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-  2015 

椎弓根外侧壁破坏对脊柱椎弓根钉内固定生物力学强度的影响

DOI: doi:10.7507/1002-1892.20150041

Keywords: 椎弓根螺钉, 生物力学, 腰椎, 脊柱内固定,

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Abstract:

目的探讨椎弓根螺钉内固定术中椎弓根外侧壁穿破后,向内侧重新定向后打入矫正螺钉(redirectionally correctly placed pedicle screw,RS)对脊柱内固定的生物力学影响。 方法6只市售家猪,体重95~105 kg,雌雄不限。取其新鲜腰椎标本30个(L1~5椎体各6个)。每个椎体标本一侧椎弓根打入最佳位置的椎弓根螺钉(optimum placed pedicle screw,OS);对侧在椎弓根和椎体连接处破坏椎弓根外侧壁,然后拧入RS螺钉。分别测量每个椎弓根钉最大拧入扭矩、锁紧扭矩、螺钉松动力和轴向拔出力。 结果OS螺钉和RS螺钉的最大拧入扭矩分别为(111.4±8.2) N·cm和(78.9±6.4) N·cm,差异有统计学意义(Z=3.038,P=0.002);OS螺钉和RS螺钉的锁紧扭矩分别为(86.3±7.7) N·cm和(59.7±5.3) N·cm,差异有统计学意义(Z=2.802,P=0.005)。OS螺钉和RS螺钉的螺钉松动力分别为(76.3±6.2)N和(53.0±5.8)N,差异有统计学意义(Z=2.861,P=0.004);OS螺钉和RS螺钉的轴向拔出力分别为(343.0±12.6)N和(287.0±10.5)N,差异有统计学意义(Z=2.964,P=0.003)。 结论与OS相比,椎弓根外侧壁破坏后RS在最大拧入扭矩、锁紧扭矩、螺钉松动力和轴向拔出力方面均显著降低,强化螺钉可能是较好的补救方法

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