短節(jié)段跨傷椎固定橫連對椎弓根皮質(zhì)劈裂穩(wěn)定性的生物力學(xué)研究
發(fā)布時(shí)間：2018-08-31 12:45
【摘要】：本研究通過生物力學(xué)測試在成年綿羊胸腰椎椎弓根劈裂模型下探討橫連位置及數(shù)目對脊柱內(nèi)固定的影響進(jìn)行評價(jià)。進(jìn)而通過附加橫連彌補(bǔ)椎弓根螺釘打劈椎弓根皮質(zhì)引起的失穩(wěn)。通過人工篩查以及X線透視排除病變,選用正常新鮮綿羊胸腰椎標(biāo)本(T13~L3節(jié)段)60具,建立L1椎體壓縮骨折模型,將其隨機(jī)分成A、B、C、D、E、F,共6組。T14,L2雙側(cè)椎弓根置入螺釘,連接鈦棒固定T14-L2節(jié)段。然后對B、C、D、E、F組在T14椎體右側(cè)的椎弓根行外側(cè)1/4骨皮質(zhì)切除,即為置入的螺釘通道的外側(cè)1/4(長為10mm,寬為5mm),直至露出螺釘外側(cè)螺紋,并清除螺紋內(nèi)骨質(zhì),作為椎弓根皮質(zhì)劈裂椎體骨折模型。最后各組采用不同的橫連數(shù)目固定:A組(0個(gè)橫連,Intact)、B組(0個(gè)橫連,NCL),C組(1個(gè)橫連,連接棒的1/2處,MCL),D組(1個(gè)橫連,連接棒的1/3處,靠近T14椎體,PCL),E組(1個(gè)橫連,連接棒的2/3處,遠(yuǎn)離T14椎體,DCL),F組(2個(gè)橫連,連接棒的1/3和2/3處,TCL)。各組標(biāo)本然后在HY-3080微機(jī)控制電子萬能材料試驗(yàn)機(jī)和HY-1000NM微機(jī)控制扭轉(zhuǎn)試驗(yàn)機(jī)上以頻率為1.5Hz的載荷對標(biāo)本進(jìn)行10000次疲勞試驗(yàn),分別測量疲勞試驗(yàn)后6組標(biāo)本的軸向壓縮剛度,前屈、后伸、左側(cè)彎、右側(cè)彎、左軸向旋轉(zhuǎn)及右軸向旋轉(zhuǎn)6個(gè)方向的活動(dòng)范圍(ROM)及T14椎體椎弓根劈裂側(cè)螺釘最大拔出力的大小,比較6組的差異。6組標(biāo)本的軸向壓縮剛度比較:A、C、D、E、F 5組的模型剛度明顯高于B組(P0.05);C、D、E三組模型剛度差異與F組相比無統(tǒng)計(jì)學(xué)意義(P0.05);C、D、E三組剛度差異均無統(tǒng)計(jì)學(xué)意義(P0.05);F組模型剛度均小于A組(P0.05)。6組標(biāo)本的活動(dòng)度(ROM)比較:B組模型在屈伸(圍繞冠狀軸)、側(cè)彎(圍繞矢狀軸)、旋轉(zhuǎn)(圍繞垂直軸)6個(gè)方向的運(yùn)動(dòng)范圍(ROM)均明顯高于A、C、D、E、F 5組(P0.05);C、D、E三組模型在旋轉(zhuǎn)2個(gè)方向的運(yùn)動(dòng)范圍(ROM)均大于F組(P0.05);在屈伸、側(cè)彎4個(gè)方向的運(yùn)動(dòng)范圍(ROM)與F組相比差異無統(tǒng)計(jì)學(xué)意義;C、D、E三組活動(dòng)度差異均無統(tǒng)計(jì)學(xué)意義(P0.05);F組模型在屈伸、側(cè)彎、旋轉(zhuǎn)6個(gè)方向的運(yùn)動(dòng)范圍(ROM)與A組比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。6組標(biāo)本的螺釘最大拔出力比較:A、C、D、E、F 5組的螺釘最大拔出力均高于B組(P0.05);C、D、E三組模型螺釘最大拔出力均小于F組(P0.05);C、D、E三組螺釘最大拔出力差異均無統(tǒng)計(jì)學(xué)意義(P0.05);F組模型螺釘最大拔出力均小于A組(P0.05)。椎弓根固定劈裂時(shí),內(nèi)固定穩(wěn)定性明顯下降。放置1個(gè)橫連就可以提高內(nèi)固定的穩(wěn)定性,放置2個(gè)橫連可近似達(dá)到椎弓根固定未劈裂時(shí)的穩(wěn)定性。單個(gè)橫連在短節(jié)段固定上不論在近端、遠(yuǎn)端還是中間的脊柱固定之間差異無統(tǒng)計(jì)學(xué)意義。
[Abstract]:In this study, biomechanical tests were carried out to evaluate the effect of the position and number of transverse connections on spinal internal fixation in adult sheep with thoracolumbar pedicle splitting model. Furthermore, the instability of pedicle cortex caused by pedicle screw was compensated by additional transverse connection. By artificial screening and X-ray fluoroscopy, 60 normal sheep thoracolumbar vertebrae specimens (T13~L3 segment) were selected to establish L1 vertebral compression fracture model. The model was randomly divided into 6 groups. Fix T14-L2 segment with titanium rod. Then the pedicle of the right side of the T14 vertebrae was treated with lateral 1 / 4 cortical resection of the pedicle in group B (10 mm long, wide 5mm), which was the lateral 1 / 4 of the inserted screw channel, until the lateral screw thread was exposed and the internal bone was cleared. As the pedicle cortical fracture model of vertebral body. Finally, each group was treated with different number of transverse connections: group A (0 transversals Intact) and group B (0 transverse connection NCL) and group C (1 horizontal connection, 1 / 2 MCL of connecting rod) group D (1 transverse connection, 1 / 3 of connecting rod, near T14 vertebral body PCL) group E (1 horizontal connection, 23 / 3 of connecting rod). Group F (two transverse connections, 1 / 3 and 2 / 3 of the connectors). The specimens were subjected to 10000 fatigue tests on HY-3080 microcomputer controlled electronic universal material testing machine and HY-1000NM microcomputer controlled torsion testing machine. The axial compression stiffness and forward flexion of 6 groups of specimens were measured after fatigue test. The maximum pull-out force of (ROM) and T14 pedicle split side screws in 6 directions of extension, left bending, right