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三种下颈椎内固定技术稳定性的生物力学比较 总被引:1,自引:0,他引:1
目的比较不同颈椎内固定器械的稳定性能,为临床合理选择内固定提供生物力学基础。方法6具新鲜颈椎标本,制成C4~5节段三柱损伤模型,分别用侧块螺钉钢板Roy~Camille法(LMS)、椎弓根钉棒系统(TPS)和经关节螺钉(TAS)三种方法固定,测试三种内固定技术下的稳定性并进行比较。结果侧块螺钉钢板固定的三维稳定性不及经关节螺钉固定,椎弓根钉棒系统固定各种运动稳定指标均最好。结论经关节螺钉固定技术与椎弓根螺钉固定功能相当,却优于侧块螺钉钢板固定技术。 相似文献
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目的通过测量T1—8节段胸椎肋椎关节的形态学特征,探讨经肋椎关节进钉的可行性及临床意义。方法选择12具国人胸椎标本(男7、女5)共96个椎体,选取T4—5节段,使用康辉6.0mm椎弓根螺钉进行经椎肋关节内固定,并使用X线评估螺钉置人位置,并实体测量T1—8每个椎体肋椎关节及相应节段椎弓根的横径、钉道长度及e角(肋椎关节、椎弓根轴线与矢状线的夹角)。结果各节段肋椎关节的横径均明显大于椎弓根(P〈0.01);经肋椎关节植入螺钉可提供的钉道长度明显优于椎弓根(P〈0.01);经肋椎关节植入螺钉的e角普遍大于椎弓根钉(P〈0.01)。影像学结果显示:所有螺钉均处于椎肋关节中未进入椎管及突破外侧肋骨。结论从解剖学研究的角度看,经肋椎关节植入螺钉的安全性优于传统的椎弓根内固定。 相似文献
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胸椎旁路法植入椎弓根螺钉的力学实验研究 总被引:5,自引:0,他引:5
目的:研究在胸椎节段应用椎弓根旁路法植入椎弓根螺钉的力学可行性。方法:5副成人新鲜尸体胸椎(T1-8), 分解为40个单一椎体标本,每一标本左右两侧分别使用经椎弓根入路法(n=40)和旁路法(n=40)植入螺钉,并进行螺钉沿椎体矢状轴拔出强度的力学测量,比较两种方法的拔出强度。结果:旁路法植入螺钉后出现两种情况A和B,A:19个椎体(47.5%),为螺钉经横突后沿椎弓根外壁固定至椎体;B:21个椎体(52.5%),为螺钉经椎弓根外侧皮质至椎体。旁路法中A植入螺钉的拔出强度为(827.01±260.00)N,旁路法中B植入螺钉的拔出强度为(954.25±254.00)N。结合A、B两种情况,旁路法中植入螺钉的平均拔出强度为(890.63±342.00)N,胸椎经椎弓根入路螺钉的拔出强度为(1 001.23±220.00)N,二者比较,旁路法螺钉的平均拔出强度较经椎弓根入路法螺钉的拔出强度降低11.04%,但差异无显著性(P>0.05)。结论:胸椎椎弓根旁路法植入椎弓根螺钉在力学上是可行的。 相似文献
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目的 探讨经后路伤椎置入椎弓根螺钉短节段固定治疗胸腰椎骨折的生物力学稳定性及刚度。 方法 取 15 具新 鲜猪骨胸腰段椎体(T11~L3)标本,随机分为跨节段双椎间 4 枚椎弓根螺钉固定组(4 钉固定组)、经伤椎单侧椎弓根螺钉固定组(5 钉固 定组)、经伤椎双侧椎弓根螺钉固定组(6 钉固定组),每组 5 具,建立胸腰椎爆裂性骨折模型,对 3 组标本进行后路短节段跨节段椎弓 根螺钉固定或经伤椎椎弓根螺钉固定,测试 3 组标本在正常、骨折、固定、疲劳状态下的前屈后伸、左右侧屈的运动范围(ROM)以及生 物力学刚度。 结果 3 组标本的固定方法均能提高胸腰椎骨折模型的生物力学稳定性及刚度;生物力学刚度方面,5 钉固定组、6 钉 固定组均明显高于 4 钉固定组,差异均有统计学意义(均 P<0.05),5 钉固定组与 6 钉固定组之间比较差异无统计学意义(P >0.05);运动范围方面,5 钉固定组与 6 钉固定组在前屈后伸、左右侧屈 4 个方向的 ROM 均明显低于 4 钉固定组,差异均有统计学意义(均 P<0.05),5 钉固定组与 6 钉固定组之间比较差异无统计学意义 (P >0.05)。 结论 经后路伤椎置入椎弓根螺钉短节段固定可提高 胸腰椎骨折模型各个运动方向上的生物力学稳定性及刚度,但经伤椎单侧与双侧椎弓根钉固定在刚度及稳定性方面无统计学差异。 相似文献
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后路脊柱侧凸矫正术的新探索—15例初步报告 总被引:1,自引:1,他引:0
采用经椎弓根螺钉及撑开棍与压缩棍方式治疗脊柱侧凸15例,术前侧凸度数Cobb37°~110°,平均69.1°。椎弓根固定范围7~16节,平均12.3节;最高固定节段为T1。手术后侧凸度数Cobb9°~30°,平均12.8°。侧凸矫正率53.3%~85.7%,平均71.9%。经椎弓根撑开(或加压缩)矫正率高,固定可靠,克服了目前常用方法的缺点;突破了胸-9以上不能用椎弓根钉的限制,是一种较理想的脊柱 相似文献
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目的 测量C3〜C7颈椎数据,为临床颈椎经椎弓根内固定手术提供螺钉长度,螺钉直径和倾斜角的数据。
方法 采用螺旋CT测量30名华人颈椎C3〜C7锥体的数据,并重建颈椎椎弓根图像。
结果 CT重建图像显示:C3〜C7椎弓根宽度由上到下越来越大;椎弓根厚度也逐渐变大;椎弓根倾斜角越来越小,从33.76º到47.20º;椎弓根中线距离也从C3〜C7逐渐变小。同一人的椎弓根,右侧和左侧没有统计学差异,但在男性和女性椎弓根之间有统计学差异。
结论 CT重建图像可以为临床颈椎经椎弓根内固定术提供有用的参考数据。 相似文献
