經后路傷椎置釘對椎弓根劈裂后內固定生物力學穩(wěn)定性的影響
發(fā)布時間：2018-07-22 20:02
【摘要】：本研究選用綿羊脊柱標本建造椎弓根劈裂模型,初步探討椎弓根劈裂對脊柱椎體骨折椎弓根螺釘內固定穩(wěn)定性的影響。在此實驗研究基礎上,采取不同傷椎置釘方式對椎弓根劈裂進行置釘,進一步探討不同傷椎置釘方式對螺釘內固定穩(wěn)定性的影響。椎弓根劈裂對脊柱椎體骨折椎弓根螺釘內固定穩(wěn)定性影響的實驗研究:選取新鮮(宰殺后6h內)綿羊脊柱標本20具,截取(T13~L3)脊柱段,在排除腫瘤、骨折及先天性脊柱畸形等情況后,對20具標本制作單椎體壓縮骨折模型,然后將20具標本隨機分為A、B兩組,以A組標本模型作為單純壓縮骨折模型;再對B組標本T14胸椎的左側椎弓根行外側1/4切除,作為壓縮骨折合并椎弓根劈裂椎體模型。然后對A、B兩組模型分別置釘,進釘深度為釘道全長。然后在生物力學機上對標本進行模型行10000次疲勞實驗,在疲勞實驗后測定兩組標本模型前屈、后伸、左側彎、右側彎4個方向運動范圍(range of motion,ROM)的大小和螺釘拔出力大小,并比較兩組差異[1]。在疲勞實驗后,A、B兩組實驗標本模型活動度檢測結果顯示:A組(單純壓縮骨折模型組)各個方向活動范圍大小:前屈(1.81±0.14)°、后伸(1.68±0.37)°、左側彎(4.08±0.41)°、右側彎(4.18±0.12)°;B組(壓縮骨折合并椎弓根劈裂椎體模型組)各個方向活動范圍大小:前屈(4.49±0.40)°、后伸(3.72±0.51)°、左側彎(6.67±0.64)°、右側彎(6.73±0.58)°。經統(tǒng)計分析顯示,A組(單純壓縮骨折模型組)各個方向的活動范圍均顯著小于B組(壓縮骨折合并椎弓根劈裂椎體模型組)(p0.01)。A、B兩組標本模型螺釘最大拔出力檢測結果顯示:A、B組螺釘最大拔出力分別為(252.34±51.27)N;(115.50±36.74)N。經統(tǒng)計分析顯示,A組(單純壓縮骨折模型組)螺釘最大拔出力顯著大于B組(壓縮骨折合并椎弓根劈裂椎體模型組)(p0.01)。不同傷椎置釘方式對螺釘內固定穩(wěn)定性的影響的實驗研究:選取新鮮(宰殺后6h內)綿羊脊柱標本36具,取(t13~l3)脊柱段,在排除腫瘤、骨折、及先天性脊柱畸形等情況后,將36具標本隨機分為a、b、c、d四組,a、b兩組標本處理同前;c、d兩組處理同b組制作椎弓根劈裂椎體骨折模型,然后分別對四組標本行椎弓根置釘,進釘深度為釘道全長,a、b組標本置釘同前,c組標本置入四根椎弓根螺釘后,再在骨折椎體左側椎弓根置入一根螺釘,d組置入四根椎弓根螺釘后,再在骨折椎體兩側椎弓根內均置入螺釘,即c組為置入5根螺釘組,d組為置入6根螺釘組。實驗脊柱標本椎弓根置釘后,在生物力學機上以1.5hz的頻率及(300±105)n的載荷對四組模型進行10000次循環(huán)加壓,檢測a、b、c、d四組標本模型的屈、伸及左右側彎的活動范圍,四組標本t14椎體左側椎弓根螺釘的最大拔出力的大小及四組標本的軸向壓縮剛度[1]。實驗結果如下:四組標本模型的軸向壓縮剛度結果顯示:a(單純壓縮骨折模型組)、c(5釘組)、d(6釘組)三組的的軸向壓縮剛度均顯著大于b組(壓縮骨折合并椎弓根劈裂椎體模型組),差異均具有統(tǒng)計學意義(p0.01);c(5釘組)、d(6釘組)兩組的軸向壓縮剛度均顯著大于a組(單純壓縮骨折模型組),差異均有統(tǒng)計學意義(p0.01);c(5釘組)、d(6釘組)兩組的軸向壓縮剛度比較無明顯差異(p0.05)。四組標本螺釘最大拔出力檢測結果顯示:b組(壓縮骨折合并椎弓根劈裂椎體模型組)、c(5釘組)、d(6釘組)三組最大螺釘拔出力均顯著低于a組(單純壓縮骨折模型組)(p0.01);b組(壓縮骨折合并椎弓根劈裂椎體模型組)、c(5釘組)、d(6釘組)三組螺釘最大拔出力比較差異均無統(tǒng)計學意義(p0.05)。四組標本活動度檢測結果顯示:a(單純壓縮骨折模型組)、c(5釘組)、d(6釘組)三組在屈、伸及左、右側彎4個方向上的活動度均小于b組(壓縮骨折合并椎弓根劈裂椎體模型組)(p㩳0.01);c(5釘組)、d(6釘組)兩組在屈伸、側彎4個方向的運動范圍均顯著低于a組(單純壓縮骨折模型組)(p0.01);c(5釘組)、d(6釘組)兩組在屈伸、側彎4個方向的運動范圍比較無明顯差異(p0.05)。本研究結果提示,椎弓根皮質劈裂將會降低椎弓根螺釘內固定的穩(wěn)定性,傷椎置釘能增加劈裂椎弓根內固定的穩(wěn)定性,甚至穩(wěn)定性優(yōu)于椎弓根完整時的穩(wěn)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].
【學位授予單位】：河北北方學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
本文編號：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].
【學位授予單位】：河北北方學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
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