bending, left axial rotation and right axial rotation. Comparison of the axial compression stiffness of six groups of specimens the stiffness of the model of the group 1: C CX DX E 5 was significantly higher than that of the group B (P0.05). There was no significant difference in the stiffness of the three groups compared with the group F (P0.05). There was no significant difference in the stiffness of the three groups (P0.05) between the three groups. (P0.05) the stiffness of the three groups was not significantly different from that of the group F (P 0.05), and there was no significant difference in the stiffness of the three groups (P0.05). (ROM) comparison of the Model stiffness in Group A (P0.05) .6; the (ROM) of group B in flexion and extension (around coronal axis), lateral bend (around sagittal axis) and rotation (around vertical axis) in six directions were significantly higher than that in group A (P05). (P0.05) the motion range of group B was significantly higher than that of group A (P05) in the six directions of flexion and extension (around the coronal axis), lateral bend (around the sagittal axis) and rotation (around the vertical axis). The range of motion of the three groups in two directions of rotation was larger than that of group F (P0.05), and the range of motion in flexion and extension was higher than that in group F (P0.05). There was no significant difference in the range of motion in four directions of lateral curvature between (ROM) and group F. There was no significant difference in the range of motion between group C and group F (P0.05), and there was no significant difference in flexion and extension, lateral curvature of group F. There was no significant difference in the range of rotation between (ROM) and group A (P0.05) the maximum pull-out force of screw in group 1 was higher than that in group B (P0.05). The maximum pull-out force of screw in group F5 was higher than that in group B (P0.05). The maximum pull-out force of screw in group C was lower than that in group A (P0.05). There was no significant difference in the maximum pull-out force among the three groups (P0.05). The maximum pull-out force of the model screws in the F group was lower than that in the A group (P0.05). The stability of internal fixation decreased significantly when pedicle fixation split. The stability of internal fixation can be improved by placing one transverse connection, and the stability of pedicle fixation without splitting can be approximately achieved by placing two transverse connections. There was no significant difference in single transversal fixation between proximal distal and intermediate spinal fixation.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3
[Abstract]:In this study, biomechanical tests were carried out to evaluate the effect of the position and number of transverse connections on spinal internal fixation in adult sheep with thoracolumbar pedicle splitting model. Furthermore, the instability of pedicle cortex caused by pedicle screw was compensated by additional transverse connection. By artificial screening and X-ray fluoroscopy, 60 normal sheep thoracolumbar vertebrae specimens (T13~L3 segment) were selected to establish L1 vertebral compression fracture model. The model was randomly divided into 6 groups. Fix T14-L2 segment with titanium rod. Then the pedicle of the right side of the T14 vertebrae was treated with lateral 1 / 4 cortical resection of the pedicle in group B (10 mm long, wide 5mm), which was the lateral 1 / 4 of the inserted screw channel, until the lateral screw thread was exposed and the internal bone was cleared. As the pedicle cortical fracture model