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采用经椎弓根螺钉及撑开棍与压缩棍方式治疗脊柱侧凸15例,术前侧凸度数Cobb37℃110°,平均69.1°。椎弓根固定范围7~16节,平均12.3节;最高固定节段为T。手术后侧凸度数Cobb9°~30°,平均12.8°。侧凸矫正率53.3%~85.7%,平均71.9%。经椎弓相撑开(或加压缩)矫正率高,固定可靠,克服了目前常用方法的缺点;突破了胸-9以上不能用椎弓根钉的限制,是一种较理想的脊柱矫形内固定方法。 相似文献
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目的探讨后路经椎弓根钉棒系统内固定治疗多节段胸腰椎骨折的临床效果.方法21例多节段胸腰椎骨折,根据唐三元分类法ⅠA型骨折19例,ⅡA型骨折2例.神经功能按Frankel分级:A级7例,B级4例,C级3例,D级4例,E级3例,均在2周内行后路经椎弓根螺钉内固定治疗.手术前和随访时分别进行Frankel评分和锥体高度及后凸角度的测量,并进行对比分析,结果X线片示后凸角由术前平均24°(15—48°)矫正到术后平均5°(0~10°),椎体前缘高度由术前平均38%(20%~65%)恢复到术后平均95%(85%~100%),随访时间7—48个月,平均25个月,椎体高度无丧失,内固定无松动、断裂.7例FrankelA级的患者,其中2例无变化,5例恢复至B级,3例B级恢复至C级,1例B级恢复至E级,3例C级恢复至E级,4例D级恢复至E级,3例FrankelE级的患者术后无神经功能障碍.结论后路经椎弓根钉棒系统内固定治疗多节段胸腰椎骨折,方法可行,疗效满意, 相似文献
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目的探讨一种术中判断矢状面椎弓根螺钉置入角度的方法。方法71例胸腰椎骨折患者,术前拍摄标准的以伤椎为中心正侧位X片,侧位片测量准备置椎弓根螺钉的椎体进钉点和棘突后上缘最高点连线与上终板水平线的夹角(A角),作为术中椎弓根钉头(尾)向偏的角度,做到每一椎体个体化。术中根据透视情况进行适当调整。结果本组71例患者,共置椎弓根螺钉292枚。按照这种方法首次置定位钉后与上终板水平线相差(2.2.±1.7)°,经透视后适当调整置入的椎弓根螺钉,全部与同位椎体上终板保持平行。结论利用同位棘突后上缘最高点的解剖定位,决定术中螺钉头(尾)偏方向及角度技术上可行,方法简单,操作安全,准确可靠,具临床指导价值。 相似文献
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Biomechanical comparison of cervical transfacet pedicle screws versus pedicle screws 总被引:4,自引:0,他引:4
Background Transfacet pedicle screws provide another alternative for standard pedicle screw placement for plate fixation in the lumbar spine. However, few studies looking at transfacet pedicle screw fixation in the cervical spine are available. Therefore, cervical transfacet pedicle screw fixation and standard pedicle screw fixation techniques were biomechanically compared in this study. Methods Ten fresh human cadaveric cervical spines were harvested. On one side, transfacet pedicle screws were placed at the C3-4, C5-6, and C7-T1 levels. On the other side, pedicle screws were placed at the C3, C5, and C7 levels. The screw insertion technique at each level was randomized for right or left. The starting point for the transfacet pedicle screw insertion was located at the midpoint of the inferolateral quadrant of the lateral mass and the direction of the screw was about 50° caudally in the sagittal plane and about 45° toward the midline in the axial plane. Screws were placed from the inferior articular process, across the facet complex and the pedicle into the body of the caudal vertebra. The entry point for the pedicle screw was located at the midpoint of the superolateral quadrant of the lateral mass, and the direction of the screw was about 45° toward the