直入式注入PMMA骨水泥强化椎弓根钉内固定生物力学研究

doi:10.3969/j.issn.1009-976X.2016.01.016

摘要/Abstract

摘要： 【摘要】目的分析直入式骨水泥注入椎体强化方法在体外提高螺钉稳定性的效果。方法采用新鲜尸体脊柱标本共24个椎体,一侧椎弓根采用直入式注入PMMA骨水泥强化椎弓根钉固定作(试验组),另一侧椎弓根采用常规椎弓根螺钉固定(对照组),两侧进行最大轴向拔出力试验、最大旋出力矩试验、周期抗屈试验生物力学测试,比较两组测试结果。结果〓骨水泥强化组中螺钉的稳定性均显著强于单纯常规椎弓根螺钉组(P < 0.05)。结论〓应用PMMA行椎体强化椎弓根钉固定有利于增强对椎弓根钉的把持力,可有效防止椎弓根钉的松动及脱落,具有良好的临床效果。

关键词: 椎弓根钉, 生物力学, 骨水泥强化

Abstract: 【Abstract】〓Objective〓To analyze the effect of direct injection approach of PMMA (polymethyl methacrylate) on strengthening the stability of the screw. Methods〓A total of 24 fresh cadaver vertebrae were used for research and were randomized into treatment group and control group for study of biomechanics by load-displacement, torque, and twisting stiffness tests. The treatment group were used direct approach of PMMA bone cement with the addition of pedicle screws fixation on one side of the pedicles, while the control group were only used conventional pedicle screws fixation on the other side of the pedicles. Then two groups'biomechanical test results of maximum axial pull output experiment, maximum spin the torque test and periodical anti-bending test were compared. Results Through vertebral specimens underwent injection of PMMA in treatment group, the stability of the screws was significantly better than that in control group by the only conventional pedicle screws(all P values were less than 0.05). Conclusion〓The vertebrae strengthened by PMMA and pedicle screws fixed showed more advantage to enhancing the holding force of the pedicle screws, preventing the pedicle screws from loosing and falling off.

Key words: Pedicle Screws, Strengthened Bone Cement, Biomechanics

中图分类号:

R681.5

陈超关宏刚区杏枝王刚禤天航. 直入式注入PMMA骨水泥强化椎弓根钉内固定生物力学研究[J]. 岭南现代临床外科, 2016, 16(01): 63-66.

CHEN Chao, GUAN Honggang, OU Xingzhi, WANG Gang, XUAN Tianhang. The biomechanics research of direct approach of PMMA bone cement with the addition of pedicle screws[J]. Lingnan Modern Clinics in Surgery, 2016, 16(01): 63-66.

参考文献

【参考文献】
[1] 毛宁方, 石志才. 骨水泥在脊柱外科中的应用现状与进展[J]. 脊柱外科杂志, 2006, 4 (4):2392242.
[2] 张绍东,滕宇飞,许龙吉,等.改良经椎间孔椎体间融合术治疗腰椎退行性疾病[J].中国矫形外科杂志,2008,11(6): 812-814.
[3] H itchon PW , B renton MD, B lack A G, et al. In vitrobiom echanical comparison of pedicle screws sublam inar hook s and sublam inar cables [J ]. J N euro surg,2003, 99: 122.
[4] M cGrego r AH, Cat termo le HR, Hughes SP. Global spinal motion in subjects with lumbar spondylo lysis and spondylo listhesis: does the grade or type of slip affect global spinal motion [J ]Spine, 2001, 26 (3) :282-286.
[5] Cook SD, Salkeld SL, Stanley T, et al. Biomechanical study of pedicle screw fixation in severely osteoporotic bone[J ]. Spine,2004, 4 (4) : 402 - 408.
[6] Tan JS, Kwon BK, DvorakMF, et al. Pedicle screw motion in the osteoporotic spine after augmentation with laminar hooks, sublam inarwires, or calcium phosphate cement: a comparative analysis[J]. Spine, 2004, 29 (16) : 1723 - 1730.
[7] 樊仕才, 刘成恩, 王宏波, 等. 骨水泥强化骨质疏松椎弓根螺钉的生物力学特征[J]. 中国临床康复, 2006,10(17):59261.
[8] TurnerAW, Gillies RM, SvehlaMJ, et al. Hydroxyapatite com2posite resin cement augmentation of pedicle screw fixation [ J ].Clin Orthop Relat Res, 2003, (406) : 253 - 261.
[9] 贺强龙，邹远航．骨水泥强化椎弓根螺钉治疗胸腰椎骨折［J］．实用骨科杂志，2007，13（6）：326－327．
[10] 张思胜，赵红卫，刘杨，等．经皮椎弓根螺钉内固定并伤椎植骨成形治疗胸腰椎骨折［J］．实用医学杂志，2011，27（4）：648－650．
[11] 柯楚群 ,林英权,许知光，等.骨水泥固定桡骨远端不稳定性骨折的生物力学研究［J］．中国临床解剖学杂志，2001，19（3）：272-273.
[12] 王刚，吴峰，关宏刚，等.直入式注入聚甲基丙烯酸甲酯骨水泥强化椎弓根钉内固定治疗骨质疏松性胸腰椎骨折［J］.中华创伤骨科杂志，2011,13(6):549-552.
[13] 邑晓东，卢海霖，陈明．医用骨水泥在骨质疏松患者行椎弓根钉固定中的作用［J］．中国脊柱脊髓杂志，2005，15（2）：95－97．
[14] Wuisman PIJM, Dijk MV, Heleen S, et al. Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique［J］. Eur Spine 2000; 9:528–33.
[15] 黎宁, 彭阿钦, 张国山，等.骨水泥强化动力髋固定效果的生物力学研究［J］．中国临床解剖学杂志，2006，24（2）：204-206.
[16] Sarzier JS, Evans AJ, Cahill SW. Increased pedicle screw pukkout strength with vertebroplasty augmentation in osteoporotic spine［J］. Neurosurg. 2002, 96(3 Supp): 309-312
[17] Derincek A, Wu C, Mehbod A, et al. Biomechanical comparison of anatomic trajectory pedicle screw versus injectable calcium sulfate graft-augmented pedicle screw for salvage in cadaveric thoracic bone［J］. Spinal Disord Tech 2006;19:286–91.
[18] 张亘瑷，陈建庭，王灵秀，等．定向灌注椎弓根螺钉的生物力学分析［J］．中国组织工程研究与临床康复，2008，12( 22) : 4225 －4228．
[19] 杨惠林，王志荣，王根林，等．可灌注骨水泥椎弓根螺钉的生物力学研究［J］．中华骨科杂志，2009，29( 3) : 241 － 247．