磷酸钙强化椎弓根螺钉的动态生物力学研究
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Biomechanical performance of pedicle screw augmented with an injectable calcium phosphate cement: an in vivo study
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    摘要:

    目的 研究磷酸钙骨水泥强化椎弓根螺钉后生物力学强度的体内动态变化。方法 成年雌性绵羊12只,年龄4~6岁;体重33~45Kg。经每只羊的L1~L6椎体双侧椎弓根,分直接植入、CPC强化和PMMA强化三种植钉方法植入椎弓螺钉,每只动物体内植钉方法按平衡不完全随机进行分配,每种方法各植4枚。植钉后动物被随机分配至术后1d,4w,12w和24w四个观察时间点,每点3只。在观察点获取植钉腰椎标本,测定螺钉的轴向拔出力和拔出能量吸收值,进行相同时间点各植钉方法之间和同一植钉方法各时间点之间的指标对比分析。结果 四个观察时间点动物的骨密度按序依次是,0.923±0.082g/cm2,0.910±0.098 g/cm2,0.952±0.123 g/cm2和0.912±0.126 g/cm2,组间均未见显著差异(P﹥0.05)。在术后1d,4w,12w和24w四个观察时间点CPC强化组的最大轴向拔出力(Fmax)依次是,893.13±63.91N,916.50±109.88N,1022.04±73.85N和1104.91±112.33N。拔出能量吸收值(EAV)与相应的Fmax呈正相关(P﹤0.001)。同一方法各时间点内的Fmax 和EAV均无显著性差异(P﹥0.28)。相同时间点,CPC强化组的Fmax和EAV均显著高于对照组(P﹤0.001)。另外,除24周的EAV二者无差异(P﹥0.18)外,PMMA强化组两项指标均高于CPC强化组(P﹤0.003)。结论 结果表明用CPC强化能显著提高椎弓根螺钉的固定强度,且强化作用在体内是动态稳定的。在椎弓根螺钉强化方面,CPC是PMMA理想的替代材料。

    Abstract:

    Objectives To investigate the long-term changes of fixation strength of pedicle screw augmented with calcium phosphate cement in vivo. Methods Twelve pedicle screws were bilaterally planted in to six lumbar vertebrae of each sheep, including 4 non-augmented as control, 4 augmented with calcium phosphate cement (CPC) and 4 augmented with polymethylmethacrylate (PMMA). A total of twelve female adult sheep were operated, and they were randomized into four study periods of 1 day, 4 weeks, 12 weeks and 24 weeks after operation. At the end of every assigned study period, the animals were killed and lumbar vertebrae were harvested. Then axial pull-out tests conducted on the pedicle screws of the isolated vertebrae. The maximum pull-out force (Fmax) and energy absorption value (EAV) of the different screw planting methods at the same time and those of the same screw planting method but at the different study periods were compared by twos, respectively. Results The mean BMD was 0.923±0.082g/cm2 in the group of one day after surgery, 0.910±0.098 g/cm2 group at 4 w, 0.952±0.123 g/cm2 group at 12w and 0.912±0.126 g/cm2 group at 24w. There was no significant difference in the bone mineral density (BMD) of the animals between every two group (p﹥0.05). The mean maximum pull-out force in the CPC group was 893.13±63.91N 24 hours after operation,916.50±109.88N at 4w,1022.04±73.85N at 12w and 1104.91±112.33N at 24w. A positive correlation existed between Fmax and EAV (P﹤0.001). No significant difference in Fmax and EAV was found among the 1-day, 4-week, 12-week and 24- week control group, so were CPC group and PMMA group (P﹥0.28). At the end of every study period, the Fmax and EAV of CPC group were unanimously greater than those of control group (P﹤0.001). And the Fmax and EAV of PMMA group were statistically greater than those of CPC group (P﹤0.003) but an exception, the 24-week EAV (P﹥0.18). Conclusions Results of this research demonstrated that the fixation strength of pedicle screw can be significantly improved by augmentation using the injectable calcium phosphate cement, and the augmentation is not only immediate but maintainable in vivo for quite a long time. CPC may be a favorable substitute of PMMA for the augmentation of pedicle screw.

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高明暄,甄平,薛云,田琦.磷酸钙强化椎弓根螺钉的动态生物力学研究[J].医用生物力学,2009,24(5):384-389

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  • 收稿日期:2009-03-02
  • 最后修改日期:2009-05-21
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