上胸椎前路钛板内固定系统的研制及其体外生物力学稳定性的评价
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摘要
目的:根据国人上胸椎的解剖特点,设计了上胸椎前路钛板内固定系统(upper thoracic anterior titanium plate fixed systen,UTAP)。并对其进行体外生物力学稳定性的评价
方法:根据国人上胸椎的解剖特点设计了一套适合上胸椎的UTAP。研究由二部分组成:(一)、UTAP的研制:复习文献并结合我们前期的研究获得国人上胸椎的解剖学参数,采用单皮质螺钉、钢板撑开加压原理和钢板螺钉锁定技术设计出UTAP;(二)UTAP的体外生物力学稳定性的评价:建立UTAP的有限元模型,并分析其应力分布情况;15具新鲜人体尸体上胸椎标本随机分成三组:UTAP内固定组(B组),颈前路锁定钛板(cervical anterior locking titanium plate fixation,CALP)预弯内固定组(C),CALP未预弯内固定组(D)。对15具完整标本进行三维活动度的测量,然后分别安装好各组内固定,再次进行三维活动度的测量。结果进行统计学分析。
结果:UTAP符合国人上胸椎的解剖特点。在完整状态下B、C、D三组标本的三维运动稳定性无显著性统计学意义(P>0.05);三组间前屈的稳定性排列:B>D>C>完整(A),B、A之间有显著性差异(P=0.012),其他各组间无显著性差异。其后伸的稳定性排列:B>C>A>D, B与A、C、D之间有显著性差异(P=0.001,P=0.021,P=0.01)其他各组间无显著性差异。其在旋转状态下的稳定性排列: B>C>A>D,各组之间无显著性差异。其侧弯的稳定性排列:A>B>C>D,A、B之间无显著性差异,A和C、D之间有显著性差异(P=0.005、P=0.002)。其他各组之间无显著性差异。
结论:1、UTAP的有限元分析表明应力分布在钛板中央植骨钉周围。
2、UTAP结构简单、操作方便,同CALP在上胸椎前方减压、融合内固定重建中比较,UTAP能提供较好的生物力学稳定,UTAP能提供即刻稳定。
3、如果采用CALP内固定重建上胸椎建议根据上胸椎的生理曲度塑型。
Objective: Upper thoracic anterior titanium plate fixed systen(upper thoracic anterior titanium plate fixed systen,UTAP) was designed according to the anatomic characteristics of upper thoracic spine of Chinese and evaluated biomechanical stability of it in vitro study
Methods: UTAP was designed according to the anatomy of upper thoracic spine of Chinese.The study composed of the two parts: Design of UTAP was the first parts.Anatomic parameters of the upper thoracics of Chinese were obtained on basis of literature and our previous researches UTAP on the basis of distraction and compression plate fixation,locking technique between screw and plate and unicortical screw fixation.Part two was for biomechanical study of UTAP.Stress distribution of plate was analyzed by setting up the model of three-dimension finite elements. Fifteen fresh intact C7-T6 structure of spine cadaveric speciments randomly were divided into three groups:Group B with UTAP,Group C with prespred cervical anterior locking plate fixation(cervical anterior locking plate fixation,CALP).Group D with imprespred CALP.After the range of motion(range of motion,ROM) of 15 intact speciments were tested ,ROM of models of different fixations were succedently performed.The results were analyzed by statistic at last.
Resuths: UTAP answered for the anatomic feature of Chinese upper thoracis. ROM of natural intact speciments of three groups were no significant difference(p>0.05).The stability of flexion was B>D>C>intact speciments(A),Significant difference between B and A was found(p=0.012).there was not significant difference in others. The stability of extension arranged as follows: B>C>A>D,Under the extention between B and A,C,D was significant difference(P=0.001,P=0.021,P=0.01), and with no significant difference in the others.Under the rotion the order of stability was B>C>A>D.Between groups have no significant difference in the rotation.The order of stabilities under the lateral bending was A>B>C>D.There were not significant difference between B and A,with significant diffirence between A and C,D(P=0.005、P=0.002). Between other groups was no significant difference under the lateral bending.
Conclusion:1.The analysis of three-dimension finite elements indicated that the stress concentrated on the surround of bone screw. 2.UTAP is simple and easily operated,can suppy immediate stability in anterior fusion and plate fixation in the upper thoracic spine.UTAP has better biomechanical stability than CALP. 3. If CALP was applied to upper thoracic spine,plate should be prespred according to physiological kyphosis of upper thoracic spine.
