内固定结合伤椎骨水泥增强治疗骨质疏松性胸腰椎爆裂骨折的生物力学评价

摘要
图/表
参考文献(26)
相关文章 (15)

全文: PDF (664 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的评估内固定结合伤椎骨水泥增强治疗骨质疏松性胸腰椎爆裂骨折的稳定性，为临床应用提供参考。方法 2018年1月至2019年6月通过上海中医药大学收集6具老年胸腰段（T11~L3）脊柱标本，用于制备L1椎体爆裂骨折模型。然后按照完整状态（空白组）、骨折状态（骨折组）、6钉内固定状态（6钉组）、6钉内固定结合伤椎骨水泥增强状态（6钉+骨水泥组）、4钉内固定结合伤椎骨水泥增强状态（4钉+骨水泥组）的顺序进行生物力学测试，各组标本在不同阶段分别完成前屈，后伸，左、右侧屈及轴向加压测试，CCD摄像机采集标本形变图像，基于Image J软件，采用数字标记点质心跟踪法测量冠状面上T12的垂直位移来反映固定节段的刚度，并进行比较。结果在轴向加压、前屈、后伸、左右侧屈加载模式下，骨折组的标本刚度均显著低于空白组、6钉组、4钉+骨水泥组、6钉+骨水泥组，差异有统计学意义（P ＜ 0.05）。在后伸、左右侧屈加载模式下，6钉组的标本刚度高于空白组，在轴向加压和前屈加载模式下，6钉组的标本刚度低于空白组，差异有统计学意义（P ＜ 0.05）。在轴向加压、后伸、左右侧屈加载模式下，4钉+骨水泥组与6钉+骨水泥组的标本刚度高于空白组和6钉组，且6钉+骨水泥组高于4钉+骨水泥组，差异有统计学意义（P ＜ 0.05）。在前屈加载模式下，4钉+骨水泥组的标本刚度低于空白组但高于6钉组，6钉+骨水泥组高于空白组和6钉组，差异有统计学意义（P ＜ 0.05）。结论三种固定方式均能达到固定节段的稳定，但6钉内固定结合伤椎骨水泥增强的手术方式稳定性最强，生物力学性能最佳。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	翟伟峰1 贾永伟1 颜昊1 倪明2 张建坡1 魏礼成1 黄正1 金浪1

关键词 ：骨质疏松, 胸腰椎爆裂骨折, 骨水泥, 内固定, 生物力学

Abstract：Objective To evaluate the stability of internal fixation combined with injured vertebrae cement reinforcement in the treatment of osteoporotic thoracolumbar burst fracture, and to provide reference for clinical application. Methods Six elderly thoracolumbral (T11-L3) spinal specimens were collected by Shanghai University of Traditional Chinese Medicine from January 2018 to June 2019 to prepare L1 vertebral body burst fracture model. Then biomechanical tests were performed in the order of complete state (blank group), fracture state (fracture group), 6-screw internal fixation state (6-screw group), 6-screw internal fixation combined with injured vertebrae cement reinforcement state (6-screw + cement group), and 4-screw internal fixation combined with injured vertebrae cement reinforcement state (4-screw + cement group). The specimens in each group were tested in different stages of flexion, extension, left and right bending and axial compression respectively. The deformation images of the specimens were collected by CCD camera. Based on Image J software, digital marker point centroid tracking method was used to measure the vertical displacement of T12 on the coronal plane to reflect the stiffness of the fixed segment, and the comparison was made. Results Under axial compression, flexion, extension, and left and right bending loading modes, the specimen stiffness of fracture group was significantly lower than that of blank group, 6-screw group, 4-screw + cement group, and 6-screw + cement group, with statistically significant differences (P < 0.05). The stiffness of specimens in the 6-screw group was higher than that in the blank group under extension and left and right bending loading modes, and the stiffness of specimens in the 6-screw group was lower than that in the blank group under axial compression and forward bending loading modes, with statistical significance (P < 0.05). Under axial compression, extension, and left and right bending loading modes, the stiffness of specimens in the 4 screw + cement group and 6 screw + cement group were higher than those in the blank group and 6 screw group, and the 6 screw + cement group was higher than the 4 screw + cement group, the differences were statistically significant (P < 0.05). In flexion loading mode, the stiffness of specimens in the 4 screws + cement group was lower than that of the blank group but higher than that of the 6 screws group, and the 6 screws + cement group was higher than those of the blank group and the 6 screws group, with statistical significance (P < 0.05). Conclusion The three fixation methods can achieve the stability of the fixed segment, but the 6-screw internal fixation combined with injured vertebrae cement reinforcement has the strongest stability and the best biomechanical performance.

