胸腰椎内固定及椎体增强技术对邻近节段影响生物力学分析.docVIP

胸腰椎内固定及椎体增强技术对邻近节段影响生物力学分析 　【摘要】 探讨采用内固定或椎体增强技术后邻近节段生物力学特性的变化。［方法］12具尸体胸腰椎标本，分为正常对照组、椎体压缩骨折后经椎弓根自体骨植骨组、椎体成形术组、RF内固定组分别进行实验应力分析。应力加载方式为轴向压缩、前屈、后伸、侧屈等4种，通过各种工况的生物力学测试，说明采用内固定或椎体增强技术后邻近节段力学特性的变化。［结果］采用椎体内植骨或骨水泥填充的方法，有使邻近节段的刚度降低，应力强度提高的轻微趋势，但无显著性差异(Pgt;0.05)。而采用内固定后，邻近节段刚度明显降低，应力强度明显提高，呈显著性差异(Plt;0.05)。［结论］采用椎体内植骨或骨水泥填充的方法对邻近节段的影响较小，而采用内固定后对邻近节段产生了不利的生物力学影响。 【关键词】 内固定 椎体增强技术 邻近节段 生物力学 Abstract：［Objective］To study the biomechanical effects on the adjacent segment of thoracolumbar spine with internal fixation or vertebral body enhancement.［Method］Twelve cadaver thoracolumbar spine specimens were randomly divided into 4 group: Normal contral; Thoracolumbar fractures with interbody fusion via transpedicular autogenacs bone grafting; Thoracolumbar fractures with transpedicular PMHA cement grafting; Thoracolumbar fractures with internal fixator. Four simulations (axial compression. flexion, extension and lateral bending) were applied in the biomechanical testing machine. Data of the rigidity and stress of the adjacent segment were recorded and analyzed. ［Result］Vertebral body enhancement could make a tiny tendency that the adjacent segment rigidity degrade and stress raise, but there was no significant difference (Pgt;0.05).Internal fixation could make the adjacent segment rigidity degrade and stress raise significanly(Plt;0.05). ［Conclusion］Vertebral body enhancement has little effect on the adjacent segment. Internal fixation has disadvantageous effect on the adjacent segment. Key words：internal fixation; vertebral body enhancement; adjacent segment; biomechanics 椎弓根螺钉系统内固定是严重胸腰椎骨折的常规治疗方法之一。而椎体增强技术是近年来出现的一项新技术，它通过向椎体内注入增强剂来提高椎体的刚度和抗压缩能力。广义的椎体增强剂包括各种骨水泥、生物陶瓷材料、自体骨。椎体成形术和经椎弓根椎体内植骨是椎体增强技术的代表。临床上普遍运用内固定和椎体增强技术后发现，邻近节段增生、退变加快，骨折、滑脱的发生增多。究竟运用内固定或者椎体增强技术后对邻近节段产生了什么影响?作者通过对胸腰椎标本的生物力学测试，对其进行探讨。 1 材料与方法 1.1 标本制备与分组 采集12具成人新鲜脊椎标本T12～L４，男性标本7例，女性标本5例，随机抽样，X线检查排除外伤、肿瘤、畸变等疾患。剔除骨周围肌肉、脂肪和结缔组织，保留椎间盘、韧带和骨性结构的完整。标本置于-20℃的低温冰柜内保存。试验前逐级解冻。12具标本随机分为正常标本组(N组)、椎体压缩骨折后经椎弓根自体骨植骨组(SB组)、椎体压缩骨折后