midline in the axial plane and toward the upper third of the vertebral body in the sagittal plane. After screw placement we performed axial pullout testing. Results All the cervical transfacet pedicle screws and the pedicle screws were inserted successfully. The mean pullout strength for the transfacet pedicle screws was 694 N, while for the pedicle screws 670 N (P=0.013). In all but six instances (10%), the pedicle screw pullout values exceeded the values for the transfacet pedicle screws; this occurred three times at the C3/C4 level, twice at the C5/C6 level and once at the C7/T1 level. The greatest pullout strength difference at a single level was observed at the C5/C6 level, with a mean difference of 38 N (t=-1.557, P=0.154). The C7/T1 level h 相似文献
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目的:比较3种不同的节段性枕-寰-枢(C0-C1-C2)固定技术的生物力学。方法: 收集6具完整的人类尸体颈段(C0-C5),单皮质螺钉固定枕部,侧块螺钉固定C1,而C2固定技术分为三种:椎板交叉螺钉、椎弓根螺钉、C1-C2经小关节螺钉。C1侧块螺钉在置入C1-C2经小关节螺钉前取出。固定后测量每组结构C0-C2间的活动范围。结果:3种不同的固定技术跟正常脊柱相比活动范围皆缩小。3种固定技术间在屈伸和轴向旋转的活动度上无明显差异。同其他2组相比,C2椎板交叉螺钉组的侧方弯曲活动度有增加的趋势。同椎弓根螺钉组和经小关节螺钉组比较,椎板螺钉组在CT轴位和矢状面图像上远离椎动脉。结论:使用C2椎板交叉螺钉、C2椎弓根螺钉和C1-C2经小关节螺钉进行枕-寰-枢(C0-C1-C2)固定的技术都可以提供相似的生物力学稳定性。与其它2固定技术相比, C2椎板螺钉固定技术损伤椎动脉的风险较少。 相似文献
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下颈椎前路椎弓根螺钉置入的实验研究 总被引:1,自引:0,他引:1
目的 探讨下颈椎前路椎弓根螺钉置入技术的可行性.方法 取18具成人尸体正常颈椎标本,剔除其周围软组织至清楚显露椎体前壁.CT扫描后,用Mimics软件重建三维模型,并测量C3~C7个体化置钉参数,包括进钉点(即椎弓根中轴线在椎体前壁投影点)、置钉方向(螺钉在横断面和矢状面上的倾斜角度)以及螺钉长度.严格按照测量结果,直视下置入椎弓根螺钉.术后作CT扫描,评价置钉效果.结果 进针点:C3、C4位于置钉椎弓根对侧,正中矢状面旁2~3 mm,距上终板6~7 mm;C5~ C7与置钉椎弓根同侧,其中C5位于正中矢状面旁1~2 mm,距上终板7.0~7.5 mm,C6、C7则为4~5 mm和7.5 ~8.5 mm.置钉方向:理想角度在C3、C4为外倾角46°~47°,头倾角-11°~-7°;在C5外倾角约48°,头倾角接近0°;C6、C7为36°~40°和8~13°.螺钉长度:可选择28、30、32 mm,其直径为3.5 mm.本组共置钉144枚.术后CT示,全部螺钉均经椎体前方置入椎弓根内抵达侧块.其中,有16枚胀破椎弓根外侧皮质,3枚穿破外侧皮质(均发生在C3、C4节段).结论 下颈椎前路椎弓根螺钉置入技术是可行的. 相似文献
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《Upsala journal of medical sciences》2013,118(3):198-206
AbstractPurpose. Anterior plate fixation has been reported to provide satisfactory results in cervical spine distractive flexion (DF) injuries stages 1 and 2, but will result in a substantial failure rate in more unstable stage 3 and above. The aim of this investigation was to determine the biomechanical properties of different fixation techniques in a DF-3 injury model where all structures responsible for the posterior tension band mechanism are torn.Methods. The multidirectional three-dimensional stiffness of the subaxial cervical spine was measured in eight cadaveric specimens with a simulated