CAJ | 학술논문

背景:有研究表明,影响椎弓根螺钉置入机体后固定效果的因素有螺钉的结构形态、螺纹参数、骨密度,手术时螺钉拧紧力矩大小,以及进钉的深度等.脊柱椎弓根螺钉并横向牵引装置的把持力与外倾角是否也有一定关系?目的:观察不同外倾角对椎弓根螺钉并横向牵引装置的把持力的影响.设计:重复测量实验.单位:南京医科大学第一附属医院骨关节中心.对象:实验于2003-06/11在河海大学材料力学实验室完成,选择18 只成人干燥腰椎(L1-5节段)椎体标本,标本均为南京医科大学解剖学教研室提供,实验经过医院伦理委员会批准.实验用椎弓根螺钉为不锈钢材料,直径5.5 mm,螺纹参数相同,钉长150 mm,其中螺纹部分长50 mm.EW型电子万能材料实验机为河海大学材料力学实验室提供.方法:用单光子骨密度测定仪测定骨密度后按骨密度编号,完全随机法将椎体分为外倾角5.组、外倾角15.组及外倾角30.组,每组6只.①椎弓根螺钉及夹具的安装:在同一腰椎两侧进针点按Wein-stein法,取外倾角5.组外倾角5.,外倾角15.组外倾角15.,外倾角30.组外倾角30..针孔准备用3.0mm钻头打孔深50mm,拧入椎弓根螺钉50mm,钉尾部用横向牵引装置连接.用特制夹具固定脊椎椎体和DTTs.②把持力测定及椎弓根和椎体损伤观察:分别将已安装好椎弓根螺钉及横向牵引装置的脊椎椎骨连同夹具一起安置到EW型电子万能材料实验机上,测定椎弓根螺钉的把持力.传感器与电脑相连,并绘出力一位移曲线.以曲线波峰为最大把持力.同时观察椎弓根螺钉拔出时椎弓根和椎体损伤情况.主要观察指标:把持力检测结果及椎弓根和椎体损伤情况.结果:①最大把持力:外倾角5.组、外倾角15.组及外倾角30.组椎弓根螺钉平均最大把持力分别为0.878 167,1.420 333,2.154 167 KN.组间比较差异有显著性意义(F=12.554 22,P<0.01).②椎弓根和椎体损伤情况:外倾角5.组4例椎弓根入口处骨皮质骨折,2例椎弓根与椎体后缘交界区断裂:外倾角15.组1例椎弓根入口处骨皮质骨折,4例椎弓根与椎体后缘交界区断裂,1例椎体后缘冠状面断裂;外倾角30.组1例椎弓根入口处骨皮质骨折,2例椎弓根与椎体后缘交界区断裂,3例椎体后缘冠状面断裂.组间秩和检验,差异有显著性意义(P<0.01).结论:在应用经椎弓根螺钉置入机体内固定并加用横向牵引装置时,适当增加外倾角,可增大螺钉的把持力,提高固定强度,外倾角过大则易对椎体造成破坏. 揹景:有研究錶明,影響椎弓根螺釘置入機體後固定效果的因素有螺釘的結構形態、螺紋參數、骨密度,手術時螺釘擰緊力矩大小,以及進釘的深度等.脊柱椎弓根螺釘併橫嚮牽引裝置的把持力與外傾角是否也有一定關繫?目的:觀察不同外傾角對椎弓根螺釘併橫嚮牽引裝置的把持力的影響.設計:重複測量實驗.單位:南京醫科大學第一附屬醫院骨關節中心.對象:實驗于2003-06/11在河海大學材料力學實驗室完成,選擇18 隻成人榦燥腰椎(L1-5節段)椎體標本,標本均為南京醫科大學解剖學教研室提供,實驗經過醫院倫理委員會批準.實驗用椎弓根螺釘為不鏽鋼材料,直徑5.5 mm,螺紋參數相同,釘長150 mm,其中螺紋部分長50 mm.EW型電子萬能材料實驗機為河海大學材料力學實驗室提供.方法:用單光子骨密度測定儀測定骨密度後按骨密度編號,完全隨機法將椎體分為外傾角5.組、外傾角15.組及外傾角30.組,每組6隻.①椎弓根螺釘及夾具的安裝:在同一腰椎兩側進針點按Wein-stein法,取外傾角5.組外傾角5.,外傾角15.組外傾角15.,外傾角30.組外傾角30..針孔準備用3.0mm鑽頭打孔深50mm,擰入椎弓根螺釘50mm,釘尾部用橫嚮牽引裝置連接.