CAJ | 학술논문

目的：探讨椎弓根螺钉内固定时椎弓根皮质劈裂对骨折椎体稳定性的影响。方法取新鲜成年羊胸腰椎脊柱标本（T14~ L2）20具，随机分为 A、B 两组。在 A 组和 B 组标本的 L1椎体上分别制作单椎体压缩骨折模型，再单独对 B 组标本 T14胸椎任意一侧的椎弓根行外侧（1/4~1/2）切除，作为椎弓根劈裂椎体骨折模型。然后对 A、B 两组分别置钉，进钉深度为钉道全长。标本模型固定后，在 HY-3080微机控制电子万能材料试验机上，以频率为1.5 Hz 的载荷对两组标本模型行10000次疲劳实验，分别测量疲劳实验后两组标本前屈、后伸、左侧弯、右侧弯4个方向运动范围的大小和疲劳实验后两组标本模型螺钉拔出力大小，并比较两组差异。结果疲劳实验后 A 组各个方向活动范围：前屈（1.81±0.14）mm，后伸（1.68±0.37）mm，左侧弯（4.08±0.41）mm，右侧弯（4.18±0.12）mm；B 组各个方向活动范围大小：前屈（4.49±0.40）mm，后伸（3.72±0.51）mm，左侧弯（6.67±0.64）mm，右侧弯（6.73±0.58） mm；A 组各个方向活动范围均小于 B 组（P <0.01）。疲劳实验后 A 组螺钉最大拔出力为（252.34±51.27）N，B 组螺钉最大拔出力为（115.50±36.74）N，最大拔出力 A 组大于 B 组（P <0.01）。结论椎弓根皮质劈裂将严重影响骨折椎体内固定的稳定性。
목적：탐토추궁근라정내고정시추궁근피질벽렬대골절추체은정성적영향。방법취신선성년양흉요추척주표본（T14~ L2）20구，수궤분위 A、B 량조。재 A 조화 B 조표본적 L1추체상분별제작단추체압축골절모형，재단독대 B 조표본 T14흉추임의일측적추궁근행외측（1/4~1/2）절제，작위추궁근벽렬추체골절모형。연후대 A、B 량조분별치정，진정심도위정도전장。표본모형고정후，재 HY-3080미궤공제전자만능재료시험궤상，이빈솔위1.5 Hz 적재하대량조표본모형행10000차피로실험，분별측량피로실험후량조표본전굴、후신、좌측만、우측만4개방향운동범위적대소화피로실험후량조표본모형라정발출력대소，병비교량조차이。결과피로실험후 A 조각개방향활동범위：전굴（1.81±0.14）mm，후신（1.68±0.37）mm，좌측만（4.08±0.41）mm，우측만（4.18±0.12）mm；B 조각개방향활동범위대소：전굴（4.49±0.40）mm，후신（3.72±0.51）mm，좌측만（6.67±0.64）mm，우측만（6.73±0.58） mm；A 조각개방향활동범위균소우 B 조（P <0.01）。피로실험후 A 조라정최대발출력위（252.34±51.27）N，B 조라정최대발출력위（115.50±36.74）N，최대발출력 A 조대우 B 조（P <0.01）。결론추궁근피질벽렬장엄중영향골절추체내고정적은정성。
Objective To explore the impact on long-term stability of the vertebral body fracture fixed with pedicle screw internal fixation with the pedicle cortex perforation. Methods 20 of fresh thoracic and lumbar vertebrae samples of adult sheep(T14 ~ L2 )were randomly divided into group A and group B. The compression fracture of the single rertebrae was made in L1 of the two groups. Then the samples of group B were removed a quarter of either side of lateral T14 thoracic pedicle,which is considered as the pedicle cortex perforation model. The model of two groups were inserted the screw and the inserting depth of the screw was the total length of the screw. After the samples of two group was fixed,the samples were performed fatigue test of 10,000 times by 1. 5 Hz load on the HY-3080 almighty material test machine. The range of motion(ROM)of the four direc-tions-anteflexion,retroflexion,left and right lateral curvature and the drawing force of the screw was measured and the differ-ence was compared. Results After the fatigue test,the ROM value of the four directions-anteflexion,retroflexion,left and right lateral curvature on group A were(1. 81 ± 0. 14)mm,(1. 68 ± 0. 37)mm,(4. 08 ± 0. 41)mm,(4. 18 ± 0. 12)mm;the ROM value of the four directions-anteflexion,retroflexion,left and right lateral curvature on group B iS(4. 49 ± 0. 40)mm,(3. 72 ± 0. 51)mm,(6. 67 ± 0. 64)mm,(6. 73 ± 0. 58)mm;group A range in all directions were less than group B,the difference was statistically significant(P < 0. 01). Conclusion The pedicle cortex perforation will seriously affect the long-term stability of the fractured vertebral body.