横连对单节段短椎弓根螺钉内固定的影响.docVIP

横连对单节段短椎弓根螺钉内固定的影响 　　作者：武启军,王自立,戈朝晖,刘斌　　作者单位：1.宁夏医科大学，银川 750004; 2.宁夏医科大学附属医院骨科，银川 750004 　　【摘要】目的 测试使用横连在单节段短椎弓根钉内固定中的生物力学稳定性。方法 使用10具小牛脊柱标本(T12～L3)模拟体外L1～2椎间盘周围型脊柱结核前路病变椎体切除手术，即切除L1～2间盘和邻近终板，行自体髂骨植骨，后路用单节段短椎弓根螺钉进行固定。测试该模型在不使用横连、使用1根横连、使用2根横连状态下在垂直压缩、侧弯、屈伸和扭转方向上的力学稳定性。结果 在扭转载荷下，1根横连组和2根横连组分别与无横连组相比其相对运动范围(RROM)明显降低(P0.05);而1根横连组和2根横连组相比差异无统计学意义(P0.05)。结论 在扭转方向上横连能够明显增强结构的稳定性能;在单节段短椎弓根螺钉固定中，使用1根横连即能够达到最佳的抗扭转效果。 　　【关键词】 生物力学;横连;椎弓根螺钉;内固定;胸腰椎 　　Effect of Cross-linkage on Monosegment Instrument with Short Pedicle Screw　(Ningxia Med.Univ., Yinchuan 750004) 　　Abstract: Objective To test the biomechanical stiffness of cross-linkage in monosegment instrument with short pedicle screw.Methods Ten fresh calf spines(T10～L5) were made into the mechanical test models of simulating spinal tuberculosis with being cut off the L1～2 intervertebral discs and the adjacent end plates,iliac grafting in situ and posterior monosegment fixation with short pedicle screw.stability of the models were Tested without cross-linkage,with 1 and 2 cross-linkages in axial compression,lateral bending,flexion-extension and rotation.Results The relative range of movement (RROM) of fixation with 1 cross-linkage and 2 cross-linkages was significantly lower than that of fixation without cross-linkage in rotation(P0.05),however,comparison of RROM between 1 and 2 cross-linkages was no significantly different (P0.05).Conclusion Cross-linkage provided increased torsional stiffness of posterior spinal construct.With 1 cross-linkage,the monosegment instrument with short pedicle screw will achieve the best effect to resist rotation. 　　Key words:biomechanics; cross-linkage; pedicle screw; internal fixation; thoracolubar spine 　　经椎弓根内固定是脊柱结核中重建脊柱稳定性的重要方法，横连是椎弓根内固定系统中的组成部分之一。近年来，王自立[1]提出单节段融合固定治疗单一运动单元损害的脊柱结核的手术方法，并结合短椎弓根螺钉进行固定，本文旨在通过L1～2间盘周围型脊柱结核手术模型，探讨横连对单节段短椎弓根螺钉内固定的影响。 　　1 材料与方法 　　1.1 实验标本的选择及前处理 　　取10具同种新鲜小牛(2个月大小)胸腰椎(T12～L3)，剔除椎体周围所有肌肉，保留韧带、小关节及椎骨的完整。另外取每具小牛髂骨标本2.0cm×3.0cm×