髂骨釘墊片對腰-髂固定結構穩定性的生物力學影響_《中國修復重建外科雜志》

作者：

王麗冰 , 潘鶴海 , 于濱生 , 謝超凡 , 許銀峰 , 鄭召民

中山大學附屬第一醫院脊柱外科骨科研究所（廣州，510700）;

關鍵詞：

髂骨釘墊片腰-髂重建髂骨釘技術內固定生物力學

DOI：

10.7507/1002-1892.20130134

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目的評價一種自主設計的髂骨釘墊片對腰-髂固定結構疲勞載荷前、后穩定性的影響。方法取自愿捐獻的12具成人防腐尸體腰椎-骨盆標本，根據是否使用髂骨釘墊片隨機分成A組（使用墊片）和B組（不使用墊片），每組6具。使用雙能X線骨密度儀測定L1～4骨密度（bone mineral density，BMD）后，行雙側L3、L4、L5椎弓根釘和髂骨釘固定，并且切除L5、S1雙側關節突關節及椎間盤制作椎間失穩模型。在MTS材料試驗機上，向標本施加0～600 N軸向壓縮和—7～7 N·m軸向扭轉載荷，測試固定結構初始壓縮及扭轉剛度。然后給標本施加2萬次40～400 N循環壓力載荷，重復剛度測試。最后，對所有螺釘進行軸向拔出測試，記錄最大拔出力。植釘及加載過程中行大體及影像學觀察。結果A、B組BMD值分別為（1.15 ± 0.13）g/cm2和（1.12 ± 0.11）g/cm2，差異無統計學意義（t=0.428，P=0.678）。所有螺釘植入位置良好，加載過程中無釘棒松動及斷裂。疲勞載荷后X線片示A、B組分別有1具（16.7%）和3具（50.0%）標本髂骨釘周圍出現“骨透亮帶”。A、 B組疲勞載荷后壓縮剛度和扭轉剛度均低于疲勞載荷前（P lt; 0.05）。疲勞載荷前，A、B組間壓縮剛度和扭轉剛度比較差異均無統計學意義（P gt; 0.05）；疲勞載荷后A組壓縮剛度顯著高于B組（t=2.664，P=0.024），而兩組扭轉剛度差異無統計學意義（t=0.410，P=0.690）。A、B組L3、L4、L5椎弓根釘的最大拔出力比較差異均無統計學意義（P gt; 0.05）；但A組的髂骨釘最大拔出力顯著高于B組（t=3.398，P=0.007）。組內比較：A、B組L3椎弓根釘的最大拔出力均顯著低于L4、L5椎弓根釘（P lt; 0.05）。A組髂骨釘最大拔出力顯著高于其他3個節段椎弓根釘（P lt; 0.05）；而B組髂骨釘拔出力顯著低于L4、L5椎弓根釘（P lt; 0.05）。結論在腰-髂重建中，髂骨釘墊片可以預防髂骨釘松動，有效保持固定結構的穩定性。

引用本文： 王麗冰,潘鶴海,于濱生,謝超凡,許銀峰,鄭召民. 髂骨釘墊片對腰-髂固定結構穩定性的生物力學影響. 中國修復重建外科雜志, 2013, 27(5): 606-611. doi: 10.7507/1002-1892.20130134 復制

