CAJ | 학술논문

目的：探讨聚DL-乳酸（poly (D, L) Lactide，PDLLA）融合器（cage）促进山羊C3，4节段椎间融合的生物力学稳定性和成骨作用。方法24只雌性山羊随机分为三组：PDLLA cage组（8只）、钛合金cage组（8只）和三面皮质髂骨组（8只）。切除C3-4椎间盘，分别植入PDLLA cage、钛合金cage和三面皮质髂骨。于术前、术后及术后1、2、4、8、12周摄X线片，测量平均椎间高度、椎间角及前凸角,术后12周摄X线片后处死动物，进行平均刚度及活动范围等生物力学评估，并进行组织学观察。结果术后各时点PDLLA cage组、钛合金cage组和三面皮质骨组的前凸角差异无统计学意义；术后4周， PDLLA cage组椎间角大于三面皮质骨组，差异有统计学意义；术后8、12周，PDLLA cage组平均椎间高度大于三面皮质骨组，差异有统计学意义。在侧屈和旋转加载下，各组C3,4节段的刚度差异有统计学意义，其中两个cage组均较三面皮质髂骨组大，而钛合金cage与PDLLA cage组的差异无统计学意义；三组间活动范围的差异有统计学意义，其中两个cage组均优于自体髂骨组。组织学观察见PDLLA cage组融合部位大量新生骨和软骨形成。结论 PDLLA cage生物相容性好、可为骨长入和界面成骨提供适合的生物学环境；其在维持椎间高度，增加融合节段的稳定性等方面具备潜在优势，能为最后的骨性融合提供良好的生物力学环境。
목적：탐토취DL-유산（poly (D, L) Lactide，PDLLA）융합기（cage）촉진산양C3，4절단추간융합적생물역학은정성화성골작용。방법24지자성산양수궤분위삼조：PDLLA cage조（8지）、태합금cage조（8지）화삼면피질가골조（8지）。절제C3-4추간반，분별식입PDLLA cage、태합금cage화삼면피질가골。우술전、술후급술후1、2、4、8、12주섭X선편，측량평균추간고도、추간각급전철각,술후12주섭X선편후처사동물，진행평균강도급활동범위등생물역학평고，병진행조직학관찰。결과술후각시점PDLLA cage조、태합금cage조화삼면피질골조적전철각차이무통계학의의；술후4주， PDLLA cage조추간각대우삼면피질골조，차이유통계학의의；술후8、12주，PDLLA cage조평균추간고도대우삼면피질골조，차이유통계학의의。재측굴화선전가재하，각조C3,4절단적강도차이유통계학의의，기중량개cage조균교삼면피질가골조대，이태합금cage여PDLLA cage조적차이무통계학의의；삼조간활동범위적차이유통계학의의，기중량개cage조균우우자체가골조。조직학관찰견PDLLA cage조융합부위대량신생골화연골형성。결론 PDLLA cage생물상용성호、가위골장입화계면성골제공괄합적생물학배경；기재유지추간고도，증가융합절단적은정성등방면구비잠재우세，능위최후적골성융합제공량호적생물역학배경。
Objective To design a type of poly (D, L) Lactide (PDLLA) cage, compare the characteristics of inter body fusion using PDLLA cage with those of titanium cage and autologous tricortical iliac crest graft in a goat cervical spine model in vi?vo. Methods Twenty?four goats underwent C3-4 discectomy and fusion were assigned to 3 groups, PDLLA cage group (n=8), titani?um alloy cage group (n=8) and autologous iliac bone group (n=8). Radiography was performed pre?and post?operatively and 1, 2, 4, 8, and 12 weeks after operation. At the same time points, disc space height (DSH), intervertebral angle (IVA), and lordosis angle (LA) were measured. After 12 weeks, the goats were killed and fusion sites were harvested. Biomechanical testing was performed in flexion, extension, axial rotation, and lateral bending to determine the stiffness and range of motion. All cervical fusion speci?mens underwent histomorphological observation. Results The IVA of PDLLA cage 4 weeks after operation and DSH 8 and 12 weeks after operation was statistically greater than that of autologous iliac bone graft (P<0.05). The LA values were shown no signif?icant difference among PDLLA cage, Titanium cage and autologous iliac bone graft groups. The stiffness of two types of cages in ax?ial rotation and lateral bending, the ROM in every movement was statistically greater than that of autologous iliac bone graft group (P<0.05). PDLLA cage and Titanium cage had no significant difference (P>0.05). Radiographic and histomorphological observa?tion showed better fusion results in cage groups than in autologous bone group. Conclusion This type of PDLLA cage has excel?lent biocompatibility and can provide an appropriate biological environment for bone ingrowth and osteogenesis at bone?implant in?terface. Furthermore, PDLLA cage can maintain DSH and increase the stability of fusion segments to create a good biomechanical environment for the last bone fusion.