两种不同椎弓根螺钉非医源性疲劳断裂的原因分析.DOC

两种不同椎弓根螺钉非医源性疲劳断裂的原因分析 孔维清 徐建广 眭述平 张长青 曾炳芳 上海交通大学附属第六人民医院骨科 200233 [摘要] 目的 通过高频疲劳试验测试GSS及SSE两种椎弓根螺钉的疲劳特性，分析造成上述差异的内在因素。 方法 应用德国进口ZWIK-100HFP-5100高频疲劳试验机分别对德产SSE椎弓根螺钉和国产GSS椎弓根螺钉进行静态及动态加载。期间记录相应值。所有数据用统计软件SPSS10.0完成T检验。并对螺钉断口进行扫描电镜分析。 结果 静态极限强度试验GSS钉3510±123N高于SSE钉3250±108N约7%（M±SD, P0.05）。；动态疲劳循环次数试验GSS为0.92±0.12×106优于SSE 0.68±0.08×106（M±SD,P0.05）。SSE椎弓根螺钉疲劳强度为329±54Mpa,而GSS椎弓根螺钉为383±67Mpa。两者相差14%（M±SD,P0.05）。断口形貌上边缘有疲劳裂纹，随后断裂时剩余部分撕裂成脆性断裂。 结论 相对SSE, GSS是临床上进行椎弓根固定时的理想选择,但体外单部件疲劳断裂提示临床治疗应以植骨融合为标准。它能在达到固定强度的同时最大限度地预防螺钉疲劳断裂的发生。 关键词：椎弓根螺钉 疲劳试验 断钉 Reason analysis of fatigue failure of 2 different pedicle screws KONG Wei-qing XU Jian-guang, SUI Shu-ping, ZHANG Chang-qing, ZENG Bing-fang Department of orthopedics, Shanghai No 6 People’s Hospital of Jiao Tong University, Shanghai 200233, China Abstract: Objective to analyze the difference between 2 screws, fatigue characteristics of GSS and SSE pedicle screw were tested by high frequency fatigue test. Method static and dynamic load were put on SSE pedicle screw made in Germany and GSS screw made in China by ZWIK-100HFP-5100 high frequency fatigue tester imported from Germany. All data was recorded and analyzed by software SPSS10.0. Result the static ultimate strength of GSS (3510±123N) was higher than that of SSE (3250±108N),（M±SD, P0.05）. the dynamic fatigue cycling times of GSS (0.92±0.12×106) was greater than that of SSE (0.68±0.08×106),（M±SD, P0.05）. The fatigue strength of GSS (383±67Mpa) was higher than that of SSE (329±54 Mpa) by 14%. （M±SD, P0.05）fatigue crack can be seen at the edge of cut. Conclusion compared to SSE, GSS was the ideal choice for pedicle screw fixation. Bone graft fusion is still our ultimate clinic purpose. It can prevent fatigue failure and keep enough fixation strength at the same time. Key words: pedicle screw, fatigue test, screw broken 前言 我院自2003年起随机应用德国蛇牌SSE内固定系统和国产武进三厂的GSS系统治疗胸腰段脊柱骨折患者。经2-3年的随访发现SSE固定患者的螺钉断裂发生率远高于GSS系统。其中SSE断裂发生时间为6月至13月不等。而GSS发生断裂的情况则较为罕见，发生时间多为一年半以上。 观察发现，上述两种螺钉除螺纹设计