向最大拔出力的平均值是340.6±55.0N,兩者比較的差別沒有統(tǒng)計(jì)學(xué)上的意義(P=0.254)。結(jié)論：選擇較粗和較長(zhǎng)的螺釘固定時(shí),前路逆向椎弓根-肋骨復(fù)合體螺釘?shù)纳锪W(xué)性能與椎弓根螺釘?shù)纳锪W(xué)性能基本相似,前路逆向椎弓根-肋骨復(fù)合體螺釘固定技術(shù)可以為脊柱的重建提供堅(jiān)強(qiáng)的固定。
[Abstract]:The purpose of the first part of the Th3-Th5 shape measurement of anterior transpedicular screw fixation of rib complex imaging in the Mimics reconstruction model of CT flat two-dimensional and three-dimensional Th3-Th5 scan on thoracic of normal people were observed and measured, for upper thoracic spine (Th3 ~ Th5) of the anterior reverse pedicle rib complex screw fixation technique to provide morphological data for reference. Methods: 30 patients with upper thoracic spine (Th1 ~ Th6) of the thin CT scan data reconstruction, measurement of pedicle and pedicle rib complex in the cross section of the nail into the angle of transverse diameter, screw path length and cross section, in the coronal plane measurement of pedicle longitudinal diameter and effective the longitudinal diameter of the pedicle rib complex. Select the CT scan data of 20 cases of the patients, using Mimincs software to reconstruct the Th1 ~ Th6 pedicle rib complex 3D model, and then use the built-in simulation software A simulation of Th3 ~ Th5 Shiumi Ne rib complex best screw and screw axis, and finally use the 3-D tool for measuring screw transverse and sagittal screw point distance, transverse and sagittal screw angle and the length of screws. Results: Th3 ~ Th5 segment Shiumi Ne rib bone complex the average diameter (5.03 mm) was significantly higher than Shiumi Ne's average diameter (12.73 mm), the average effective Shiumi Ne longitudinal rib complex size (9.17 mm) was significantly less than the average Shiumi Ne longitudinal diameter (11.72 mm). In view of the nail Shiumi Ne rib complex is greater than the nail angle (31.43 degrees of Shiumi Ne 13.32 ~ VS), screw length (56.48 mm VS 38.77mm). Shiumi Ne longitudinal segment Th3-Th5 diameter greater than the diameter, but the effective longitudinal Shiumi Ne rib complex size smaller than the transverse diameter, Shiumi Ne cross and larger segments of the same size. The anterior reverse Shiumi Ne ribs 澶嶅悎浣撹灪閽夌殑騫沖潎闀垮害鏄，

本文編號(hào)：1614987