Key words： Osteoporosis Thoracolumbar burst fracture Cement Internal fixation Biomechanics

基金资助:国家自然科学基金面上项目（81972118）；
上海市科学技术委员会科研计划项目（18401904500）；
上海市卫生和计划生育委员会面上项目（201840361）；
上海市卫生健康委员会三年行动计划中医优势病种培育建设项目[ZY（2018-2020）-ZYBZ-04]；
上海市长宁区科学技术委员会重点项目（CNKW2017Z05）。

通讯作者: 贾永伟（1972.11-），男，博士，主任医师，硕士生导师；研究方向：脊柱外科。

作者简介: 翟伟峰（1990.5-），男，硕士；研究方向：脊柱外科。

引用本文:

翟伟峰1 贾永伟1 颜昊1 倪明2 张建坡1 魏礼成1 黄正1 金浪1 . 内固定结合伤椎骨水泥增强治疗骨质疏松性胸腰椎爆裂骨折的生物力学评价[J]. 中国医药导报, 2021, 18(30): 96-100.
ZHAI Weifeng1 JIA Yongwei1 YAN Hao1 NI Ming2 ZHANG Jianpo1 WEI Licheng1 HUANG Zheng1 JIN Lang1. Biomechanical evaluation of internal fixation combined with injured vertebrae cement reinforcement in the treatment of osteoporotic thoracolumbar burst fractures#br#. 中国医药导报, 2021, 18(30): 96-100.

链接本文:

https://www.yiyaodaobao.com.cn/CN/ 或 https://www.yiyaodaobao.com.cn/CN/Y2021/V18/I30/96

