【作者】 赵云波；

【导师】 王日光； 翟饶生； 李金良；

【作者基本信息】 佳木斯大学 ， 外科学， 2009， 硕士

【摘要】 【目的】通过生物力学测试比较跨节段椎弓根钉固定与三椎体六枚椎弓根钉固定术固定胸腰段骨折的生物力学效果。【方法】采用8具人胸腰段尸体标本(T11-L3),剔除除椎间盘、韧带、小关节囊以外的所有软组织后。采用目标椎体钻孔结合Panjabi等提出的逐级撞击法在L1节段造成骨折模型,用牙托粉包埋T11和L3椎体。实验分正常对照(无骨折、无内固定)组、L1骨折无内固定组、跨节段椎弓根钉固定组、三椎体六枚椎弓根钉固定组。应用ND-500扭转实验机和微机控制电子万能实验机对标本进行前屈、后伸、侧弯及旋转6个方位的运动范围测试,所得数据进行统计学处理,比较各组间差异。【结果】跨节段椎弓根钉固定组与三椎体六枚椎弓根钉固定组之间的运动范围、刚度值差异均有显著性意义(p<0.01)。2种螺钉固定(6钉固定、4钉固定)方式,均能提高骨折失稳脊柱的各向稳定性;4钉固定方式在稳定性方面与正常对照组差异无统计学意义(p>0.05);而6钉固定(骨折椎固定)对失稳脊柱的各向稳定性的加强程度均高于4钉固定形式(P<0.01)。【结论】生物力学测试证明,三椎体六枚椎弓根螺钉固定方法在胸腰段骨折伤椎椎弓根内固定能明显加强脊柱的稳定性,并且三椎体六枚椎弓根螺钉植入复位固定在技术操作上是可行的、有效的。更多还原

【Abstract】 Objective To compare the biomechanical properties between the two-level fixation by implantation of pedicle-screws into the adjacent upper and lower vertebrae of the fractured vertebra and the three-level fixation by implantation of pedicle screws into the fractured vertebra and its adjacent upper and lower vertebrae in the treatment of thoracolumbar fracture. Methods The thoracolumber spine specimens of eight cavaders were used in this study. The soft tissue and paraspinal muscles were removed without violating the ligaments or facet joint capsules. On the day of testing the specimens were throwed and the L1 fracture model was created with boring of the aimed vertebra combine with Panjabi method and embedding T11 and L3 in polyester resin. Each specimen was tested in four groups:control models(no fracture and no fixation), L1 fracture models(no fixation), two-level fixation models, and three-level fixation models. During the experiment, the flexion , extension , bilateral bending and axial rotation loading were applied to the specimens and the rang of motion was measured with the ND-500 test machine of rotation and the electronic test machine of computer control. Obtained data was analysis used statistical method , and to compare difference in the middle of each groups. Results there were significant differences in ROMs and stiffness between the two-level fixation and three-level fixation models (p<0.01) .All of the two kind ways for transpedical of fixation (fixed with 4 , 6 pedical screws ) can restore the stability of injured thoracolumbar vertebra in axial compression , bending , rotation . there were no significant statistical difference in stability between 4 pedicle screws fixation with control groups(no fracture and no fixation)(p>0.05); There were significant statistical difference of spine stability capacity of 6 pedicle screws fixation compare with 4 pedicle screws fixation (p<0.01) .Conclusion biomechanical test prove that the three-level vertebra fixation can obviously enhance the stability of spine in the fractured vertebra pedicle of thoracolumbar fracture . The procedure of three-vertebrae 6 pedicle-screws implantation is practical , effective .更多还原