DF-3 injury at C5–C6, stabilized with four different fixation techniques: anterior plate alone, anterior plate combined with posterior wire, transarticular facet screws, and a pedicle screw–rod construct, respectively.Results. The anterior plate alone did not improve stability compared to the intact spine condition, thus allowing considerable range of motion around all three cardinal axes (p > 0.05). The anterior plate combined with posterior wire technique improved flexion–extension stiffness (p = 0.023), but not in axial rotation and lateral bending. When the anterior plate was combined with transarticular facet screws or with a pedicle screws–rod instrumentation, the stability improved in flexion–extension, lateral bending, and in axial rotation (p < 0.05).Conclusions. These findings imply that the use of anterior fixation alone is insufficient for fixation of the highly unstable DF-3 injury. In these situations, the use of anterior fixation combined with a competent posterior tension band reconstruction (e.g. transarticular screws or a posterior pedicle screws–rod device) improves segmental stability. 相似文献
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目的:比较枕颈部后路4种不同植入方式的螺钉在施加生理载荷时所承受的应力,评价各自在生理环境中的机械性能。方法对16例新鲜人体枕颈部标本(含Oc-C3),采用后路枕寰枢复合体经关节螺钉固定和SUMMIT系统枕颈固定。对固定后的经寰枕关节螺钉(Oc-C1组)、经寰枢关节螺钉(C1-C2组)、枢椎椎弓螺钉(C2 PS组)和枕骨螺钉(Oc Screw组)在生理载荷下三维六自由度运动时,运用应变电阻测定法测定4种螺钉的应力,数据进行统计学处理。结果在侧屈状态下,电测法测得的4种螺钉局部应变均接近于0。在前屈、后伸、左旋和右旋运动时,随着加载载荷增大,测得的应力均逐步增大。在前屈和旋转时螺钉不同程度承受拔出应力,在后伸时,螺钉所受的为压应力。枕骨螺钉(Oc Screw组)在屈伸和旋转运动状态下,在所有3种载荷下所承受的应力均大于其它3种植钉方法,差异有统计学意义(P<0.05)。结论生理环境下,枕骨螺钉承受的拔出应力最大,其可能更易出现内植物相关并发症,具体应用时应结合临床实际。 相似文献
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目的通过测量颈椎椎弓根尺寸和进钉点进钉角度为置入椎钉提供依据。方法CT测量30例患者颈3-7,CT扫描测量颈椎根以下尺寸,椎根内径、外径、内侧皮质厚度、椎弓根轴长度和椎弓根长轴与中线的夹角。结果颈椎椎弓根平均内径为L3-3.3mm,颈椎椎弓根平均外径为4.0-7.0mm,最小的椎弓根在女性颈3椎体,最小的椎弓根外径为3.2 mm,最大椎弓根宽为C7,男性为11.3 mm,女性为7.4 mm。平均内壁皮质骨厚度为1.5-2.0 mm,平均椎弓根轴长度29.3to-33.7mm和平均椎弓根长轴与中线的夹角39.8度to 49.0度。结论颈椎椎弓根螺钉的置入应行CT测量,螺钉角度接近50度,进钉角度尽可能在侧块的外侧。 相似文献
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目的通过对5种不同椎弓根螺钉在脊柱标本中稳定性的生物力学研究,探讨螺钉设计参数、拧紧力矩同骨密度之间的关系,为骨质疏松患者应用椎弓根螺钉治疗莫定理论基础。方法采集固定腰椎尸体标本6具,运用生物力学实验手段,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(1)5种不同型号椎弓根螺钉固定脊柱标本,其拔出力之间存在显著性差异(P<0.05);(2)腰椎节段的拔出力从上到下,逐渐增大,轴向刚度亦然;(3)骨密度的大小直接影响螺钉内固定的强度、拔出力的大小,正常组与骨质疏松组之间存在着显著性差异(P<0.05);(4)椎弓根螺钉内固定的强度与拧紧力矩直接相关,拧紧力矩越大,固定越牢固,并与骨密度成正相关(r=0.936);(5)在骨矿量相对下降的标本中,各种螺钉的拔出力大小依次为U2>U1>SF1>SF2>RF。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,在骨矿量下降的标本中以“U”型钉的固定效果最好。 相似文献
18.