of vertebral body. Finally, each group was treated with different number of transverse connections: group A (0 transversals Intact) and group B (0 transverse connection NCL) and group C (1 horizontal connection, 1 / 2 MCL of connecting rod) group D (1 transverse connection, 1 / 3 of connecting rod, near T14 vertebral body PCL) group E (1 horizontal connection, 23 / 3 of connecting rod). Group F (two transverse connections, 1 / 3 and 2 / 3 of the connectors). The specimens were subjected to 10000 fatigue tests on HY-3080 microcomputer controlled electronic universal material testing machine and HY-1000NM microcomputer controlled torsion testing machine. The axial compression stiffness and forward flexion of 6 groups of specimens were measured after fatigue test. The maximum pull-out force of (ROM) and T14 pedicle split side screws in 6 directions of extension, left bending, right bending, left axial rotation and right axial rotation. Comparison of the axial compression stiffness of six groups of specimens the stiffness of the model of the group 1: C CX DX E 5 was significantly higher than that of the group B (P0.05). There was no significant difference in the stiffness of the three groups compared with the group F (P0.05). There was no significant difference in the stiffness of the three groups (P0.05) between the three groups. (P0.05) the stiffness of the three groups was not significantly different from that of the group F (P 0.05), and there was no significant difference in the stiffness of the three groups (P0.05). (ROM) comparison of the Model stiffness in Group A (P0.05) .6; the (ROM) of group B in flexion and extension (around coronal axis), lateral bend (around sagittal axis) and rotation (around vertical axis) in six directions were significantly higher than that in group A (P05). (P0.05) the motion range of group B was significantly higher than that of group A (P05) in the six directions of flexion and extension (around the coronal axis), lateral bend (around the sagittal axis) and rotation (around the vertical axis). The range of motion of the three groups in two directions of rotation was larger than that of group F (P0.05), and the range of motion in flexion and extension was higher than that in group F (P0.05). There was no significant difference in the range of motion in four directions of lateral curvature between (ROM) and group F. There was no significant difference in the range of motion between group C and group F (P0.05), and there was no significant difference in flexion and extension, lateral curvature of group F. There was no significant difference in the range of rotation between (ROM) and group A (P0.05) the maximum pull-out force of screw in group 1 was higher than that in group B (P0.05). The maximum pull-out force of screw in group F5 was higher than that in group B (P0.05). The maximum pull-out force of screw in group C was lower than that in group A (P0.05). There was no significant difference in the maximum pull-out force among the three groups (P0.05). The maximum pull-out force of the model screws in the F group was lower than that in the A group (P0.05). The stability of internal fixation decreased significantly when pedicle fixation split. The stability of internal fixation can be improved by placing one transverse connection, and the stability of pedicle fixation without splitting can be approximately achieved by placing two transverse connections. There was no significant difference in single transversal fixation between proximal distal and intermediate spinal fixation.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3
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