目的 对一期侧前路病灶清除钛笼植骨融合联合双钉棒系统内固定在重建腰骶段脊柱稳定性的效果进行生物力学评价,为其在临床上的推广提供生物力学支持。 方法 于西安交通大学医学部解剖教研室获取腰骶段脊柱标本15具,通过CT扫描及骨密度检查剔除骨折、畸形及骨质疏松的标本,剩余标本随机分为生理组、前固定组与后固定组。对前固定组与后固定组中的所有标本行L 5椎体及邻近椎间盘次全切除术,通过钛笼与双钉棒前路固定前固定组标本;单纯利用双钉棒后路固定后固定组标本;生理组标本不作处理。所有标本术后摄X线片,并行薄层CT扫描等影像学检查以判断假体植入位置是否合适,有无脊髓压迫等不良现象。对3组腰骶段脊柱标本进行屈伸、侧弯、轴向扭转以及轴向压缩等状态下的力学测试,以评估前路双钉棒系统联合钛笼在固定腰骶段脊柱的力学效果。 结果 所有腰骶段脊柱标本均无骨折、畸形、骨质疏松等疾患。术后影像学检查显示植入的假体位置均正常,未见椎弓根钉刺入椎管及脊髓压迫等不良现象。体外力学测试结果显示在屈伸、侧弯、轴向压缩及扭转方向上,生理组标本达到最大加载位移(5 mm)或转角(5°)时所需的载荷均明显小于前固定组与后固定组标本,差异均有统计学意义( F 前屈=1335.989, P 前屈=0.000; F 背伸=166.688, P 背伸=0.000; F 左侧弯=258.872, P 左侧弯=0.000; F 右侧弯=335.766, P 右侧弯=0.000; F 轴向压缩=481.444, P 轴向压缩=0.000; F 左扭转=21.682, P 左扭转=0.000; F 右扭转=34.990, P 右扭转=0.000)。前固定组标本在前屈、左右侧弯、轴向压缩方向上达到最大加载位移(5 mm)时所需的载荷明显大于与后固定组标本,差异均有统计学意义( P 前屈=0.000; P 左侧弯=0.006; P 右侧弯=0.016; P 轴向压缩=0.000),而在背伸方向上达到最大加载位移(5 mm)所需的载荷却较后固定组标本明显减小,差异有统计学意义( P= 背伸0.000)。前固定组标本与后固定组标本在左右扭转方向上达到最大加载转角时(5°)所需的载荷相似,差异无统计学意义( P 左扭转=0.820; P 右扭转=0.259)。 结论 通过钛笼联合双钉棒对腰骶段脊柱标本进行前路固定可以使其获得较好的即刻稳定性,而且其在前屈、侧弯及轴向压缩方向上的稳定性优于后路双钉棒固定。
Objective To conduct the biomechanical evaluation of the effect of the new operative method, one stageanterior debridement and fusion combined withtitanium cage and dual screw-rod anterior instrumentation inter-fixation on the reconstruction of lumbosacral spine stability and provide biomechanical support for its further promotion in clinical practice. Methods Fifteen lumbosacral spine specimens were obtained from the department of anatomy, Xi'an Jiaotong University Health Science Center. Fracture, deformity and osteoporosis were removed by CT and bone density examination. The remaining specimens were randomly divided into intact group, anterior fixation group and posterior fixation group. L5 vertebral body and adjacent intervertebraldisc subtotal resection were performed on all specimens in the anterior fixation group and the posterior fixation group. The specimens in the anterior fixation group were fixed through titanium cage and dual screw-rod from front approach and the specimens inthe posterior group were fixed by dual screw-rod from posterior approach. Specimens in the intact group were not treated. All specimens were examined by X-ray and thin-slice CT after surgery to determine whether implant placement was appropriate andwhether there was spinal cord compression or not. Three groups of lumbosacral spine specimens were subjected to mechanical testsunder the conditions of flexion and extension, lateral bending, axial torsion and axial compression to evaluate the mechanical effect of anterior dual screw-rod system combined with titanium cage on the fixation of lumbosacral spine. Results All lumbosacralspine specimens were free of fractures, deformities, osteoporosis and other diseases. Postoperative imaging examination showed thatthe implant was in normal position and no adverse phenomena such as pedicle screw insertion into the spinal canal and spinalcord compression were observed. Mechanical test results in vitro showed that the load required for maximum loading displacement (5 mm) or rotation angle (5°) of the specimens in the intact group was less than that of the specimens in anterior and posterior fixation group in flexion, lateral bending and axial compression and torsion direction ( F flexion=1335.989, P flexion=0.000; F extension=166.688, P extension=0.000; F left lateral bending=258.872, P left lateral bending=0.000; F right lateral bending=335.766, P right lateral bending=0.000; F axial compression=481.444, P axial compression=0.000; F left rotation=21.682, P left rotation=0.000; F right rotation=34.990, P right rotation==0.000). When the maximum loading displacement (5 mm) was reached, the load required for the specimens in anterior fixation group was significantly greater than that for specimens in posterior fixation groupin the direction of flexion, left and right lateral bending and axial compression ( P flexion=0.000; P left lateral bending=0.006; P right lateral bending=0.016; P axial compression=0.000). However, the load required to reach the maximum loading displacement (5 mm) in the anterior fixation group in the direction of extension was significantly lower than that in the posterior fixation group ( P=0.000). When the maximum load angle (5°) was reached intorsion direction, the required load of the specimens in both anterior and posterior fixation groups was similar ( P left rotation=0.820; P right rotation=0.259). Conclusion The anterior fixation of lumbosacral spine specimens with titanium cage combined with dualscrew rod can provide better immediate stability and its stability in flexion, lateral bending and axial compression is better than that of back double nailing rodfixed.