骨密度對膨脹式椎弓根螺釘固定強度影響的力學研究_《中國修復重建外科雜志》

作者：

高明暄 ¹ , 李旭升 ¹ , 甄平 ¹ , 吳智鋼 ¹ , 周勝虎 ¹ , 田琦 ¹ , 雷偉 ²

1 蘭州軍區蘭州總醫院骨科全軍創傷骨科研究所（蘭州，730050）;;
2 第四軍醫大學附屬西京醫院骨科全軍骨科研究所;

關鍵詞：

膨脹式椎弓根螺釘骨質疏松拔出試驗生物力學

DOI：

10.7507/1002-1892.20130211

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目的評價不同骨質疏松條件下膨脹式椎弓根螺釘（expansive pedicle screw，EPS）的穩定性，為其應用于合并有骨質疏松癥的患者脊柱手術提供力學理論基礎。方法取新鮮尸體脊柱（T12～L5）標本，根據骨密度檢測結果，按臨床骨質疏松程度診斷標準分成骨質正常、骨量減少、骨質疏松和重度骨質疏松4個水平，每個水平各2具標本12個椎體。于每個椎體兩側椎弓根分別植入普通椎弓根螺釘（conventional pedicle screw，CPS；CPS組）和EPS（EPS組）。采用AG-IS萬能材料試驗機，以5 mm/min勻速加載進行螺釘軸向拔出試驗，測定最大拔出力、剛度和能量吸收值。結果兩組隨骨密度水平下降，最大拔出力及剛度均逐漸下降（P lt; 0.05）；CPS組能量吸收值逐漸下降（P lt; 0.05），EPS組能量吸收值除正常骨質與骨量減少間比較、骨質疏松與重度疏松間比較差異無統計學意義（P gt; 0.05）外，其余各密度水平間比較差異均有統計學意義（P lt; 0.05）。同一骨密度水平EPS組最大拔出力均顯著高于CPS組（P lt; 0.05）；除正常骨質水平外，同一骨密度水平EPS組剛度均顯著高于CPS組（P lt; 0.05）；除骨量減少水平外，同一骨密度水平兩組能量吸收值比較差異均無統計學意義（P gt; 0.05）。骨質疏松水平EPS組最大拔出力、剛度、能量吸收值與骨量減少水平CPS組比較，差異均無統計學意義（P gt; 0.05）；但重度骨質疏松水平EPS組以上指標均顯著低于骨量減少水平CPS組（P lt; 0.05）。結論與CPS相比，EPS能明顯提高固定強度，尤其對于骨量減少或骨質疏松患者。

引用本文： 高明暄,李旭升,甄平,吳智鋼,周勝虎,田琦,雷偉. 骨密度對膨脹式椎弓根螺釘固定強度影響的力學研究. 中國修復重建外科雜志, 2013, 27(8): 969-973. doi: 10.7507/1002-1892.20130211 復制