方法:根据国人上胸椎的解剖特点设计了一套适合上胸椎的UTAP。研究由二部分组成:(一)、UTAP的研制:复习文献并结合我们前期的研究获得国人上胸椎的解剖学参数,采用单皮质螺钉、钢板撑开加压原理和钢板螺钉锁定技术设计出UTAP;(二)UTAP的体外生物力学稳定性的评价:建立UTAP的有限元模型,并分析其应力分布情况;15具新鲜人体尸体上胸椎标本随机分成三组:UTAP内固定组(B组),颈前路锁定钛板(cervical anterior locking titanium plate fixation,CALP)预弯内固定组(C),CALP未预弯内固定组(D)。对15具完整标本进行三维活动度的测量,然后分别安装好各组内固定,再次进行三维活动度的测量。结果进行统计学分析。
结果:UTAP符合国人上胸椎的解剖特点。在完整状态下B、C、D三组标本的三维运动稳定性无显著性统计学意义(P>0.05);三组间前屈的稳定性排列:B>D>C>完整(A),B、A之间有显著性差异(P=0.012),其他各组间无显著性差异。其后伸的稳定性排列:B>C>A>D, B与A、C、D之间有显著性差异(P=0.001,P=0.021,P=0.01)其他各组间无显著性差异。其在旋转状态下的稳定性排列: B>C>A>D,各组之间无显著性差异。其侧弯的稳定性排列:A>B>C>D,A、B之间无显著性差异,A和C、D之间有显著性差异(P=0.005、P=0.002)。其他各组之间无显著性差异。
结论:1、UTAP的有限元分析表明应力分布在钛板中央植骨钉周围。
2、UTAP结构简单、操作方便,同CALP在上胸椎前方减压、融合内固定重建中比较,UTAP能提供较好的生物力学稳定,UTAP能提供即刻稳定。
3、如果采用CALP内固定重建上胸椎建议根据上胸椎的生理曲度塑型。
Objective: Upper thoracic anterior titanium plate fixed systen(upper thoracic anterior titanium plate fixed systen,UTAP) was designed according to the anatomic characteristics of upper thoracic spine of Chinese and evaluated biomechanical stability of it in vitro study
Methods: UTAP was designed according to the anatomy of upper thoracic spine of Chinese.The study composed of the two parts: Design of UTAP was the first parts.Anatomic parameters of the upper thoracics of Chinese were obtained on basis of literature and our previous researches UTAP on the basis of distraction and compression plate fixation,locking technique between screw and plate and unicortical screw fixation.Part two was for biomechanical study of UTAP.Stress distribution of plate was analyzed by setting up the model of three-dimension finite elements. Fifteen fresh intact C7-T6 structure of spine cadaveric speciments randomly were divided into three groups:Group B with UTAP,Group C with prespred cervical anterior locking plate fixation(cervical anterior locking plate fixation,CALP).Group D with imprespred CALP.After the range of motion(range of motion,ROM) of 15 intact speciments were tested ,ROM of models of different fixations were succedently performed.The results were analyzed by statistic at last.
Resuths: UTAP answered for the anatomic feature of Chinese upper thoracis. ROM of natural intact speciments of three groups were no significant difference(p>0.05).The stability of flexion was B>D>C>intact speciments(A),Significant difference between B and A was found(p=0.012).there was not significant difference in others. The stability of extension arranged as follows: B>C>A>D,Under the extention between B and A,C,D was significant difference(P=0.001,P=0.021,P=0.01), and with no significant difference in the others.Under the rotion the order of stability was B>C>A>D.Between groups have no significant difference in the rotation.The order of stabilities under the lateral bending was A>B>C>D.There were not significant difference between B and A,with significant diffirence between A and C,D(P=0.005、P=0.002). Between other groups was no significant difference under the lateral bending.
Conclusion:1.The analysis of three-dimension finite elements indicated that the stress concentrated on the surround of bone screw. 2.UTAP is simple and easily operated,can suppy immediate stability in anterior fusion and plate fixation in the upper thoracic spine.UTAP has better biomechanical stability than CALP. 3. If CALP was applied to upper thoracic spine,plate should be prespred according to physiological kyphosis of upper thoracic spine.
引文
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[3]Sundaresan N.Tumors of the Spine:Diagnosis and Clinical Management.Philadelphia:WB Saunders 1990;358–68
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[8]Pal GP, Routal RV.A study of weight transmission through the cervical and upperthoracic regions of the vertebral column in man. J Anat 1986 148:245-261.
[9]Boyle JJ,Singer KP,Milne N.Morphological survey of the cervicothoracic Junctional region.Spine 1996;21:544-548.
[10]Le H,Balabhadra R,Park J,Kim D.Surgical treatment of tumors involving the cervicothoracic junction. Neurosurg Focus 2003;15:E3.
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