椎弓根螺钉内固定稳定性的生物力学测试
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A BIOMECHANICAL STUDY OF THE STABILIZATION OF TRANSPEDICLE SCREW FIXATION
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    摘要:

    目的 胸腰椎骨折采用椎弓根螺钉内固定 ,其疗效与螺钉固定的长度、螺钉的植入方向以及骨密度大小诸因素相关 ,为此进行生物力学分析 ,为临床手术提供依据。方法 采用 6具成人新鲜脊柱标本 ,应用实验应力分析手段进行测试。结果 长螺钉的应变比短螺钉应变在压缩、前屈、后伸、侧屈分别小 1 6%、4 1 %、5 6%、4 1 % ;其强度分别提高 1 6%、4 1 %、5 5 %、4 1 % ;其脊柱位移分别小1 8%、2 5 %、32 %、30 % ;轴向刚度分别提高 1 8%、2 5 %、32 %、30 % ( P 均 <0 .0 5 )。螺钉平行植入与椎弓根成 7°角植入 ,后者其拔出力大 2 0 % ,拔出位移增加 7% ,能量增加 1 8% (P <0 .0 5 )。骨密度对拔出力的影响 ,正常组与骨质疏松组相差 67% ,相应的相对位移、应变、能量两组平均相差均在 1 6%以上(P <0 .0 5 )。结论 手术中应注意椎弓根螺钉固定相关因素 ,这对提高手术质量 ,减少并发症起着重要作用。

    Abstract:

    Objective The thoracolumbar vertebra fracture is usually treated by transpedicle screw fixation. Since its effects are correlated to such factors as the length and the implanted direction of screw ,BMD etc. This study was made to provide some biomechanical evidence for better clinical operation.Methods To take six cadaveric lumbar spines to undertake tests with experimental stress analysis.Results The strain of long screw compared with short ones,is respectively 16%, 41%, 56%, 41% lesser in compression,anterior flection,posterior extension and luteral flection;the strength is improved by 16%, 41%, 55% and 41%; the displecement of spine is lower by 18%, 25%, 32% and 30%;the axial rigidity is improved by 18%, 25%, 32% and 30%(P<0.05).The drawing strength of screw implanted in parallel direction is larger by 20% than screw implanted in 7° direction,while the drawing displacement increased by 7%,the energy increased by 18%(P<0.05). With regard to the bone density effect on drawing strength, the normal group is larger than osteoprotic group by 67%. There is average 16% difference in the relative displacement ,strain and energy.Conclusion The relative factors of the fixation that mentioned above should be caused attention in operation so that it can improve the operative quality and reduce complications.

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王正,沈国平,陈伟兵,王以进.椎弓根螺钉内固定稳定性的生物力学测试[J].医用生物力学,2002,17(2):80-84

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