骨密度对膨胀式椎弓根螺钉固定强度影响的力学研究_《中国修复重建外科杂志》

作者：

高明暄 ¹ , 李旭升 ¹ , 甄平 ¹ , 吴智钢 ¹ , 周胜虎 ¹ , 田琦 ¹ , 雷伟 ²

1 兰州军区兰州总医院骨科全军创伤骨科研究所（兰州，730050）;;
2 第四军医大学附属西京医院骨科全军骨科研究所;

关键词：

膨胀式椎弓根螺钉骨质疏松拔出试验生物力学

DOI：

10.7507/1002-1892.20130211

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的评价不同骨质疏松条件下膨胀式椎弓根螺钉（expansive pedicle screw，EPS）的稳定性，为其应用于合并有骨质疏松症的患者脊柱手术提供力学理论基础。方法取新鲜尸体脊柱（T12～L5）标本，根据骨密度检测结果，按临床骨质疏松程度诊断标准分成骨质正常、骨量减少、骨质疏松和重度骨质疏松4个水平，每个水平各2具标本12个椎体。于每个椎体两侧椎弓根分别植入普通椎弓根螺钉（conventional pedicle screw，CPS；CPS组）和EPS（EPS组）。采用AG-IS万能材料试验机，以5 mm/min匀速加载进行螺钉轴向拔出试验，测定最大拔出力、刚度和能量吸收值。结果两组随骨密度水平下降，最大拔出力及刚度均逐渐下降（P lt; 0.05）；CPS组能量吸收值逐渐下降（P lt; 0.05），EPS组能量吸收值除正常骨质与骨量减少间比较、骨质疏松与重度疏松间比较差异无统计学意义（P gt; 0.05）外，其余各密度水平间比较差异均有统计学意义（P lt; 0.05）。同一骨密度水平EPS组最大拔出力均显著高于CPS组（P lt; 0.05）；除正常骨质水平外，同一骨密度水平EPS组刚度均显著高于CPS组（P lt; 0.05）；除骨量减少水平外，同一骨密度水平两组能量吸收值比较差异均无统计学意义（P gt; 0.05）。骨质疏松水平EPS组最大拔出力、刚度、能量吸收值与骨量减少水平CPS组比较，差异均无统计学意义（P gt; 0.05）；但重度骨质疏松水平EPS组以上指标均显著低于骨量减少水平CPS组（P lt; 0.05）。结论与CPS相比，EPS能明显提高固定强度，尤其对于骨量减少或骨质疏松患者。

引用本文： 高明暄,李旭升,甄平,吴智钢,周胜虎,田琦,雷伟. 骨密度对膨胀式椎弓根螺钉固定强度影响的力学研究. 中国修复重建外科杂志, 2013, 27(8): 969-973. doi: 10.7507/1002-1892.20130211 复制

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, 周胜虎, 邓晓文, 等. 骨质疏松对椎弓根螺钉稳定性影响的实验研究. 中国骨质疏松杂志, 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.	杨亚军, 崔燎. FoxO/Wnt通路在氧化应激介导的骨质疏松中的调控机制. 中国药理学通报, 2013, 29(1): 27-30.
5.	刘瑶瑶, 孙东, 张泽华, 等. 用于骨质疏松椎体固定的椎弓根螺钉进展. 中国矫形外科杂志, 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.	吴子祥, 雷伟, 孙明林, 等. 膨胀式椎弓根螺钉脊柱后路内固定的生物力学测试. 医用生物力学, 2004, 19(2): 98-102.
9.	张伟, 雷伟, 吴子祥. 膨胀式椎弓根螺钉的强度测试. 科学技术与工程, 2008, 8(16): 4635-4637, 4653.
10.	石磊, 王陵, 雷伟, 等. 低弹性模量膨胀螺钉在骨质疏松绵羊的体内研究. 中国骨质疏松杂志, 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. 骨质疏松诊断方法综述. 药品评价, 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.	李宏伟, 马远征, 鲍达, 等. 膨胀与普通椎弓根钉治疗脊柱胸腰段骨折合并骨质疏松的对比研究. 中国骨质疏松杂志, 2006, 12(1): 13-16.
19.	王祥善, 孙保国, 刘建民, 等. 膨胀式椎弓根螺钉在骨质疏松椎体的生物力学研究. 实用诊断与治疗杂志, 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, 刘兴炎, 甄平, 等. 膨胀式椎弓根螺钉联合椎间融合器治疗腰椎滑脱症. 中国修复重建外科杂志, 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.	高石军, 魏景超, 陆博, 等. 微骨折结合未培养的兔自体骨髓单个核细胞修复全层关节软骨缺损的实验观察. 中华医学杂志, 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, 周胜虎, 邓晓文, 等. 骨质疏松对椎弓根螺钉稳定性影响的实验研究. 中国骨质疏松杂志, 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. 杨亚军, 崔燎. FoxO/Wnt通路在氧化应激介导的骨质疏松中的调控机制. 中国药理学通报, 2013, 29(1): 27-30.
5. 刘瑶瑶, 孙东, 张泽华, 等. 用于骨质疏松椎体固定的椎弓根螺钉进展. 中国矫形外科杂志, 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. 吴子祥, 雷伟, 孙明林, 等. 膨胀式椎弓根螺钉脊柱后路内固定的生物力学测试. 医用生物力学, 2004, 19(2): 98-102.
9. 张伟, 雷伟, 吴子祥. 膨胀式椎弓根螺钉的强度测试. 科学技术与工程, 2008, 8(16): 4635-4637, 4653.
10. 石磊, 王陵, 雷伟, 等. 低弹性模量膨胀螺钉在骨质疏松绵羊的体内研究. 中国骨质疏松杂志, 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. 骨质疏松诊断方法综述. 药品评价, 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. 李宏伟, 马远征, 鲍达, 等. 膨胀与普通椎弓根钉治疗脊柱胸腰段骨折合并骨质疏松的对比研究. 中国骨质疏松杂志, 2006, 12(1): 13-16.
19. 王祥善, 孙保国, 刘建民, 等. 膨胀式椎弓根螺钉在骨质疏松椎体的生物力学研究. 实用诊断与治疗杂志, 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, 刘兴炎, 甄平, 等. 膨胀式椎弓根螺钉联合椎间融合器治疗腰椎滑脱症. 中国修复重建外科杂志, 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. 高石军, 魏景超, 陆博, 等. 微骨折结合未培养的兔自体骨髓单个核细胞修复全层关节软骨缺损的实验观察. 中华医学杂志, 2012, 92(35): 2463-2467.

《中国修复重建外科杂志》

骨密度对膨胀式椎弓根螺钉固定强度影响的力学研究

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《中国修复重建外科杂志》

骨密度对膨胀式椎弓根螺钉固定强度影响的力学研究

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