椎体成形术后邻近椎间盘、椎体的力学性质变化
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THE BIOMECHANICAL INFLUENCE OF VERTEBROPLASTY ON THE ADJACENT VERTEBRAL BODY AND INTERVERTEBRAL DISC
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    摘要:

    目的 探讨椎体成形强化后对邻近椎间盘、椎体的力学影响。方法 将包括 3个椎体2个椎间盘的脊柱功能单元 (FSU)分为两组 ,行中间椎体骨折后 ,分别在中间椎体行磷酸钙骨水泥(CPC)和医用骨水泥 (PMMA)成形强化 ,以代表不同程度的强化。骨折前、成形后分别行屈曲压缩力学实验。结果 FSU中间椎体成形后刚度比骨折前刚度升高 1 9%时 ,FSU整体刚度和强度无影响 ;邻近椎体刚度降低 6.7% (P >0 .0 5 ) ,但不显著 ;对邻近椎间盘高度有明显影响 (P <0 .0 1 )。当FSU中间椎体成形后刚度比骨折前刚度升高 5~ 6倍时 ,FSU整体刚度和强度仍无明显变化 (P >0 .0 5 ) ;邻近椎体刚度降低 2 4 .4 % (P <0 .0 1 ) ;对邻近椎间盘高度的影响最大 (P <0 .0 1 )。结论 CPC强化椎体后 ,对邻近椎体造成的应力集中很小 ,而对邻近椎间盘有一定的影响 ;即使椎体刚度超过原来数倍时 ,可在邻近椎间盘造成明显的应力集中 ,但对邻近椎体刚度的影响远小于强化椎体本身刚度的增加幅度 ,而对节段刚度仍无明显影响

    Abstract:

    Objective To investigate the biomechanical influence of vertebroplasty on the adjacent vertebral body and intervertebral disc. Methods Six fresh cadaver specimens were applied to make 6 T 12-L 2 function spine unit (FSU) as group A,and 6 L 3-L 5 FSU as group B, respectively. All the FSU were underwent flexion-axial loading to result in middle vertebral body fracture. Following reduction,the middle fractured vertebral body were strengthened by the method of vertetroplasty, with group A using Calcium Phosphate Cement (CPC), group B using Polymethylmethacrylate(PMMA) respectively. Before fracture and after vertebroplasty, all the FSU were conducted biomechanical test. Results In the CPC group(group A), the stiffness of middle vertebral body were enhanced by 19%, without any affection on the stiffness and strength of the whole FSU, the stiffness of upper vertebral body decreased by 6.7%, the height of upper disc is decreased evidently. In group B, even when the stiffness of middle vertebral body were 5 to 6 times augmented, the stiffness and strength of the whole FSU were still not affected ,the stiffness of upper vertebral body decreased by 24.4%, the height of upper disc were decreased very evidently. Conclusion Following vertebroplasty, the enhanced vertebral body don't result in great stress concentration in the adjacent vertebral body, especially with CPC, it means that vertebroplasty technique is safe in the respect of biomechanics. While some extend of stress concentration are present in the adjacent dise, which will possibly accelerate disc degeneration process.

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赵必增,王以进,李家顺,贾连顺.椎体成形术后邻近椎间盘、椎体的力学性质变化[J].医用生物力学,2002,17(4):215-219

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