用特製夾具固定脊椎椎體和DTTs.②把持力測定及椎弓根和椎體損傷觀察:分彆將已安裝好椎弓根螺釘及橫嚮牽引裝置的脊椎椎骨連同夾具一起安置到EW型電子萬能材料實驗機上,測定椎弓根螺釘的把持力.傳感器與電腦相連,併繪齣力一位移麯線.以麯線波峰為最大把持力.同時觀察椎弓根螺釘拔齣時椎弓根和椎體損傷情況.主要觀察指標:把持力檢測結果及椎弓根和椎體損傷情況.結果:①最大把持力:外傾角5.組、外傾角15.組及外傾角30.組椎弓根螺釘平均最大把持力分彆為0.878 167,1.420 333,2.154 167 KN.組間比較差異有顯著性意義(F=12.554 22,P<0.01).②椎弓根和椎體損傷情況:外傾角5.組4例椎弓根入口處骨皮質骨摺,2例椎弓根與椎體後緣交界區斷裂:外傾角15.組1例椎弓根入口處骨皮質骨摺,4例椎弓根與椎體後緣交界區斷裂,1例椎體後緣冠狀麵斷裂;外傾角30.組1例椎弓根入口處骨皮質骨摺,2例椎弓根與椎體後緣交界區斷裂,3例椎體後緣冠狀麵斷裂.組間秩和檢驗,差異有顯著性意義(P<0.01).結論:在應用經椎弓根螺釘置入機體內固定併加用橫嚮牽引裝置時,適噹增加外傾角,可增大螺釘的把持力,提高固定彊度,外傾角過大則易對椎體造成破壞.
배경:유연구표명,영향추궁근라정치입궤체후고정효과적인소유라정적결구형태、라문삼수、골밀도,수술시라정녕긴력구대소,이급진정적심도등.척주추궁근라정병횡향견인장치적파지력여외경각시부야유일정관계?목적:관찰불동외경각대추궁근라정병횡향견인장치적파지력적영향.설계:중복측량실험.단위:남경의과대학제일부속의원골관절중심.대상:실험우2003-06/11재하해대학재료역학실험실완성,선택18 지성인간조요추(L1-5절단)추체표본,표본균위남경의과대학해부 학교연실제공,실험경과의원윤리위원회비준.실험용추궁근라정위 불수강재료,직경5.5 mm,라문삼수상동,정장150 mm,기중라문 부분장50 mm.EW형전자만능재료실험궤위하해대학재료역학실험실제공.방법:용단광자골밀도측정의측정골밀도후안골밀도편호,완전수궤법장추체분위외경각5.조、외경각15.조급외경각30.조,매조6지.①추궁근라정급협구적안장:재동일요추량측진침점안Wein-stein법,취외경각5.조외경각5.,외경각15.조외경각15.,외경각30.조외경각30..침공준비용3.0mm찬두타공심50mm,녕입추궁근라정50mm,정미부용횡향견인장치련접.용특제협구고정척추추체화DTTs.②파지력측정급추궁근화추체손상관찰:분별장이안장호추궁근라정급횡향견인장치적척추추골련동협구일기안치도EW형전자만능재료실험궤상,측정추궁근라정적파지력.전감기여전뇌상련,병회출력일위이곡선.이곡선파봉위최대파지력.동시관찰추궁근라정발출시추궁근화추체손상정황.주요관찰지표:파지력검측결과급추궁근화추체손상정황.결과:①최대파지력:외경각5.조、외경각15.조급외경각30.조추궁근라정평균최대파지력분별위0.878 167,1.420 333,2.154 167 KN.조간비교차이유현저성의의(F=12.554 22,P<0.01).②추궁근화추체손상정황:외경각5.조4례추궁근입구처골피질골절,2례추궁근여추체후연교계구단렬:외경각15.조1례추궁근입구처골피질골절,4례추궁근여추체후연교계구단렬,1례추체후연관상면단렬;외경각30.조1례추궁근입구처골피질골절,2례추궁근여추체후연교계구단렬,3례추체후연관상면단렬.조간질화검험,차이유현저성의의(P<0.01).결론:재응용경추궁근라정치입궤체내고정병가용횡향견인장치시,괄당증가외경각,가증대라정적파지력,제고고정강도,외경각과대칙역대추체조성파배.
