椎弓根螺钉在骨矿量下降椎体中应用的生物力学研究
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Biomechanical Application Study of Pedicle Screw on Low BMD Vertebrae
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    摘要:

    目的通过对5种不同型号椎弓根螺钉(U1、U2、SF1、SF2、RF)在脊柱标本中内固定稳定性的生物力学测试,探讨螺钉设计参数、拧紧力矩同骨密度之间的关系,为临床骨质疏松患者应用椎弓根螺钉提供理论依据。方法采集腰椎标本6具,按骨密度ρ分正常组(ρ>1.00g/cm2)、骨矿量下降组(0.90g/cm2<ρ<1.00g/cm2)和骨质疏松组(ρ<0.90g/cm2),应用WD鄄10A万能实验机,测定不同骨密度下螺钉设计参数、拧紧力矩等对椎弓根螺钉内固定稳定性的影响。结果5种不同型号椎弓根螺钉(U1、U2、SF1、SF2、RF)固定的脊柱标本,其拔出力之间存在显著性差异(P<0.05)。骨密度的大小直接影响螺钉内固定的强度(以拔出力的大小衡量),正常组、骨矿量下降组与骨质疏松组之间存在着显著性差异(P<0.05)。椎弓根螺钉内固定的强度与拧紧力矩大小存在正相关关系,与骨密度也存在正相关(r=0.936)。在骨矿量相对下降的标本中,5种螺钉中U2的拔出力最大。结论螺钉的类型、被固定标本的骨密度同固定的稳定性密切相关。骨密度与最大拔出力、拧紧力矩具有正相关性.“U”型钉在对骨矿量下降标本的固定中具有一定优势。

    Abstract:

    Objective By biomechanical study about the stability of using 5 different types of pedicle screws (U1,U2,RF,SF1,SF2) on spinal specimen, to discuss the relationship between design parameter of screw,insertion torque,BMD and provide the theoretical foundation for clinical application of pedicle screw on osteoporotic patients; Method Six fixed lumbar cadaver specimens were used and divided into: normal group(ρ>1.00g/cm2, low BMD group (0.90g/cm2<ρ<1.00g/cm2)and osteoporosis group(ρ<0.90g/cm2). To determine the effects of the design parameter and the insertion torque of different screws on their fixation stability under various BMD by using WD-10A testing machine; Result There is a significant difference on the pullout strength of 5 different screws (U1,U2,RF,SF1,SF2) (P<0.05) . BMD of bone directly affect the intensity of fixation(according to the measured pullout strength). There is a significant difference among group of normal, low BMD and osteoporosis (P<0.05); The fixation intensity is in positive relation with insertion torque, the bigger the torque, the greater the fastness. And it is also in positive relation with BMD(r=0.936); Among specimens of low BMD, U2 has the greatest pullout strength among the 5 screws. Conclusion There is a close relationship between the type of screw, BMD and stability. BMD is in the positive relationship with pullout strength and insertion torque. In this study, the "U"-type screw displays the best fixation effect on specimen of low BMD

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李琦,杨惠林,唐天驷,吴翼伟,王以进.椎弓根螺钉在骨矿量下降椎体中应用的生物力学研究[J].医用生物力学,2005,20(1):32-36

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