CAJ | 학술논문

背景：有研究表明胸椎骨折椎弓根螺钉的置入方式、进针点、角度、长度已经有统一定论，单个螺钉的轴向拔出力及生物力学行为报道也很多，但关于3种螺钉置入并连接钉棒后的生物力学行为研究较少。目的：通过生物力学测试来进一步观察并比较3种胸椎螺钉置入并连接钉棒后的生物力学行为，从而了解胸椎置钉并连接钉棒后的强度，及其拔出后对胸椎置钉周围骨质的应力影响。方法：实验将新鲜冰冻胸椎标本随机分3组，经椎弓根固定组，经横突-椎体固定组，经改良肋横突法固定组，每组照标准胸椎置钉法分别置入胸椎钉棒系统，在力学仪器上测试，动态曲线描述拔出过程中钉棒系统及胸椎置钉周围骨质所承受力量，并进行统计学分析，比较3种置钉方法在胸椎上把持力的差异性。结果与结论：3种伤椎置钉方式中，经椎弓根固定组拔持力明显大于经横突-椎体法及经改良肋横突法组的把持力(P <0.01)，经横突-椎体法及经改良肋横突法组的把持力差异无显著性意义。结果证实，经椎弓根固定法固定节段的胸椎置钉周围骨质所承受力稳定性明显优于经横突-椎体法及经改良肋横突法组。
배경：유연구표명흉추골절추궁근라정적치입방식、진침점、각도、장도이경유통일정론，단개라정적축향발출력급생물역학행위보도야흔다，단관우3충라정치입병련접정봉후적생물역학행위연구교소。목적：통과생물역학측시래진일보관찰병비교3충흉추라정치입병련접정봉후적생물역학행위，종이료해흉추치정병련접정봉후적강도，급기발출후대흉추치정주위골질적응력영향。방법：실험장신선빙동흉추표본수궤분3조，경추궁근고정조，경횡돌-추체고정조，경개량륵횡돌법고정조，매조조표준흉추치정법분별치입흉추정봉계통，재역학의기상측시，동태곡선묘술발출과정중정봉계통급흉추치정주위골질소승수역량，병진행통계학분석，비교3충치정방법재흉추상파지력적차이성。결과여결론：3충상추치정방식중，경추궁근고정조발지력명현대우경횡돌-추체법급경개량륵횡돌법조적파지력(P <0.01)，경횡돌-추체법급경개량륵횡돌법조적파지력차이무현저성의의。결과증실，경추궁근고정법고정절단적흉추치정주위골질소승수력은정성명현우우경횡돌-추체법급경개량륵횡돌법조。
BACKGROUND:Studies have shown that placement, needling point, angle and length of pedicle screws for thoracic vertebral fractures have been unified. Many studies concerned axial pul-out force and biomechanical behavior of a single screw, but few reports addressed the biomechanical behavior after the replacement with three kinds of screw connecting to rods. OBJECTIVE:To further observe and compare biomechanical behavior after three kinds of thoracic screw placement connecting rod using biomechanical testing, to understand the strength of thoracic pedicle screw replacement connecting rods, and the effects of its puling out on the stress of the bone surrounding the placement site. METHODS:The fresh frozen specimens of thoracic vertebra were divided into three groups at random: the pedicle fixation group, the transverse process-vertebral body fixation group, and modified rib transverse process fixation group. Thoracic pedicle screw system was inserted by the standard placement method in each group. The experiment was measured on the mechanical equipment. During puling out, the strength that bone bore was described with dynamic curve, folowed by statistical analysis. The difference in the gripping force on the thoracic vertebra among three kinds of screw placement method was compared. RESULTS AND CONCLUSION: Among three kinds of screw placement methods and among three kinds of screw placement methods on the injured vertebral body, the gripping force was significantly bigger in the pedicle fixation group than in the transverse process-vertebral body fixation group and modified rib transverse process fixation group (P < 0.01). No significant difference in the gripping force was detected between the transverse process-vertebral body fixation group and modified rib transverse process fixation group. Results verified that the stability of loading ability was apparently better in the pedicle fixation group compared with the transverse process-vertebral body fixation group and modified rib transverse process fixation group.