【作者】 冯涛；

【导师】 赵宝林；

【作者基本信息】 吉林大学 ， 外科学， 2012， 硕士

【摘要】 背景:脊髓型颈椎病的主要病理机制是颈椎间盘退变突出以及椎体后缘骨赘对锥体皮质脊髓束的直接压迫或局部血供减少而导致相应的临床症状。大量临床研究已经证实，颈椎前路减压加植骨融合可较好的缓解近期和远期疼痛，因此替代传统的保守治疗应用于治疗脊髓型颈椎病。可是这种手术方式存在植入的骨块稳定等一系列问题，术后常存在颈椎潜在性的稳定性降低、植骨块易脱出、移植骨不融合、椎间塌陷、颈椎进行性后凸畸形、椎间孔径变小、融合节段的高度降低，脊柱排列紊乱和症状容易复发等问题。患者常常需要较长时间的进行颈托等外固定治疗，患者的治疗效果受到影响。随着内固定技术的发展，为了获得植骨的稳定性，同时改善患者的术后早期生活，患者开始接受颈椎前路减压加自体髂骨植骨融合钢板内固定治疗。随着近年来材料学的研究，各种骨替代材料也逐渐在临床上得以应用，它同样具备较好的骨传导能力，强度又高，同时又可以避免自体取骨给患者带来痛苦，具有很好的临床效果。颈椎椎体次全切除减压钛网植入钢板内固定术即为其中一种新发展起来的术式，已广泛应用于临床,其优点也被认可。目的：模拟采用颈椎前路钛网钢板内固定及自体髂骨植骨钢板内固定模拟治疗双节段脊髓型颈椎病,对于椎体次全切钛网钢板内固定及自体髂骨植骨钢板内固定的固定效果进行系统的、客观的分析及评价。为临床双节段脊髓型颈椎病选择合理的术式、选择合适的植入物及固定器械提供科学依据。方法：在12具新鲜猪尸体C3-7颈椎标本。随机选取4具完整标本作为对照组，随机选取4具标本行C5椎体次全切钛网植骨钢板内固定术，其余4具标本行C5椎体次全切自体髂骨植骨钢板内固定术.为了能够是标本的上下两端平整稳定以方便进行前屈实验，用稀释完后的牙托粉把猪颈椎标本的两端进行固定处理。固化标本时间为24小时，固化后标本脱模，再将融合器置入标本内。随机取4个标本模拟为钛网植骨钢板内固定组；随机取4个标本模拟为自体髂骨植入钢板内固定组。其余4个完整标本作为对照组。1号测点为与钢板相邻的C7椎体前上缘、2号测点为钢板固定后C6左侧下螺钉孔下方、3号测点为钢板固定后C6右侧下螺钉孔下方、4号测点为钢板固定后C4右侧上方螺钉孔上方、5号测点为C4左侧上方螺钉孔上方、6号测点为与钢板相邻的C3椎体前下缘。如下图选用50,100,150,200Ncm三种载荷进行加载，因50及100Ncm载荷过小引起数据误差过大而废弃，而200Ncm载荷过大出现标本破坏，韧带断裂现象因此废弃。故最终选取的载荷条件为150Ncm进行试验，记录相应测点应变应力数据。采用SpSS11.0软件来完成统计数据的处理工作，得出的数据用x±s来表示，采用完全的随机分组数据来进行比较，P＜0.05为差异有显著意义。结果：各状态下各标本在实验过程中均无自体髂骨骨块及钛网脱出或移位,钛网植骨内固定组和自体髂骨植骨内固定组最大应力应变都发生在1号测点，此测点位于颈6-7间盘水平。自体髂骨植骨内固定组和钛网内固定分组与对照组相比，除6号测点前屈应力变化范围不大，差异无统计学意义(P>0.05)外,其余位点运动范围均减小,前屈应力与应变均减小，且差异有统计学意义(P <0.05)。颈5椎体次全切后钛网植入钢板内固定组与自体髂骨植骨钢板内固定组相比，除测点4和测点6前屈运动范围变化不大,差异无统计学意义(P>0.05)外,其余位点运动范围均减小,前屈应力与应变均减小，且差异有统计学意义(P <0.05)。结论：1.在150Ncm弯矩作用下，前屈实验自体髂骨植骨内固定组和钛网置入内固定组最大应力应变都发生在1号测点，这个测点位于颈6-颈7椎间盘水平，即颈5椎体次全切植骨融合内固定后颈6-7间盘水平是退变好发部位。2.颈椎前路椎体次全切除之后,钛网植骨钛板内固定和自体髂骨植骨钛板内固定相比，自体髂骨植骨钛板内固定仅能部分改善颈椎稳定性,但应用颈椎前路钛网植骨钛板内固定可以明显的增强颈椎的稳定性,也比完整的颈椎功能单位稳定.更多还原

