| 脊柱颈胸段全脊椎切除术内固定重建的生物力学 |
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Received:August 16, 2005
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| 作者 | Author | 单位 | Unit | E-Mail |
| 滕红林 |
TENG Hong-lin |
温州医学院附属第一医院骨科,浙江温州325000 |
Department of Orthopaedics,the First Affiliated Hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China |
honlinten@yahoo.com.cn |
| 肖建如 |
XIAO Jian-ru |
上海长征医院骨科 |
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| 倪向明 |
NI Xiang-ming |
温州医学院附属第一医院骨科,浙江温州325000 |
Department of Orthopaedics,the First Affiliated Hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China |
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| 王健 |
WANG Jian |
温州医学院附属第一医院骨科,浙江温州325000 |
Department of Orthopaedics,the First Affiliated Hospital of Wenzhou Medical College,Wenzhou 325000,Zhejiang,China |
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| 魏海峰 |
WEI Hai-feng |
上海长征医院骨科 |
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| 贾连顺 |
JIA Lian-shun |
上海长征医院骨科 |
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| 徐华梓 |
XU Hua-zi |
温州医学院第二医院骨科 |
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| 池永龙 |
CHI Yong-long |
温州医学院第二医院骨科 |
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| 期刊信息：《中国骨伤》2006年19卷，第5期，第287-290页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
| 基金项目:温州医学院科研发展基金(编号:Z01) |
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目的:研究颈胸段脊柱肿瘤在T1椎体全脊椎切除术后,前路、后路或者前后联合内固定重建方法的生物力学的优缺点。
方法:使用6具颈胸段脊柱标本。在完整状态进行力学分析后,T1脊椎根据WBB脊柱肿瘤解剖区域分类依次切除。然后前路利用颈椎前路带锁Orion钢板和钛网进行固定和重建,后路利用SUMMIT方向螺钉枕颈胸钉棒系统或者联合前后路两种重建方法进行测试。在非破坏性生物力学状态下进行屈伸和左右侧屈等不同工况下测试。
结果:T1脊椎全脊椎切除术后,前路钢板固定加后路短节段的椎弓根螺钉固定,其刚度优于单纯后路双节段的经椎弓根螺钉固定。前路钢板固定加后路双节段的椎弓根螺钉固定,其刚度优于前路钢板固定加后路单节段的椎弓根螺钉固定,但两者之间无显著性差异。全脊椎切除后,单纯前后钢板固定,其刚度下降明显,在肋椎关节切除后,已近失稳。
结论:临床上在全脊椎切除后,尽可能采用前后联合固定,后路可以采用单节段的经椎弓根螺钉固定。临床医师应该注意的是,全脊椎切除后,单纯前路钢板固定,稳定性较差,尤其在患者肋椎关节已被肿瘤破坏的情况下,稳定性更差。 |
| [关键词]:颈椎 胸椎 骨折固定术,内 生物力学 |
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| Biomechanical evaluation of spinal reconstruction for the total spondylectomy in the cervicothoracic spine |
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Abstract:
Objective:To investigate the stiffness of anterior,posterior and circumferential spinal reconstructions for different anatomic stages of tumor lesion so as to effectively treat with the tumorous lesion in the cervicothoracic spine.
Methods:Six human cadaveric cervicothoracic spines were studied.The T1 vertebral body and posterior elements were resected in sequence based on the Weinstein-Boriani-Biagini（WBB）anatomic zone classification for tumor lesion in the spine.Anterior reconstruction with titanium mesh and Orion plates systems,posterior reconstruction with the SUMMIT universal-axial transpedicular rod-screw systems or both of them were used in the reconstruction after the spondylectomy of the T1 vertebra.Nondestructive biomechanical test was performed under different loading situations.
Results:There were no statistical differences observed between the group of S+AP+PPS+M and the group of S+AP+PPS+S,even if the stiffness of group S+AP+PPS+M was higher than that of the group of S+PPS+S.Anterior instrumentation alone for total spondylectomy did not restore stiffness to the intact level,and it was more deteriorated when the costovertebral joint were destructed by the tumor.
Conclusion:The instrumentation of S+AP+PPS+S is the optimal reconstruction method though S+AP+PPS+M provide more stability,but they do not demonstrate statistical difference.Attention should be paid that anterior reconstruction alone could not exhibited more stability than that of the intact spine when the T1 total spondylectomy is performed,especially when the costovertebral joints are destructed in certain circumstances. |
| KEYWORDS:Cervical vertebrae Thoracic vertebrae Fracture fixation,internal Biomechanics |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 滕红林,肖建如,倪向明,王健,魏海峰,贾连顺,徐华梓,池永龙.脊柱颈胸段全脊椎切除术内固定重建的生物力学[J].中国骨伤,2006,19(5):287~290 |
| 英文格式: | TENG Hong-lin,XIAO Jian-ru,NI Xiang-ming,WANG Jian,WEI Hai-feng,JIA Lian-shun,XU Hua-zi,CHI Yong-long.Biomechanical evaluation of spinal reconstruction for the total spondylectomy in the cervicothoracic spine[J].zhongguo gu shang / China J Orthop Trauma ,2006,19(5):287~290 |
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