胸腰椎爆裂骨折模型中硫酸钙骨水泥椎体成形术的生物力学性能.DOCVIP

临床医学论文-胸腰椎爆裂骨折模型中硫酸钙骨水泥椎体成形术的生物力学性能 ??????????????? 作者：姜星杰，吴小涛， 张绍东，杨惠林，唐天驷，陈辉，蒋赞利? 【摘要】? ［目的］评价硫酸钙骨水泥椎体成形术的生物力学性能并探讨用于胸腰椎爆裂骨折的可行性。［方法］16具新鲜小牛胸腰椎标本分为4组，每组4具，A、B、C 3组（实验组）标本在制成爆裂骨折模型后分别实施3种骨水泥（CSC、CPC、PMMA）椎体成形术，D组为无骨折对照组。测量爆裂骨折前、后、复位后及椎体成形术后的椎体前缘高度；测量达到完全填充时的3种骨水泥的注射量；生物力学检测比较4组标本间的极限抗压强度及刚度差别。［结果］(1)实验组12具标本均形成胸腰椎爆裂骨折模型，平均撞击能量为66.2 J；(2)CSC、CPC、PMMA的注射量分别为：4.4 ml±0.8 ml、3.7 ml±0.7 ml、4.0 ml±0.6 ml，组间无差别（P0.05）；(3)3种骨水泥均能有效充填爆裂骨折椎体复位后遗留的骨缺损，显著恢复伤椎高度（P0.01）；(4)A、B、C、D组的极限抗压强度分别为：1 659 N±154 N、1 011 N±142 N、2 821 N±897 N及2 439 N±525 N。PMMA能够完全恢复骨折椎的抗压强度，CSC、CPC均只能部分恢复骨折椎的强度，但CSC优于CPC（P0.01）；(5)4组椎体的刚度分别为：140 N/mm±40 N/mm、148 N/mm±33 N/mm、236 N/mm±97 N/mm、224 N/mm±38 N/mm。CSC的刚度低于完整椎体（62.5%，P0.05），但与PMMA、CPC差异无统计学意义（P0.05）。［结论］经CSC椎体成形术的骨折椎的强度优于CPC，刚度与PMMA、CPC相当。将CSC椎体成形术作为一种辅助治疗方式用于胸腰椎爆裂骨折能满足力学要求、手术安全可行。 【关键词】? 硫酸钙骨水泥； 爆裂骨折； 生物力学； 椎体成形术 ??? Abstract：［Objective］To evaluate the biomechanical performance of vertebroplasty using calcium sulfate cement for thoracolumbar burst fractures.［Method］Sixteen bovine thoracolumbar spines (T11～L1) were into divided 4 groups(A, B, C and D).After burstfracture model was created ,12 vertebral bodies in group A,B,C were augmented with calcium sulfate cement (CSC), calcium phosphate cement (CPC) and polymethacrylate (PMMA) bone cement respectively. Each anterior vertebral body (VB) height was measured with a caliper at 4 time points: intact conditions (HInt), postfracture (HFr), postreduction (HRe) and postvertebroplasty (HVP).The vertebroplasty treatment consisted of inserting a biopsy needle bipedicularly into each VB, and filling the void with different bone cements. The filling volume of 3 different bone cements also was measured. Each VB was compressed at 0.5mm/s using a hinged plating system on a materials testing machine to 50% of the postvertebroplasty height to determine strength and stiffness. Difference was checked for significance (P0.05) using t tests or Oneway ANOVA.［Result］The average crash energy was 66.2J.Vertebro