经皮质骨轨迹螺钉在腰椎结核病椎间固定的生物力学研究

doi:10.3969/j.issn.1000-6621.2021.02.013

摘要/Abstract

摘要：

目的探究经皮质骨轨迹(cortical bone trajectory,CBT)螺钉病椎间固定在治疗腰椎结核的生物力学稳定性及其优势,为临床固定方式的选择提供生物力学依据。方法选取猪脊柱标本(T₁₂~L₅)16具,模拟体外(L₂~L₃)腰椎结核骨质破坏模型,通过随机数字表法分为4组,每组4具,分别予以短节段(病椎椎弓根钉)固定(A组)、短节段(病椎CBT钉)固定(B组),病椎间椎弓根螺钉固定(C组)、病椎间CBT螺钉固定(D组)。各组每具标本依次进行完整状态(状态1)和L₂~L₃脊柱结核造模植骨融合并内固定状态(状态2)下的生物力学测试。将各标本装载到脊柱三维运动机上,分别施予2N·m、2.5N·m、1N·m、3N·m纯力矩,记录标本在前屈、后伸、侧弯、扭转4个方向上的活动度,比较并分析各组活动度。结果 A组在状态1和状态2模式下前屈、后伸、侧弯和扭转运动的活动度分别为(8.47±1.76)°、 (7.01±1.10)°、 (5.03±0.92)°和 (4.48±0.41)°; (4.78±0.07)°、 (2.91±0.16)°、 (2.66±0.09)°和 (2.23±0.05)°;B组在状态1和状态2模式下前屈、后伸、侧弯和扭转运动的活动度分别为(7.32±0.75)°、 (5.35±0.69)°、 (3.44±0.51)°和 (3.36±1.02)°;(3.51±0.29)°、 (1.74±0.04)°、 (1.53±0.31)°和 (1.23±0.08)°;C组在状态1和状态2模式下前屈、后伸、侧弯、扭转运动的活动度分别为(10.01±0.39)°、 (9.05±0.25)°、 (7.42±1.06)°和 (6.92±1.15)°; (7.21±0.17)°、 (5.07±0.02)°、 (5.12±0.74)°和 (4.58±0.01)°;D组在状态1和状态2模式下前屈、后伸、侧弯、扭转运动的活动度分别为(9.20±1.37)°、 (7.38±0.88)°、 (6.89±1.22)°和 (6.00±0.52)°; (6.06±0.16)°、 (3.99±0.02)°、 (3.85±0.08)°和 (3.47±0.10)°。各固定模式组状态2的活动度均较状态1减小,差异均有统计学意义(A组t值分别为4.531、5.346、6.008、4.149,P值分别为0.020、0.013、0.009、0.025;B组t值分别为9.481、16.181、11.814、4.769,P值分别为0.002、0.001、0.001、0.018;C组t值分别为4.349、8.002、4.473、4.800,P值分别为 0.022、0.004、0.021、0.017;D组t值分别为5.041、4.146、12.232、10.583,P值分别为0.015、0.025、0.001、0.002)。结论 4组固定模式状态2均比状态1有更强的力学支持,CBT螺钉病椎间固定不但可以提供足够的力学稳定,而且可在采用相同的固定节段时提供更强的稳定性,可以最大限度地减少了固定节段。

关键词: 结核,脊柱, 内固定器, 脊柱融合术, 疾病模型,动物, 对比研究

Abstract:

Objective To explore the biomechanical stability and advantages of cortical bone trajectory (CBT) screws in the treatment of lumbar spine tuberculosis and provide biomechanical evidence for the choice of clinical fixation methods. Methods Sixteen pig spine specimens (T₁₂-L₅) were selected to simulate the in vitro (L₂-L₃) lumbar spine tuberculosis bone destruction. The 16 specimens were randomly divided into 4 groups (short-segment (vertebra pedicle screw) fixation (group A), short-segment (spine CBT screw) fixation (group B), intervertebral pedicle screw fixation (group C), vertebrae fixation with CBT screw (group D)), 4 specimens in each group, each specimen in each group was subjected to biomechanical testing in the state of complete specimen (state 1) and L₂-L₃ spinal tuberculosis model bone graft fusion and internal fixation (state 2). We loaded each specimen on the spine 3D exercise machine, applied moments of 2 N·m, 2.5 N·m, 1 N·m, 3 N·m, respectively, then recorded the range of movement (ROM) of the specimens in the four directions of flexion, extension, lateral bending and torsion, compared and analyzed each group of ROM. Results The ROMs of flexion, extension, lateral bending, and torsion in group A in state 1 and state 2 modes were (8.47±1.76)°, (7.01±1.10)°, (5.03±0.92)°, (4.48±0.41)° and (4.78±0.07)°, (2.91±0.16)°, (2.66±0.09)°, (2.23±0.05)°; the ROMs of flexion, extension, lateral bending and torsion in group B in state 1 and state 2 modes were (7.32±0.75)°, (5.35±0.69)°, (3.44±0.51)°, (3.36±1.02)° and (3.51±0.29)°, (1.74±0.04)°, (1.53±0.31)°, (1.23±0.08)°; the ROMs of flexion, extension, lateral bending, and torsion in group C in state 1 and state 2 modes were (10.01±0.39)°, (9.05±0.25)°, (7.42±1.06)°, (6.92±1.15)° and (7.21±0.17)°, (5.07±0.02)°, (5.12±0.74)°, (4.58±0.01)°; the ROMs of flexion, extension, lateral bending, and torsion in group D in state 1 and state 2 modes were (9.20±1.37)°, (7.38±0.88)°, (6.89±1.22)°, (6.00±0.52)° and (6.06±0.16)°, (3.99±0.02)°, (3.85±0.08)°, (3.47±0.10)°. The ROM value of each fixed mode group under the state of bone graft fusion and internal fixation (state 2) was lower than that of the intact state (state 1), and the difference was statistically significant (group A: t values were 4.531, 5.346, 6.008, 4.149, P values were 0.020, 0.013, 0.009, 0.025; group B: t values were 9.481, 16.181, 11.814, 4.769, P values were 0.002, 0.001, 0.001, 0.018; group C: t values were 4.349, 8.002, 4.473, 4.800, P values were 0.022, 0.004, 0.021, 0.017; group D: t values were 5.041, 4.146, 12.232, 10.583, P values were 0.015, 0.025, 0.001, 0.002). Conclusion The state 2 of the 4 groups of fixation modes all have stronger mechanical support than state 1. CBT screw intervertebral fixation can not only provide sufficient mechanical stability, but also provide stronger stability when using the same fixed segment, thus could minimize number of segments for fixation.

Key words: Tuberculosis,spine, Internal fixator, Spinal fusion, Disease model,animal, Comparative study

费骏, 石仕元, 胡胜平, 胡德新, 张晨威. 经皮质骨轨迹螺钉在腰椎结核病椎间固定的生物力学研究[J]. 中国防痨杂志, 2021, 43(2): 171-177. doi: 10.3969/j.issn.1000-6621.2021.02.013

FEI Jun, SHI Shi-yuan, HU Sheng-ping, HU De-xin, ZHANG Chen-wei. Biomechanical study of cortical bone trajectory screw in lumbar spine tuberculosis intervertebral fixation[J]. Chinese Journal of Antituberculosis, 2021, 43(2): 171-177. doi: 10.3969/j.issn.1000-6621.2021.02.013

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参考文献 17

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