三种内固定器械对胸腰段脊柱骨折固定的力学特点及对比研究

【作者】 谭映军；

【导师】 应大君；

【作者基本信息】 第三军医大学 ， 人体解剖学， 2001， 硕士

【摘要】 [目的]二十世纪八十年代，随着椎弓根螺丝钉问世以来，脊柱创伤的手术治疗效果明显优于以往传统保守疗法。对椎弓根的解剖及脊柱生物力学研究的不断深入，脊柱骨折三维空间解剖复位的生物力学原则及解剖结构复位机理，也通过实验得到了证实，为各种内固定器械的设计提供了依据。在此基础上，我们设计制作了一种ARRIF系统，通过与目前国内外临床上广泛应用的Dick钉和AF钉做力学对比研究，为进一步的临床应用提供可靠依据。 [方法]选取六具新鲜尸体胸腰段脊柱标本，根据Panjabi的方法制作成单纯椎体压缩骨折模型及伴有三柱损伤的椎体压缩骨折模型。根据拉丁方实验设计的原则，骨折标本分别用ARRIF钉、Dick钉及AF钉固定，给予轴向压缩、前屈、侧弯及轴向旋转负荷。观察各种负荷变化下位移及角度的变化，所有数据使用SPSS软件进行方差分析，判定三种固定方式的力学特征异同。同时，观察实验后椎体钉道周围骨小梁的变化情况，以确定实验结果的准确性。 [结果]单纯椎体压缩骨折模型，在分别使用APPIF钉及AF钉固定方式后，给予轴向压缩、前屈、侧弯负荷，位移的变化无明显差异，力学特征基本相似。 伴有三柱损伤的椎体压缩骨折模型中，在垂直压力负荷下，三种固定方式的力学特征基本相似，但在轴向旋转压力负荷下，三种固定方式有明显差异，根据角度变化的均值进行两两比较，在10°以下，ARRIF钉明显优于DICK钉及AF钉，但在10°--20°范围内，ARRIF钉和AF钉明显优于DICK钉，组织学观察记录，在所有负荷下，钉道周围的骨小梁无明显改变，结构正常。 〔结论〕A职IF钉的力学特点与AF钉、DICK钉基本相似，由于其设计特点，其抗轴向旋转的能力明显优于后两者，在应用过程中安装简便，极大的节约术中时间，减少出血，降低感染机会，因此在临床上有一定的价值。更多还原

【Abstract】 Objective Since 1.980’s, with the invention of transpedicle screw, the curative effect of operation to pedicle of vertebral arch has shown out a significant superiority to the traditional conservative treatment. With the further research on qualitative and quantitative anatomy and spinal column biomechanics, the biochemical theory on anatomical restoration by three-dimensional space of spinal column fracture and the mechanism of anatomical reduction have been proved by experiments, which provides the basis for the design of various internal fixation devices. With such basis, we designed a system called ARRIF, and by mechanical contrast study with the Dick and AF prevailing in clinic now at home and abroad, the reliable basis for further clinical application has been gained. Method A single spinal compression fracture model and a model of spinal compression fracture with three-axes spinal damages were made according to the Panjabi Method with the thoraculumnbar spinal column specimens taken from six fresh cavaders. According to the Latin Square experimental designing principle, the fracture specimens were fixed witi~i ARRIF, Dick and AF separately and axial compression, forward flexion, lateral bending and axial torsion load were given. The shift and angle changes were observed under different loads, and the analysis of variance was performed to all the data with the SPSS software. If differences appear, pair contrast study was performed to the mean of the data to decide the similarities and differences of the mechanical features. At the same time, the changes of the bone trabecula round the vertebral nail pass were observed to set the accuracy of the experiment results. Results The single spinal compression fracture model showed no significant shift and the mechanical features are similar when it was fixed by ARRIf, AF separately and axial compression, forward flexion and lateral bending loads were given. The model of spinal compression fracture with three spinal damages showed similar mechanical feature in the three fixings when vertical tension was given. However, significant differences were shown out in the three fixings when axial torsion load was given. The pair contrast study was performed with the means of angle changes. When the angel change under 10 ~, ARRIF showed out significant superiority to Dick and AF. But when the angel changed within 10 to 20 ~, ARRIF and AF showed out clearly a superiority to Dick, the histological observation of ARRIF recorded no significant changes of the bone trabecula round the nail pass and the structure kept normal. Conclusion The mechanical feature of ARRIF was basically similar to that of AF and Dick. Because of the characteristics of its designing, its ability of anti-axial torsion is significantly superior to that the other two. It can be easily fixed in application, and it can save the operation time, reduce bleeding and the possibility of infection, thus it holds certain value in clinical practice.更多还原