BACKGROUND: It has been demonstrated that pedicle screw internal fixation influencing factors involve screw structural morphology, thread parameter, bone density, moment size for tightening screw during operation, and depth of screw placement. There is little known about the correlation of pullout strength of spinal pedicle screw with device for transverse traction to extraversion angle. OBJECTIVE: To assess effect of the spinal pedicle screw with device for transverse traction on pullout strength at different extraversion angles. DESIGN: Repeated measurement. SETTING: Center for Bone Joint, the First Affiliated Hospital of Nanjing Medical University. PARTICIPANTS: This study was performed at Laboratory for Material Mechanics, Hehai University between June and November 2003. A total of 18 adult dried lumbar vertebrae (L1-5) were provided by Department of Anatomy, Nanjing Medical University, and recruited for this study. The protocol was approved by the hospital's Ethics Committee. The pedicle screw was made of stainless steel. Each pedicle screw had a diameter of 5.5 nun, total length of 150 nun (thread part 50 into included), and the same thread parameter. Electrical universal material machine (EW type) was provided by Laboratory for Material Mechanics of Hehai University. METHODS: Bone density was measured with a single photon bone density determinator. According to the bone density, the lumbar vertebrae were numbered and randomly divided into 3 groups with 6 lumbar vertebrae in each: extraversion angle 5 ° group, extraversion angle 15° group, and extraversion angle 30° group. ① Installation of pedicle screw and clamping apparatus: According to Wein-Stein method, one entry-point was selected at each side of lumbar vertebra, and at the sametime, extraversion angle 5°, 15° ,and 30° were respectively defined for extraversion angle 5° , 15° ,and 30° groups. A 50 mm-depth pinhole was drilled with a drill bit with a diameter of 3.0 nun. Pedicle screw was screwed into 50 nun, and its end part was connected to the device for transverse traction. Spinal vertebrae and the device for transverse traction were fixed with a specially made clamping apparatus. ② Determination of pullout strength and observation of pedicle and vertebral injury: Spinal vertebrae, on which pedicle screw and device for transverse traction were installed, was placed on a EW electrical universal material machine together with clamping apparatus for determining the pullout strength of pedicle screw. Sensor was connected to a computer to draw strength-displacement curve. The wave crest of the curve was considered the maximum pullout strength. At the same time, injuries to pedicle and vertebra caused by pullout of pedicle screw were observed. MAIN OUTCOME MEASURES: Pullout strength and injuries to pedicle and vertebra. RESULTS:①The mean maximum pullout strength of pedicle screw was respectively 0.878 167, 1.420 333, and 2.154 167 KN for extraversion angle 5° , 15 ° , and 30° groups. There was significant difference among the 3 groups (F = 12.554 22, P < 0.01). ② In the extraversion angle 5° group, 4 patients presented with cortical bone fracture which occurred at the entrance for pedicle screw, and 2 patients presented with fragmentation of junctional zone between pedicle and vertebral posterior edge; In the extraversion angle 15° group, 1 patient presented with cortical bone fracture which occurred at the entrance for pedicle screw, 4 patients presented with fragmentation of junctional zone between pedicle and vertebral posterior edge, and 1 patient presented with vertebral posterior coronal fragmentation; In the extraversion angle 30° group, 1 patient presented with cortical bone fracture which occurred at the entrance for pedicle screw, 2 patients presented with fragmentation of junctional zone between pedicle and vertebral posterior edge, and 3 patients presented with vertebral posterior coronal fragmentation. There was statistical significance in the intergroup rank-sum test (P < 0.01).CONCLUSION: During application of pedicle screw with device for transverse traction, proper accrescence of extraversion angle can increase pullout strength of the screw and enhance fixative strength, and excessive extraversion angle easily injures vertebra.