1.	Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone, 2004, 35(2): 375-382.
2.	高明暄, 周勝虎, 鄧曉文, 等. 骨質疏松對椎弓根螺釘穩定性影響的實驗研究. 中國骨質疏松雜志, 2013, 19(1): 39-42.
3.	Scarvell JM, Van Twest MS, Stanton SF, et al. Prevalence of undisclosed osteoporosis in patients with minimal trauma fractures: A prospective cohort study. Phys Sportsmed, 2013, 41(2): 44-49.
4.	楊亞軍, 崔燎. FoxO/Wnt通路在氧化應激介導的骨質疏松中的調控機制. 中國藥理學通報, 2013, 29(1): 27-30.
5.	劉瑤瑤, 孫東, 張澤華, 等. 用于骨質疏松椎體固定的椎弓根螺釘進展. 中國矯形外科雜志, 2011, 19(23): 1982-1986.
6.	Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg (Am), 2000, 82-A(10): 1458-1476.
7.	Lei W, Wu Z. Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J, 2006, 15(3): 321-326.
8.	吳子祥, 雷偉, 孫明林, 等. 膨脹式椎弓根螺釘脊柱后路內固定的生物力學測試. 醫用生物力學, 2004, 19(2): 98-102.
9.	張偉, 雷偉, 吳子祥. 膨脹式椎弓根螺釘的強度測試. 科學技術與工程, 2008, 8(16): 4635-4637, 4653.
10.	石磊, 王陵, 雷偉, 等. 低彈性模量膨脹螺釘在骨質疏松綿羊的體內研究. 中國骨質疏松雜志, 2011, 17(9): 761-765.
11.	Liu Z, Piao J, Pang L, et al. The diagnostic criteria for primary osteoporosis and the incidence of osteoporosis in China. J Bone Miner Metab, 2002, 20(4): 181-189.
12.	廖二元. 骨質疏松診斷方法綜述. 藥品評價, 2012, 9(7): 14-20.
13.	Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res, 1986, (203): 7-17.
14.	Roy-Camille R, Benazet JP, Desauge JP, et al. Lumbosacral fusion with pedicular screw plating instrumentation. A 10-year follow-up. Acta Orthop Scand Suppl, 1993, 251: 100-104.
15.	Ying SH, Kao HC, Chang MC, et al. Fixation strength of PMMA-augmented pedicle screws after depth adjustment in a synthetic bone model of osteoporosis. Orthopedics, 2012, 35(10): e1511-e1516.
16.	Higashino K, Kim JH, Horton WC, et al. A biomechanical study of two different pedicle screw methods for fixation in osteoporotic and nonosteoporotic vertebrae. J Surg Orthop Adv, 2012, 21(4): 198-203.
17.	Cook SD, Barbera J, Rubi M, et al. Lumbosacral fixation using expandable pedicle screws. An alternative in reoperation and osteoporosis. Spine J, 2001, 1(2): 109-114.
18.	李宏偉, 馬遠征, 鮑達, 等. 膨脹與普通椎弓根釘治療脊柱胸腰段骨折合并骨質疏松的對比研究. 中國骨質疏松雜志, 2006, 12(1): 13-16.
19.	王祥善, 孫保國, 劉建民, 等. 膨脹式椎弓根螺釘在骨質疏松椎體的生物力學研究. 實用診斷與治療雜志, 2005, 19(8): 552-557.
20.	Cook SD, Salkeld SL, Stanley T, et al. Biomechanical study of pedicle screw fixation in severely osteoporotic bone. Spine J, 2004, 4(4): 402-408.
21.	Wu ZX, Gao MX, Sang HX, et al. Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation: a biomechanical study and a 2-year follow-up of 20 patients. J Surg Res, 2012, 173(1): 91-98.
22.	高明暄, 劉興炎, 甄平, 等. 膨脹式椎弓根螺釘聯合椎間融合器治療腰椎滑脫癥. 中國修復重建外科雜志, 2009, 23(8): 904-908.
23.	Koller H, Zenner J, Hitzl W, et al. The impact of a distal expansion mechanism added to a standard pedicle screw on pullout resistance. A biomechanical study. Spine J, 2013, 13(5): 532-541.
24.	Kocak T, Däxle M, Reichel H, et al. Alternative technique of cement augmentation of loosened pedicle screws—technical note and presentation of two cases. Acta Chir Orthop Traumatol Cech, 2013, 80(1): 89-91.
25.	Li Y, Cheng H, Liu ZC, et al. In vivo study of pedicle screw augmentation using bioactive glass in osteoporosis sheep. J Spinal Disord Tech, 2013, 26(4): E118-E123.
26.	Jonvaux J, Hoc T, Budyn E. Analysis of micro fracture in human Haversian cortical bone under compression. Int J Numer Method Biomed Eng, 2012, 28(9): 974-998.
27.	高石軍, 魏景超, 陸博, 等. 微骨折結合未培養的兔自體骨髓單個核細胞修復全層關節軟骨缺損的實驗觀察. 中華醫學雜志, 2012, 92(35): 2463-2467.

1. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone, 2004, 35(2): 375-382.
2. 高明暄, 周勝虎, 鄧曉文, 等. 骨質疏松對椎弓根螺釘穩定性影響的實驗研究. 中國骨質疏松雜志, 2013, 19(1): 39-42.
3. Scarvell JM, Van Twest MS, Stanton SF, et al. Prevalence of undisclosed osteoporosis in patients with minimal trauma fractures: A prospective cohort study. Phys Sportsmed, 2013, 41(2): 44-49.
4. 楊亞軍, 崔燎. FoxO/Wnt通路在氧化應激介導的骨質疏松中的調控機制. 中國藥理學通報, 2013, 29(1): 27-30.
5. 劉瑤瑤, 孫東, 張澤華, 等. 用于骨質疏松椎體固定的椎弓根螺釘進展. 中國矯形外科雜志, 2011, 19(23): 1982-1986.
6. Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg (Am), 2000, 82-A(10): 1458-1476.
7. Lei W, Wu Z. Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J, 2006, 15(3): 321-326.
8. 吳子祥, 雷偉, 孫明林, 等. 膨脹式椎弓根螺釘脊柱后路內固定的生物力學測試. 醫用生物力學, 2004, 19(2): 98-102.
9. 張偉, 雷偉, 吳子祥. 膨脹式椎弓根螺釘的強度測試. 科學技術與工程, 2008, 8(16): 4635-4637, 4653.
10. 石磊, 王陵, 雷偉, 等. 低彈性模量膨脹螺釘在骨質疏松綿羊的體內研究. 中國骨質疏松雜志, 2011, 17(9): 761-765.
11. Liu Z, Piao J, Pang L, et al. The diagnostic criteria for primary osteoporosis and the incidence of osteoporosis in China. J Bone Miner Metab, 2002, 20(4): 181-189.
12. 廖二元. 骨質疏松診斷方法綜述. 藥品評價, 2012, 9(7): 14-20.
13. Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res, 1986, (203): 7-17.
14. Roy-Camille R, Benazet JP, Desauge JP, et al. Lumbosacral fusion with pedicular screw plating instrumentation. A 10-year follow-up. Acta Orthop Scand Suppl, 1993, 251: 100-104.
15. Ying SH, Kao HC, Chang MC, et al. Fixation strength of PMMA-augmented pedicle screws after depth adjustment in a synthetic bone model of osteoporosis. Orthopedics, 2012, 35(10): e1511-e1516.
16. Higashino K, Kim JH, Horton WC, et al. A biomechanical study of two different pedicle screw methods for fixation in osteoporotic and nonosteoporotic vertebrae. J Surg Orthop Adv, 2012, 21(4): 198-203.
17. Cook SD, Barbera J, Rubi M, et al. Lumbosacral fixation using expandable pedicle screws. An alternative in reoperation and osteoporosis. Spine J, 2001, 1(2): 109-114.
18. 李宏偉, 馬遠征, 鮑達, 等. 膨脹與普通椎弓根釘治療脊柱胸腰段骨折合并骨質疏松的對比研究. 中國骨質疏松雜志, 2006, 12(1): 13-16.
19. 王祥善, 孫保國, 劉建民, 等. 膨脹式椎弓根螺釘在骨質疏松椎體的生物力學研究. 實用診斷與治療雜志, 2005, 19(8): 552-557.
20. Cook SD, Salkeld SL, Stanley T, et al. Biomechanical study of pedicle screw fixation in severely osteoporotic bone. Spine J, 2004, 4(4): 402-408.
21. Wu ZX, Gao MX, Sang HX, et al. Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation: a biomechanical study and a 2-year follow-up of 20 patients. J Surg Res, 2012, 173(1): 91-98.
22. 高明暄, 劉興炎, 甄平, 等. 膨脹式椎弓根螺釘聯合椎間融合器治療腰椎滑脫癥. 中國修復重建外科雜志, 2009, 23(8): 904-908.
23. Koller H, Zenner J, Hitzl W, et al. The impact of a distal expansion mechanism added to a standard pedicle screw on pullout resistance. A biomechanical study. Spine J, 2013, 13(5): 532-541.
24. Kocak T, Däxle M, Reichel H, et al. Alternative technique of cement augmentation of loosened pedicle screws—technical note and presentation of two cases. Acta Chir Orthop Traumatol Cech, 2013, 80(1): 89-91.
25. Li Y, Cheng H, Liu ZC, et al. In vivo study of pedicle screw augmentation using bioactive glass in osteoporosis sheep. J Spinal Disord Tech, 2013, 26(4): E118-E123.
26. Jonvaux J, Hoc T, Budyn E. Analysis of micro fracture in human Haversian cortical bone under compression. Int J Numer Method Biomed Eng, 2012, 28(9): 974-998.
27. 高石軍, 魏景超, 陸博, 等. 微骨折結合未培養的兔自體骨髓單個核細胞修復全層關節軟骨缺損的實驗觀察. 中華醫學雜志, 2012, 92(35): 2463-2467.

《中國修復重建外科雜志》

骨密度對膨脹式椎弓根螺釘固定強度影響的力學研究

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《中國修復重建外科雜志》

骨密度對膨脹式椎弓根螺釘固定強度影響的力學研究

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