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2.	Hyun SJ, Rhim SC, Kim YJ, et al. A mid-term follow-up result of spinopelvic fixation using iliac screws for lumbosacral fusion. J Korean Neurosurg Soc, 2010, 48(4): 347-353.
3.	Moshirfar A, Rand FF, Sponseller PD, et al. Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques. J Bone Joint Surg (Am), 2005, 87 Suppl 2: 89-106.
4.	Schwend RM, Sluyters R, Najdzionek J. The pylon concept of pelvic anchorage for spinal instrumentation in the human cadaver. Spine (Phila Pa 1976), 2003, 28(6): 542-547.
5.	Phillips JH, Gutheil JP, Knapp DJ. Iliac screw fixation in neuromuscular scoliosis. Spine (Phila Pa 1976), 2007, 32(14): 1566-1570.
6.	Tsuchiya K, Bridwell KH, Kuklo TR, et al. Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine (Phila Pa 1976), 2006, 31(3): 303-308.
7.	Emami A, Deviren V, Berven S, et al. Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine (Phila Pa 1976), 2002, 27(7): 776-786.
8.	Mindea SA, Salehi SA, Ganju A, et al. Lumbosacropelvic junction reconstruction resulting in early ambulation for patients with lumbosacral neoplasms or osteomyelitis. Neurosurg Focus, 2003, 15(2): E6.
9.	Isaacs RE, Hyde J, Goodrich JA, et al. A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S322-330.
10.	Yu BS, Li ZM, Zhou ZY, et al. Biomechanical effects of insertion location and bone cement augmentation on the anchoring strength of iliac screw. Clin Biomech (Bristol, Avon), 2011, 26(6): 556-561.
11.	Yu BS, Zhuang XM, Zheng ZM, et al. Biomechanical advantages of dual over single iliac screws in lumbo-iliac fixation construct. Eur Spine J, 2010, 19(7): 1121-1128.
12.	Yu BS, Zhuang XM, Zheng ZM, et al. Biomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic condition. J Spinal Disord Tech, 2010, 23(6): 404-409.
13.	Zheng ZM, Yu BS, Chen H, et al. Effect of iliac screw insertion depth on the stability and strength of lumbo-iliac fixation constructs: an anatomical and biomechanical study. Spine (Phila Pa 1976), 2009, 34(16): E565-572.
14.	Yu B, Zheng Z, Zhuang X, et al. Biomechanical effects of transverse partial sacrectomy on the sacroiliac joints: an in vitro human cadaveric investigation of the borderline of sacroiliac joint instability. Spine (Phila Pa 1976), 2009, 34(13): 1370-1375.
15.	Zhu Q, Lu WW, Holmes AD, et al. The effects of cyclic loading on pull-out strength of sacral screw fixation: an in vitro biomechanical study. Spine (Phila Pa 1976), 2000, 25(9): 1065-1069.
16.	Akesen B, Wu C, Mehbod AA, et al. Revision of loosened iliac screws: a biomechanical study of longer and bigger screws. Spine (Phila Pa 1976), 2008, 33(13): 1423-1428.
17.	Yu BS, Yang ZK, Li ZM, et al. Which is the preferred revision technique for loosened iliac screw? A novel technique of boring cement injection from the outer cortical shell. J Spinal Disord, 2011, 24(6): E49-56.
18.	Miller F, Moseley C, Koreska J. Pelvic anatomy relative to lumbosacral instrumentation. J Spinal Disord, 1990, 3(2): 169-173.
19.	Mindea SA, Chinthakunta S, Moldavsky M, et al. Biomechanical comparison of spinopelvic reconstruction techniques in the setting of total sacrectomy. Spine (Phila Pa 1976), 2012, 37(26): E1622-1627.
20.	Yu BS. Biomechanical comparison of the posterolateral fusion and posterior lumbar interbody fusion using pedicle screw fixation system for unstable lumbar spine. Hokkaido Igaku Zasshi, 2003, 78(3): 211-218.
21.	Cripton PA, Jain GM, Wittenberg RH, et al. Load-sharing characteristics of stabilized lumbar spine segments. Spine (Phila Pa 1976), 2000, 25(2): 170-179.
22.	Ashman RB, Bechtold JE, Edwards WT, et al. In vitro spinal arthrodesis implant mechanical testing protocols. J Spinal Disord, 1989, 2(4): 274-281.
23.	Wittenberg RH, Shea M, Edwards WT, et al. A biomechanical study of the fatigue characteristics of thoracolumbar fixation implants in a calf spine model. Spine (Phila Pa 1976), 1992, 17(6 Suppl): S121-128.
24.	于濱生, 劉少喻, Kuniyoshi Abumi, 等. 椎體間融合器的單節段植入對腰椎多節段椎弓根固定裝置中螺釘應力的影響. 中山大學學報: 醫學科學版, 2006, 27(1): 59-62.
25.	Cho KJ, Suk SI, Park SR, et al. Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis. Eur Spine J, 2009, 18(4): 531-537.

