【摘要】：目的：胸腰椎爆裂骨折在臨床工作中較為常見。臨床上多采取手術(shù)治療，但對(duì)于術(shù)式的選擇爭議較大。本研究通過進(jìn)行體外胸腰椎爆裂骨折動(dòng)物模型生物力學(xué)實(shí)驗(yàn)，測(cè)量經(jīng)傷椎單節(jié)段固定（簡稱單節(jié)段固定）組與短節(jié)段固定組（簡稱短節(jié)段固定）在自動(dòng)控制電子萬能試驗(yàn)機(jī)上模擬前屈、后伸垂直應(yīng)力下手術(shù)及鄰近節(jié)段載荷-應(yīng)變變化，對(duì)比兩種固定方式的生物力學(xué)特性。用生物電測(cè)方法評(píng)價(jià)兩種固定方式對(duì)胸腰椎生物力學(xué)特性的影響，為臨床應(yīng)用提供理論依據(jù)和實(shí)驗(yàn)指導(dǎo)。 材料與方法：8具小牛的新鮮T11-L3脊柱標(biāo)本，排除骨病與畸形。將標(biāo)本包埋、固定后在自動(dòng)控制電子萬能試驗(yàn)機(jī)上，分別以0.1in/min的載荷增加速度對(duì)標(biāo)本施加150N的前屈、后伸載荷，通過電阻應(yīng)變儀測(cè)出相關(guān)測(cè)點(diǎn)的應(yīng)變值。隨后將標(biāo)本采用預(yù)損傷后壓縮或撞擊的方法制作L1椎體爆裂骨折模型，破壞上終板，保留下終板完整。將8具標(biāo)本隨機(jī)分為經(jīng)傷椎單節(jié)段固定組，跨傷椎短節(jié)段固定組。并采用同樣方法測(cè)量各測(cè)點(diǎn)應(yīng)變值。分析手術(shù)節(jié)段及鄰近節(jié)段的載荷-應(yīng)變變化。數(shù)據(jù)的分析使用的是SPSS16.0軟件包（SPSS，Chicago，IL，，USA），各組間數(shù)據(jù)的比較采用單因素方差分析法和scheffe法，配對(duì)t檢驗(yàn)，P0.05為差異有顯著意義。 結(jié)果：1.兩種固定方式均可以獲得滿意的固定強(qiáng)度，足夠維持椎體的穩(wěn)定性。 2.與短節(jié)段固定相比單節(jié)段固定同等撐開高度的釘棒承受的應(yīng)力更小，能更好的恢復(fù)椎體的高度，且釘棒疲勞斷裂的發(fā)生率更低。 3.單節(jié)段組與短節(jié)段組均存在一定的應(yīng)力遮擋，但本次未能比較出哪種固定方式應(yīng)力遮擋效應(yīng)更明顯。 結(jié)論：經(jīng)傷椎單節(jié)段固定與跨傷椎短節(jié)段固定均能獲得滿意的固定強(qiáng)度，足夠維持椎體的穩(wěn)定性。針對(duì)特定的Denis B型爆裂骨折，單節(jié)段固定是一種良好的選擇。
[Abstract]:Objective: thoracolumbar burst fracture is more common in clinical work. Surgical treatment is more common in clinical practice, but the choice of surgical procedure is controversial. In this study, the biomechanical experiment of the animal model of thoracolumbar burst fracture in vitro was carried out. The changes of the load-strain of the adjacent segments of the injured vertebrae under vertical stress were measured by simulating flexion and postextension in the single segment fixation (single segment fixation) group and the short segment fixation group (short segment fixation) in the automatic control electronic universal tester, and the changes of the load-strain of the adjacent segments were measured under the vertical stress of the injured vertebrae. The biomechanical properties of the two fixation methods were compared. The effects of two fixation methods on biomechanical properties of thoracolumbar spine were evaluated by bioelectric measurement, which provided theoretical basis and experimental guidance for clinical application. Materials and methods: 8 fresh T11-L3 spine specimens of calf were used to exclude bone disease and deformity. The specimens were embedded and fixed on the automatic control electronic universal testing machine. The specimens were subjected to 150 N forward flexion and extension loads at the increasing speed of 0.1in/min load respectively. The strain values of the relevant measurement points were measured by the resistance strain gauge. The fracture model of L1 vertebral body was made by compression or impact after pre-injury. The upper endplate was destroyed and the lower endplate was intact. Eight specimens were randomly divided into single segment fixation group and transtraumatic short segment fixation group. The strain values of each measuring point are measured by the same method. The load-strain variation of the operative segment and adjacent segment was analyzed. SPSS16.0 software package (SPSS,Chicago,IL,USA) was used to analyze the data. One-way ANOVA method and scheffe method were used to compare the data among each group. Pairing t-test showed that there was significant difference between the two groups (P0.05). Results: 1. Both fixation methods can obtain satisfactory fixation strength, enough to maintain the stability of the vertebral body. 2. Compared with the short segment fixation, the stress of the screw rod with the same opening height as that of the single segment fixation is lower, the height of the vertebral body can be recovered better, and the incidence of fatigue fracture of the screw rod is lower than that of the short segment fixation. 3. The single segment group and the short segment group both have certain stress shielding, but this time it is unable to compare which fixed mode stress shielding effect is more obvious. Conclusion: both single segment fixation and short segment fixation of injured vertebrae can obtain satisfactory fixation intensity and maintain the stability of vertebral body. Single segment fixation is a good choice for specific Denis B type burst fractures.
【學(xué)位授予單位】：吉林大學(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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