椎体成形治疗胸腰段压缩骨折的力学研究
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Biomechanical study of vertebroplasty in treatment of thoracolumbar compression fracture
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    摘要:

    目的探讨体位复位结合椎体成形治疗创伤性压缩骨折的生物力学及形态学变化。方法6具新鲜小牛T12-L3的L1制作创伤性压缩骨折模型后,采用体位复位结合椎体成形强化。于完整、损伤、成形即刻、3000次疲劳后测试并观察标本的生物力学及形态学变化,数据行统计学处理。结果体位复位结合椎体成形即刻L1椎前高度、应变与完整状态无显著差异(P>0.05),脊柱标本稳定性恢复至完整状态(P>0.05)。3000次疲劳后L1椎前高度及应变无明显变化(P>0.05)。生理载荷作用下垂直压缩、后伸时标本刚度值与完整状态无统计学差异(P>0.05),前屈、左/右弯屈时标本刚度值达不到完整状态(P<0.05),左/右旋转时部分维持标本的稳定性。疲劳后在4N穖的纯力偶矩的作用下,T12-T13、L2-L3各向运动范围和完整状态一致(P>0.05)。T13-L1后伸、左/右旋转与完整状态相比无差异(P>0.05),前屈时达不到完整水平,但与损伤状态有显著性差异(P<0.05),左/右弯曲与损伤状态相比无差异(P>0.05);L1-L2后伸、左/右旋转与完整状态相比无差异(P>0.05),前屈与损伤状态相比无差异(P>0.05),左/右弯曲疲劳后运动范围增加,但和损伤状态有显著性差异(P<0.05)。强化和完整椎体抗极限压缩强度无差异(P>0.05)。形态学示疲劳后伤椎仍呈解剖复位,未见骨水泥断裂现象发生。结论体位复位结合椎体成形术后即刻可以有效稳定创伤性压缩骨折,3000次疲劳载荷循环后脊柱标本的生物力学性能出现不同程度的下降。

    Abstract:

    Objective To assess the biomechanical effects and morphologic transformation in treating thoracolumbar traumatic compression fracture by precutaneous vertebralplasty (PVP) combined with reduction.M ethod L1 traumatic compression fracture was created with six fresh calf spines (T12-L3) and the destabilized specimens were augmented using PVP combined with reduction procedure. Each specimen was tested in four states: intact state as the control, L1 flexion-compression fracture state, PVP combined with reduction state, 3000 cycles of fatigue state, respectively. Biomechanical and morphologic analyses were made to test the mechanical stability of the fractured spine.R esults PVP combined with reduction can restore the L1 prevertebral height、strain and the spinal stability to intact states immediately after operation (P>0.05). 3000 fatigue cycles had no effect on the L1 prevertebral height and strain P(>0.05). In physiological loading, the specimens were associated with a significant decrease in rigidity from the intact state with flexio、nleft/right lateral bending (P<0.05) except axial compression and extension(P>0.05)after the fatigue. In left/right axial rotation, PVP was able to stabilize the spine after fatigue but not to the same extent as the intact state. Fatigue had no effect on ROM of T12- T13、L2-L3 at 4Nm moment (P>0.05). In T13-L1, no difference was encountered between the fatigue and intact state in extension、left/right axial rotation (P>0.05), PVP was able to stabilize the spine after fatigue but not to the same extent as the intact state in flexion ,ROM of left/right lateral bending after fatigue was the same as that of fracturedP (>0.05). In L1-L2, no difference was encountered between the fatigue and intact state in extensio、nleft/right axial rotation (P>0.05), PVP was able to stabilize the spine but not to the same extent as the intact state in left/right bending, ROM of flexion after fatigue was the same as that of fractured(P>0.05). No significant difference was found between intact and augmented vertebra for the failure strength after fatigue. Radiographs and cross-sectional observations indicated a good cement-bone bonding and fracture fill. Conclusion PVP combined with reduction can restore the stability of traumatic compression fracture immediately after operation, but the spinal stability decreased in some extent after 3000 cycles fatigue.

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陈劲松,刘艺明,刘志成,赵卫东,魏力今,龚立,王善松,宁仁德,张之栋,江渟.椎体成形治疗胸腰段压缩骨折的力学研究[J].医用生物力学,2008,23(4):311-316

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