1. Shen FH, Harper M, Foster WC, et al. A novel “four-rod technique” for lumbo-pelvic reconstruction: theory and technical considerations. Spine (Phila Pa 1976), 2006, 31(12): 1395-1401.
2. Hyun SJ, Rhim SC, Kim YJ, et al. A mid-term follow-up result of spinopelvic fixation using iliac screws for lumbosacral fusion. J Korean Neurosurg Soc, 2010, 48(4): 347-353.
3. Moshirfar A, Rand FF, Sponseller PD, et al. Pelvic fixation in spine surgery. Historical overview, indications, biomechanical relevance, and current techniques. J Bone Joint Surg (Am), 2005, 87 Suppl 2: 89-106.
4. Schwend RM, Sluyters R, Najdzionek J. The pylon concept of pelvic anchorage for spinal instrumentation in the human cadaver. Spine (Phila Pa 1976), 2003, 28(6): 542-547.
5. Phillips JH, Gutheil JP, Knapp DJ. Iliac screw fixation in neuromuscular scoliosis. Spine (Phila Pa 1976), 2007, 32(14): 1566-1570.
6. Tsuchiya K, Bridwell KH, Kuklo TR, et al. Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine (Phila Pa 1976), 2006, 31(3): 303-308.
7. Emami A, Deviren V, Berven S, et al. Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine (Phila Pa 1976), 2002, 27(7): 776-786.
8. Mindea SA, Salehi SA, Ganju A, et al. Lumbosacropelvic junction reconstruction resulting in early ambulation for patients with lumbosacral neoplasms or osteomyelitis. Neurosurg Focus, 2003, 15(2): E6.
9. Isaacs RE, Hyde J, Goodrich JA, et al. A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S322-330.
10. Yu BS, Li ZM, Zhou ZY, et al. Biomechanical effects of insertion location and bone cement augmentation on the anchoring strength of iliac screw. Clin Biomech (Bristol, Avon), 2011, 26(6): 556-561.
11. Yu BS, Zhuang XM, Zheng ZM, et al. Biomechanical advantages of dual over single iliac screws in lumbo-iliac fixation construct. Eur Spine J, 2010, 19(7): 1121-1128.
12. Yu BS, Zhuang XM, Zheng ZM, et al. Biomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic condition. J Spinal Disord Tech, 2010, 23(6): 404-409.
13. Zheng ZM, Yu BS, Chen H, et al. Effect of iliac screw insertion depth on the stability and strength of lumbo-iliac fixation constructs: an anatomical and biomechanical study. Spine (Phila Pa 1976), 2009, 34(16): E565-572.
14. Yu B, Zheng Z, Zhuang X, et al. Biomechanical effects of transverse partial sacrectomy on the sacroiliac joints: an in vitro human cadaveric investigation of the borderline of sacroiliac joint instability. Spine (Phila Pa 1976), 2009, 34(13): 1370-1375.
15. Zhu Q, Lu WW, Holmes AD, et al. The effects of cyclic loading on pull-out strength of sacral screw fixation: an in vitro biomechanical study. Spine (Phila Pa 1976), 2000, 25(9): 1065-1069.
16. Akesen B, Wu C, Mehbod AA, et al. Revision of loosened iliac screws: a biomechanical study of longer and bigger screws. Spine (Phila Pa 1976), 2008, 33(13): 1423-1428.
17. Yu BS, Yang ZK, Li ZM, et al. Which is the preferred revision technique for loosened iliac screw? A novel technique of boring cement injection from the outer cortical shell. J Spinal Disord, 2011, 24(6): E49-56.
18. Miller F, Moseley C, Koreska J. Pelvic anatomy relative to lumbosacral instrumentation. J Spinal Disord, 1990, 3(2): 169-173.
19. Mindea SA, Chinthakunta S, Moldavsky M, et al. Biomechanical comparison of spinopelvic reconstruction techniques in the setting of total sacrectomy. Spine (Phila Pa 1976), 2012, 37(26): E1622-1627.
20. Yu BS. Biomechanical comparison of the posterolateral fusion and posterior lumbar interbody fusion using pedicle screw fixation system for unstable lumbar spine. Hokkaido Igaku Zasshi, 2003, 78(3): 211-218.
21. Cripton PA, Jain GM, Wittenberg RH, et al. Load-sharing characteristics of stabilized lumbar spine segments. Spine (Phila Pa 1976), 2000, 25(2): 170-179.
22. Ashman RB, Bechtold JE, Edwards WT, et al. In vitro spinal arthrodesis implant mechanical testing protocols. J Spinal Disord, 1989, 2(4): 274-281.
23. Wittenberg RH, Shea M, Edwards WT, et al. A biomechanical study of the fatigue characteristics of thoracolumbar fixation implants in a calf spine model. Spine (Phila Pa 1976), 1992, 17(6 Suppl): S121-128.
24. 于濱生, 劉少喻, Kuniyoshi Abumi, 等. 椎體間融合器的單節段植入對腰椎多節段椎弓根固定裝置中螺釘應力的影響. 中山大學學報: 醫學科學版, 2006, 27(1): 59-62.
25. Cho KJ, Suk SI, Park SR, et al. Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis. Eur Spine J, 2009, 18(4): 531-537.

《中國修復重建外科雜志》

髂骨釘墊片對腰-髂固定結構穩定性的生物力學影響

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《中國修復重建外科雜志》

髂骨釘墊片對腰-髂固定結構穩定性的生物力學影響

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