[1] 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南（2017）[J].中国骨质疏松杂志，2019，25（3）：281-309.
[2] Defino HL，Canto FR. Low thoracic and lumbar burst fractures：radiographic and functional outcomes[J]. Eur Spine J，2007，16（11）：1934-1943.
[3] Dai LY，Jiang LS，Jiang SD. Posterior short-segment fixation with or without fusion for thoracolumbar burst fractures. A five to seven-year prospective randomized study [J]. J Bone Joint Surg Am，2009，91（5）：1033-1041.
[4] Sasso RC，Renkens K，Hanson D，et al. Unstable thoracolumbar burst fractures： anterior-only versus short-segment posterior fixation [J]. J Spinal Disord Tech，2006，19（4）：242-248.
[5] Burval DJ，McLain RF，Milks R，et al. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae： Biomechanical analysis of pedicle fixation strength [J]. Spine，2007，32（10）：1077-1083.
[6] Wu ZX，Gao MX，Sang HX，et al. Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation：a biomechanical study and a 2-year follow-up of 20 patients [J]. J Surg Res，2012，173（1）：91-98.
[7] 杨俊龙，赖震，张兆飞，等.椎弓根螺钉固定联合椎体成形术治疗老年骨质疏松性椎体爆裂骨折[J].创伤外科杂志，2016，18（12）：713-716.
[8] 崔冠宇，田伟，刘波，等.椎体强化后椎弓根螺钉内固定术治疗骨质疏松性胸腰椎爆裂骨折[J].中华创伤骨科杂志，2015，17（6）：502-508.
[9] 陈孜，赵国辉，金丹杰，等.后路短节段内固定结合伤椎强化技术治疗骨质疏松性胸腰椎爆裂性骨折[J].中国微创外科杂志，2019，19（12）：1088-1091.
[10] 程晓光，刘忠厚. 国际临床骨密度学会共识文件(2005年版)[J].中国骨质疏松杂志，2006，12（2）：205-209.
[11] Kallemeier PM，Beaubien BP，Buttermann GR，et al. Invitro analysis of anterior and posterior fixation in an experimental unstable burst fracture model [J]. J Spinal Disord Tech，2008，21（3）：216-224.
[12] Wood KB，Li W，Lebl DR，et al. Management of thoracolumbar spine fractures [J]. Spine J，2014，14（1）：145-64.
[13] Ponnusamy KE，Iyer S，Gupta G，et al. Instrumentation of the osteoporotic spine：biomechanical and clinical considerations [J]. Spine J，2011，11（1）：54-63.
[14] 李锦华，周鹰飞，赵宙，等.经伤椎和跨伤椎内固定治疗不同程度胸腰椎骨折[J].脊柱外科杂志，2019，17（4）：252-256.
[15] 蒋伟宇，潘国平，陈丹果，等.伤椎固定结合成形与跨伤椎固定结合伤椎成形治疗骨质疏松性胸腰椎爆裂骨折的疗效比较[J].中国骨伤，2020，33（5）：440-444.
[16] 刘潮坚，蔡拉加，石昭宏，等.伤椎置钉与不置钉短节段内固定治疗胸腰椎爆裂骨折的比较[J].中国矫形外科杂志，2016，24（6）：531-535.
[17] 宁广智，吴强，张蒂，等.胸腰段脊柱骨折手术治疗的研究进展[J].中华创伤杂志，2017，33（1）：43-46.
[18] 李熙雷，车武，董健，等.经伤椎单节段椎弓根螺钉固定治疗胸腰椎爆裂骨折的生物力学研究[J].中华创伤骨科杂志，2012，14（3）：225-227.
[19] 朱海明，丁亮，张东，等.胸腰椎爆裂性骨折短节段伤椎固定三维有限元模型构建及生物力学比较研究[J].中国矫形外科杂志，2015，23（10）：917-920.
[20] 程哲，何由，王卫国，等.胸腰段爆裂性骨折内固定治疗的生物力学特点[J].医用生物力学，2019，34（5）：486-492.
[21] Norton RP，Milne EL，Kaimrajh DN，et al. Biomechanical analysis of four- versus six-screw constructs for short-segment pedicle screw and rod instrumentation of unstable thoracolumbar fractures [J]. Spine J，2014，14（8）：1734-1739．
[22] 叶劲，陈艺，莫茅，等.椎弓根钉固定与椎体成形术治疗爆裂型骨折的生物力学研究[J].中国临床解剖学杂志，2009，27（3）：337-339，343.
[23] Serhan H，Hammerberg K，O’Neil M，et al. Intraoperative techniques to reduce the potential of set-screw loosening in long spinal constructs: a static and fatigue biomechanical investigation [J]. J Spinal Disord Tech，2010，23（7）：e31-e36.
[24] 付忠泉，禤天航，霍智铭，等.胸腰椎爆裂性骨折后路手术中三种不同植骨方式的疗效比较[J].中华创伤骨科杂志，2019，21（7）：623-627.
[25] Sjostrom L，Jacobsson O，Karlstrom G，et al. CT analysis of pedicles and screw tracts after implant removal in thoracolumbar fractures [J]. J Spinal Disord，1993，6（3）：225-231.
[26] Uchida K，Nakajima H，Yayama T，et al. Vertebroplasty-augmented short-segment posterior fixation of osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine：comparisons with posterior surgery without vertebroplasty and anterior surgery [J]. J Neurosurg Spine，2010，13（5）：612-621.