目的比较椎板部分切除置钉法、Abumi法、管道疏通法在颈椎(C3~7)经皮椎弓根螺钉内固定术中的应用。方法选择60例需经皮椎弓根螺钉固定术治疗的下颈椎疾病患者,根据其手术方式分成3组:椎板部分切除置钉组(A组)、Abumi组(B组)、管道疏通组(C组),各置入椎弓根螺钉80枚。出院前评估置钉满意率。结果 A组置钉评价为:优54枚,良13枚,差13枚,满意率为83.8%;B组置钉评价为:优56枚,良14枚,差10枚,满意率87.5%;C组置钉评价为:优72枚,良5枚,差3枚,满意率96.3%。C组患者的置钉满意率明显优于A、B组,3组之间差异有统计学意义。结论管道疏通法在经颈后路椎弓根螺钉内固定术中优势明显。 相似文献
19.
目的 分析寰椎椎弓根钉与寰椎侧块钉治疗寰枢椎骨折的临床疗效.方法 2007年8月~2011年11月,我院对46例寰枢椎骨折的患者进行手术治疗,其中25例采用寰椎侧块钉技术,21例采用寰椎椎弓根钉技术.通过比较术中出血量、手术时间、日本骨科协会评分(JOA)以及骨折愈合情况,对两组内固定技术的临床疗效进行分析.结果 所有患者均获得随访,随访时间24~60个月,平均32个月,术后6个月骨折均获得骨性愈合,未出现内固定失败,疼痛均明显缓解,两组JOA评分比较差异无统计学意义.与寰椎侧块钉组相比,寰椎椎弓根钉组手术时间明显缩短,术中失血量明显减少.结论 寰椎椎弓根钉固定损伤较小,操作相对简单,可优先采用. 相似文献
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Background The complicated anatomy of the cervical spine and the variation among pedicles reduces the accuracy and increases the risk of neurovascular complications associated with screw implantation in this region. In this study, we compared the accuracy of cervical (C2-C7) pedicle screw fixation assisted by X-ray fluoroscopy, computed tomography (CT)-based navigation, or intraoperative three-dimensional (3D) C-arm navigation.Methods This prospective cohort study was performed in 82 consecutive patients who underwent cervical pedicle screw fixation. The accuracy of screw insertion was assessed by postoperative CT scan with 3D reconstruction. The accuracy of screw insertion was assessed as: excellent (screw completely within pedicle); acceptable (≤ 1 mm screw outside pedicle cortex); poor (〉1 mm screw outside pedicle cortex).Results A total of 145 screws were inserted in 24 patients who underwent C-arm fluoroscopy. Of these, 96 screws (66.2%) were excellent, 37 (25.5%) were acceptable, and 12 (8.3%) were poor. One hundred and fifty-nine screws were inserted in 29 patients in the CT-based navigation group. Among these, 141 (88.7%) were excellent, 14 (8.8%) were acceptable, and 4 (2.5%) were poor. A total of 140 screws were inserted in 29 patients in the intraoperative 3D C-arm navigation group, of which 127 (90.7%) were excellent, and 13 (9.3%) were acceptable. No severe or permanent neurovascular complications associated with screw insertion were observed in any patient.Conclusione CT-based and intraoperative 3D C-arm navigation were similarly accurate, and were both significantly more accurate than C-arm fluoroscopy for guiding cervical pedicle screw fixation. They were able to accurately guide the angle and depth of screw placement using visual 3D images. These two techniques are therefore preferable for high-risk cervical pedicle screw fixation. The ease and convenience of intraoperative 3D C-arm navigation suggests that it may replace virtual-fluoroscopy and CT-based navigation systems in future clinical applications. 相似文献