【Abstract】 The main pathological mechanisms of cervical spondylotic myelopathy ofcervical disc degeneration prominent and the posterior margin of osteophyteson the direct compression of the pyramidal corticospinal tract or the local bloodsupply to reduce the lead to clinical symptoms. Numerous clinical studies haveconfirmed that the anterior cervical decompression and fusion may be better toease short-term and long-term pain, an alternative to traditional conservativetreatment used in the treatment of cervical spondylotic myelopathy. But theexistence of such a surgical approach to the implantation of bone stability,often present after cervical potentially reduce the stability of the graft easyprolapse, the transplantation of bone fusion, interbody collapse, cervicalkyphosis intervertebral foramen diameter smaller fusion segment of reducedheight, spinal derangement and symptoms recurrence. The patients often takelonger neck collar loaded with fixed treatment and patient outcomes areaffected. With the development of fixation techniques, in order to obtain thestability of the bone graft and improve the life of patients with earlypostoperative patients start receiving anterior cervical decompression andfusion plate fixation with autologous bone grafts. With the study of materialsscience in recent years, various bone substitute materials for clinical use, bothcan be avoided itself to take the bone but also the same with good boneconduction and clinical significance of cervical vertebrae resection thedecompression titanium mesh implants with plate fixation is the one of the newdeveloped technique has been widely used in clinical, its advantages are alsorecognized. Objective: to simulate anterior cervical titanium mesh plate fixation andautogenous iliac bone graft plate fixed analog treatment of double segment ofcervical spondylotic myelopathy, vertebral subtotal titanium mesh platefixation and autogenous iliac bone graft platefixed fixed a systematic, objectiveanalysis and evaluation. Choose a reasonable procedure, and choice of implantsand fixation devices provide the scientific basis for clinical double cervicalspondylotic myelopathyMethod:4-month-old adult pig specimens from healthy fresh12are male.Autologous bone removed within2hours after the pigs were sacrificed andC3-C7cervical bone ligament specimens;12specimens were removedimmediately after processing specimens, excluding the muscle attached to thespecimens to retain the anterior longitudinal ligament, yellow ligament,interspinous ligament joint capsule of the facet joint and packages. A total of12cervical functional unit. Randomly taken from four specimens implantedtitanium mesh plate fixation group; randomly taken from four specimensimplanted autologous bone plate fixation group. Complete sample as a controlgroup.Specimens at both ends can be able to facilitate the formation and for theflexion experiments, both ends of the porcine cervical specimens fixed dilutionafter the denture powder. Curing specimens for24hours, mold release aftercuring specimens, specimens fusion cage placement. Randomly taken fromfour specimens implanted titanium mesh plate fixation group; randomly takenfrom four specimens implanted autologous bone plate fixation group. Completespecimens as control group.Sanding smooth specimens of the corresponding patch site, and then patchpart of the specimen is washed repeatedly with alcohol, free of impurities andthen with acetone, the specimens SMD parts volatile drying, and then pasteprocess in accordance with strict resistance strain gauge with502quick-drying glue to paste the resistance strain gauge.521production plants, gum parkedresistance strain gauge resistance strain gauge, resistance strain gaugeresistance of120±0.1ohms, the resistance strain gauge gauge1χ1mmresistance strain gauge sensitivity coefficient of2.08±0.1%. Paste theresistance strain gauge, paste in the vicinity of the adjacent strain gaugeterminals, then electronic strain gauge leads to the line welding in the terminal,after the wire welding.1points to edge on a steel plate adjacent to the C7vertebral body,2points for C6left side of the plate fixation screw hole below,3points for the screw holes in the C6the right side of the bottom,4points for the C4the right side of the top of the plate fixation screwholes at the top,5points for the C4on the left top, above the screw holes,6points for the lower edge and the steel plate adjacent to the C3vertebralSelection50,100,150,200the Ncm three kinds of load to load,50and100Ncm load is too small to cause data errors are too large waste, but200Ncm load is too large specimen destruction, ligament rupture phenomenon is thereforeabandoned. So the final selected150Ncm as the loading conditions tested,record the strain data of the corresponding measuring point.Statistical analysis using the SpSS11.0software to complete the statisticaltreatment of data to±s, using a completely randomized data (P <0.05)significant difference.Results: the status of each specimen during the experiment no autogenousiliac bone and titanium mesh prolapse or displacement, maximum stress andstrain of the titanium mesh and bone graft and internal fixation group andautogenous iliac bone graft and internal fixation group at the1st measurementpoint, this measuring point is located in the cervical6-7disc level. Since thefixation group in the iliac bone graft and titanium mesh fixed groupingcompared with the control group, in addition to small changes in the flexionstress range of the measurement points on the6th, the difference was notstatistically significant (P>0.05), range of motion of the remaining sites bothdecreased flexion stress and strain are reduced, and the difference wasstatistically significant (P <0.05). Titanium mesh implant neck5vertebrae cutafter plate fixation group compared with autologous iliac bone graft platefixation group, in addition to the six flexion range of motion of the measuringpoint and measuring point little change, no significant difference between (P>0.05), range of motion of the remaining sites were reduced flexion stress andstrain are reduced, and the difference was statistically significant (P <0.05).Conclusion:1.150Ncm bending, flexion experiment from the internal fixation group inthe iliac bone graft and titanium mesh placed in the internal fixation group, themaximum stress and strain have occurred in the1st measuring point, themeasurement points in the cervical6-cervical disc level. Ie, cervical vertebrasubtotal interbody fusion fixed neck6-7disc degeneration predilection sites. 2. anterior cervical corpectomy, fixed and autologous bone grafts, titaniummesh and bone graft titanium plate fixation with titanium plate compared, sincethe iliac bone graft titanium plate fixed only partially improve the stability ofcervical spine the application of anterior cervical titanium mesh and bone grafttitanium plate fixation can be significantly enhanced stability of the cervicalspine than the cervical functional unit stability.更多还原