摘要
背景:经骶骨前入路的经皮腰骶椎前柱内固定系统即Axia LIF先后在美国及欧洲应用于临床,取得较好的临床疗效,但是在应用过程中出现了如内固定下沉、内固定控制旋转能力较差等一系列问题。目的:根据国人腰椎侧位片及CT横断面测量的解剖数据自行设计腰骶椎轴向螺钉,制成成品后在体外生物标本上进行三维运动实验和轴向抗压缩实验,对其固定节段的稳定性及轴向抗压刚度进行生物力学评价。方法:选取新鲜成人脊柱标本(L3-S5节段)6具,按正常组、峡部裂组、普通轴向螺钉固定组、自行设计轴向螺钉固定组顺序依次进行生物力学测试,分别测试各实验组在屈伸、左侧屈、左旋转运动状态下L5/S1节段的运动范围及轴向抗压缩位移。结果与结论:(1)在三维运动实验中,峡部裂组的ROM在屈伸及左旋转方向上均显著大于正常组(P<0.05),在左侧弯方向上与正常组差异无显著性意义(P>0.05);(2)普通螺钉固定组与自制螺钉固定组的ROM在屈伸、左侧弯方向上均显著小于正常组(P<0.05),在左旋转方向上与正常组差异无显著性意义(P>0.05),普通螺钉固定组与自制螺钉固定组间比较差异无显著性意义(P>0.05);(3)在1 000 N的轴向载荷压缩实验中,4组所产生的压缩位移差异有显著性意义(P<0.05),自制螺钉固定组<普通螺钉固定组<正常组<峡部裂组;(4)根据力学公式EF=P/v L,结合压缩位移结果,计算出轴向压缩刚度值,自制螺钉固定组>普通螺钉固定组>正常组>峡部裂组;(5)提示自行设计轴向螺钉可以显著提高腰骶椎在后柱失稳情况下各个运动方向的稳定性,与普通轴向螺钉相当,但在轴向抗压刚度方面明显强于普通轴向螺钉,为在防止轴向螺钉固定脊柱节段沉降和前凸损失方面提供了一种有效的解决思路。
BACKGROUND： Percutaneous lumbar sacral anterior column internal fixation system （AxiaLIF） through anterior sacral approach has been applied in clinical practice in the United States and Europe and has achieved good clinical efficacy. However, there are some problems such as internal fixator subsidence, and poor in controlling rotation ability. OBJECTIVE： The axial screw of lumbosacral vertebra was designed according to the anatomic data of lumbar lateral radiographs and CT cross-sectional measurements from Chinese healthy populations, and then three-dimensional movement and axial compression tests were conducted on biospecimens in vitro, and the stability of the fixed segment and the axial compressive stiffness were evaluated by biomechanical analysis. METHODS： Six fresh adult spine specimens （L3-S5 segments） were selected, then the biomechanical tests were performed sequentially in normal, isthmic fracture, conventional axial screw fixation, and self-designed axial screw fixation groups. The L5/S1 segment in each experimental group was measured under flexion, left flexion and left rotation, and axial compressive displacement was tested. RESULTS AND CONCLUSION： （1） In the three-dimensional movement experiment, the range of motion in the isthmic fracture group was significantly larger than that in the normal group in flexion and extension and left rotation （P 〈 0.05）. There was no significant difference between isthmic fracture and normal groups in left bend direction （P 〉 0.05）. （2） The range of motion in the conventional and self-designed axial screw fixation groups was significantly smaller than that in the normal group in flexion and extension and left lateral direction （P 〈 0.05）, but the range of motion in left rotation direction showed no significant difference （P 〉 0.05）. There was no significant difference in the range of motion between conventional and self-designed axial screw fixation groups （P 〉 0.05）. （3） In the axial load compression test
作者
曾德辉
王文军
张卫
宋西正
阳文任
向亮
侯威
Zeng De-hui;Wang Wen-jun;Zhang Wei;Song Xi-zheng;Yang Wen-ren;Xiang Liang;Hou Wei(Department of Orthopedics,the Affiliated Nanhua Hospital,University of South China,Hengyang 421001,Hunan Province,China;Department of Spine Surgery,the First Affiliated Hospital of University of South China,Hengyang 421001,Hunan Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2018年第27期4369-4374,共6页
Chinese Journal of Tissue Engineering Research
基金
湖南省科学技术厅资助项目(2012SK3150)~~
