摘要
目的观察单向联合万向椎弓根螺钉在胸腰椎骨折中的应用效果及生物力学情况。方法(1)2015年3月至2016年5月收治的单节段胸腰椎骨折患者60例,随机分为对照组(n=30)和观察组(n=30)。对照组采用万向钉治疗,观察组在对照组基础上联合单向钉治疗,比较两组临床治疗效果。(2)取新鲜冰冻小牛腰椎标本24具,随机分为万向钉组、联合钉组及正常对照组,每组8具。其中万向钉组和联合钉组16具结合落槌撞击法制备L1~L5椎体的单椎体爆裂骨折模型。万向钉组全部采用万向钉固定;联合钉组伤椎及下位椎以万向钉固定,上位椎以单向钉固定。正常对照组不制作爆裂骨折模型,并以联合组的方式固定。测定3组L1~L5节段不同方向的运动范围及其生物力学情况。结果(1)观察组手术时间及穿棒时间长于对照组(P<0.05);两组治疗前VAS评分、ODI比较差异无统计学意义(P>0.05),观察组治疗后VAS评分、ODI低于对照组(P<0.05);观察组治疗后GSKD角、伤椎后凸角小于对照组(P<0.05),伤椎前缘及后缘高度大于对照组(P<0.05)。(2)前屈、后伸弯曲强度,左、右侧屈弯曲强度,左、右旋转刚度以正常对照组→联合组→万向钉组之序递减(P<0.05)。结论单向钉联合万向钉的应用不会降低内固定系统的生物力学稳定性,且能提高胸腰椎骨折后凸畸形和伤椎椎体前缘高度,降低伤椎椎体后缘高度丢失率。
Objective To observe the application effect and biomechanical evaluation of one-way screw and universal screw in the thoracolumbar fracture.Methods ( 1) A total of 60 patients with single-segment of thoracolumbar fracture who received treatment from March 2015 to May 2016 were selected and divided into control group and observation group randomly ( n = 30,each).The control group was treated with universal screw, while the observation group was treated with one-way screw on the basis of the control group.The clinical effects of the two groups were compared.( 2) Twenty-four fresh frozen calf lumbar spine specimens were taken and randomly divided into universal screw group,combined screw group and normal control group ( n = 8, each).Take 16 fresh frozen calf lumbar vertebra specimens of universal screw group and combined nailscrewgroup,and combine the loess impact method to prepare a single vertebral burst fracture model of L1 - L5 vertebral body.The unidirectional screw group was fixed with universal screw.The combined screw group was fixed with universal screw in injured vertebra and lower vertebra and was fixed with unidirectional screw in upper vertebra.The normal control group was not made burst fracture model,and was fixed by the same method in combined screw group.The range of motion and biomechanics of L 1-L5 segments in different directions were measured in three groups.Results ( 1 ) The operation time and rod-piercing time in the observation group were lorger than those in the control group ( P < 0.05).There was no significant difference in VAS score and ODI between the two groups before treatment ( P > 0.05), but they were lower in the observation group than those in the control group after treatment ( P < 0.05).The GSKD angle and kyphosis angle in the observation group were lower than those in the control group after treatment ( P < 0.05).The height of anterior and posterior edges of the injured vertebra in the observation group were higher than those in control group ( P < 0.05).( 2) The flexion strengt
作者
崔一公
王璐
曹福源
刘阳
CUI Yi-gong;WANG Lu;CAO Fu-yuan;LIU Yang(Department of Orthopedics,First Affiliated Hospital of Army Medical University,Chongqing 400038,China)
出处
《中国临床研究》
CAS
2019年第5期642-646,共5页
Chinese Journal of Clinical Research
关键词
胸腰椎骨折
脊柱损伤
椎弓根螺钉
单向钉
万向钉
爆裂骨折模型
椎体后缘高度
生物力学
Thoracolumbar fracture
Spinal injury
Pedicle screw
One-way screw
Universal screw
Burst fracture model
Vertebral posterior margin height
Biomechanics
