刘俭涛,张 峰,李宇欢,牛斌斌,高正超,王一斌,梁 辉,闻志靖,贺西京.山羊可动腰椎复合体的设计及体外生物力学研究[J].中国脊柱脊髓杂志,2017,(4):345-352.
山羊可动腰椎复合体的设计及体外生物力学研究
中文关键词:  人工椎体  腰椎  次全切术  非融合  山羊
中文摘要:
  【摘要】 目的:研制一种既能重建腰椎椎体高度又能保留相应椎间隙运动功能的山羊可动腰椎复合体并进行体外生物力学测试,从而为人工腰椎假体动物模型的建立及体内研究奠定基础。方法:26个新鲜山羊腰椎标本行薄层CT检查以排除存在脊柱畸形、骨折的标本,其中2个标本因椎体骨折被排除,24个标本纳入研究。应用计算机辅助软件对山羊腰椎拟手术区解剖参数进行采集(对L4椎体及邻近的椎间盘进行解剖测量)以及可动假体模型优化设计,根据24个标本的腰椎解剖参数将假体大小设计成5种规格,并利用3D打印与机械加工技术将其制作而成。将24个标本随机分为生理、融合与非融合3组,每组8个,术前行骨密度检查。生理组标本不进行手术操作,融合组与非融合组标本行L4椎体及邻近椎间盘部分切除,融合组标本置入钛笼、钛板,非融合组标本置入山羊腰椎复合体(假体置入在L4)。术后所有标本行影像学检查以判断假体位置及脊髓受压情况,然后对3组标本在4Nm的载荷下进行生物力学活动度测试以评估可动假体的活动度及稳定性。结果:3组标本骨密度检查无统计学差异(P>0.05)。山羊L4椎体的前、中、后高分别为38.8±2.7mm、39.7±2.1mm、40.9±1.1mm;其上、中、下平面正中矢状径与正中冠状径分别为16.5±0.8mm、12.5±2.0mm、16.6±0.5mm与22.9±2.6mm、14.3±1.3mm、23.6±2.9mm;L3/4与L4/5椎间隙前、中、后高分别为4.9±1.0mm、3.0±0.5mm、1.9±1.0mm与5.0±0.4mm、3.6±0.9mm、2.4±0.9mm。山羊可动腰椎复合体由椎体部件与椎间盘部件构成,两者通过防脱球窝关节连接。术后影像学检查未发现假体位置异常及脊髓受压。与融合组相比,非融合组标本能显著保留L3/4和L4/5的运动范围、降低L2/3的运动范围(P<0.05);与生理组相比,非融合组各椎间隙的运动范围无显著性差异(P>0.05)。结论:根据山羊腰椎解剖结构设计的山羊可动腰椎复合体不但可重建手术节段的椎体高度与稳定性,而且能保留相应节段的活动度。
Design of a movable artificial lumbar complex and its preliminary biomechanical analysis in goats
英文关键词:Artificial vertebral body  Lumbar spine  Subtotal resection  Non-fusion  Goat
英文摘要:
  【Abstract】 Objectives: To design a movable artificial lumbar complex to reconstruct the height of lumbar vertebra and preserve the motion of inter-vertebral discs, and to perform the biomechanical tests in vitro. Methods: 26 fresh specimens of goat lumbar spines were used, and those with spinal deformity or fracture by the examination of thin slice CT scan were ruled out. Two specimens were finally excluded for vertebral fracture and twenty-four specimens were included in this research. The specimens were randomly divided into normal, fusion and non-fusion group, with eight specimens in each group, and bone mineral density was tested before operation. The anatomical data of goat lumbar spine dissected in operation were acquired and the design of movable prosthesis model was optimized with the computer-aided software, while the size of prosthesis was designed into five specifications according to the average anatomical parameters of 24 specimens, and the prosthesis was produced with the technique of 3D printing and machining. Image examination was performed for specimens in fusion and non-fusion groups(implants in L4) after operation to determine the position of implants and condition of spinal cord, and then bio-mechanical tests with the load of 4Nm were added to assess the activity and stability of movable prosthesis. Results: Bone mineral density showed no statistical difference among three groups(P>0.05). The anterior height, middle height and posterior height of L4 vertebra were 38.8±2.7mm, 39.7±2.1mm, and 40.9±1.1mm respectively; the upper, middle, lower sagittal diameters and horizontal diameters were 16.5±0.8mm, 12.5±2.0mm, 16.6±0.5mm and 22.9±2.6mm, 14.3±1.3mm, 23.6±2.9mm respectively; the anterior, middle and posterior heights of L3/4 and L4/5 vertebral discs were 4.9±1.0mm, 3.0±0.5mm, 1.9±1.0mm and 5.0±0.4mm, 3.6±0.9mm, 2.4±0.9mm respectively. The movable artificial complex of goat lumbar was formed by the vertebral body part and disc part and both were jointed together by ball-and-socket joints resisting dislocation. Postoperative imaging found no abnormal position of prosthesis and spinal cord compression. Compared with the fusion group, the non-fusion group could retain motion of L3/4 and L4/5 range of motion and reduce the range of motion of L2/3(P<0.05); compared with the normal group, non-fusion group had no significant difference in the range of motion of inter-vertebral discs(P>0.05). Conclusions: The movable artificial lumbar complex designed according to the anatomical structure of goat lumbar, not only can reconstruct the height and stability of operative segments but also retain the activity of inter-vertebral discs.
投稿时间:2016-12-20  修订日期:2017-03-07
DOI:
基金项目:2014年度西安交通大学综合交叉重点项目(编号:xjtc2014001)
作者单位
刘俭涛 西安交通大学第二附属医院骨科 710004 陕西省西安市 
张 峰 陕西省西安市第四医院骨科 710004 
李宇欢 西安交通大学第二附属医院骨科 710004 陕西省西安市 
牛斌斌  
高正超  
王一斌  
梁 辉  
闻志靖  
贺西京  
摘要点击次数: 2430
全文下载次数: 1591
查看全文  查看/发表评论  下载PDF阅读器
关闭