吴杰;郭征;石磊;李小康;樊博;裴延军;杨迪;王海亮;

• 1:第四军医大学附属西京医院骨肿瘤科

摘要(Abstract)：

[目的]评估直径3.2 mm PEEK棒应用于羊颈椎固定的生物力学稳定性,对比PEEK棒与传统钛合金棒固定的生物力学特点。[方法]取6具新鲜羊C_(3、4)椎体标本,通过非损伤性加载方式分别对完整标本、失稳标本、PEEK棒固定标本、钛合金棒固定标本进行生物力学测试。记录在垂直压缩方向的压缩位移及刚度、椎体前缘微应变,以及前屈、后伸、左右侧弯四个方向的移动度。[结果]PEEK棒固定组和钛合金棒固定组各方向移动度均较完整组减小(P<0.05),在左右侧弯方向,PEEK棒固定组移动度大于钛合金棒组(P<0.05)。轴向压缩实验显示,两种固定后较完整组刚度均有显著增加(P<0.05),PEEK棒固定组刚度小于钛合金棒固定组(P<0.05)。颈椎前缘应变结果显示,钛合金棒固定组椎体前缘应变显著低于完整组及PEEK棒固定组(P<0.05),PEEK棒固定组应变与完整组未见显著差异。[结论]直径3.2 mm的PEEK棒可以满足离体羊颈椎即刻生物力学稳定的要求,其较钛合金棒固定增加了椎间应力,有利于促进骨性融合。

关键词(KeyWords)： 颈椎;聚醚醚酮;PEEK棒;钛合金棒;生物力学

Abstract:

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基金项目(Foundation):

作者(Author): 吴杰;郭征;石磊;李小康;樊博;裴延军;杨迪;王海亮;

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参考文献(References)：

• [1]Jin YJ,Kim YE,Seo JH,et al.Effects of rod stiffness and fusion mass on the adjacent segments after floating mono-segmental fusion:a study using finite element analysis[J].Eur Spine J,2013,22(5):1066-1077.
• [2]Ahn Y,Chen W,Lee K,et al.Comparison of the load-sharing characteristics between pedicle-based dynamic and rigid rod devices[J].Biomed Mater,2008,3(4):44101.
• [3]Li C,Liu L,Shi JY,et al.Clinical and biomechanical researches of polyetheretherketone(PEEK)rods for semi-rigid lumbar fusion:a systematic review[J].Neurosurg Rev,2016:1-15..
• [4]Mavrogenis AF,Vottis C,Triantafyllopoulos G,et al.PEEK rod systems for the spine[J].Eur J Orthop Surg Traumatol,2014,24(S1):111-116.
• [5]Turner JL,Paller DJ,Murrell CB.The mechanical effect of commercially pure titanium and polyetheretherketone rods on spinal implants at the operative and adjacent levels[J].Spine,2010,35(21):1076.
• [6]张晋元,吴卫东,房亚峰,等.两种颈椎前路内固定方法对邻近节段应变的影响[J].中国矫形外科杂志,2015,23(16):1498-1502.
• [7]童杰,季伟,周若舟,等.下颈椎经关节螺钉与侧块钉棒固定的生物力学比较[J].中国脊柱脊髓杂志,2015(09):837-842.
• [8]Chang T,Huang C,Liu Y,et al.Biomechanical evaluation and comparison of polyetheretherketone rod system to traditional titanium rod fixation on adjacent levels[J].Formosan J Musculoskeletal Dis,2013,4(2):42-47.
• [9]Lee M J,Dettori JR,Standaert CJ,et al.Indication for Spinal Fusion and the Risk of Adjacent Segment Pathology[J].Spine,2012,37:40-51.
• [10]Cabello J,Cavanilles-Walker JM,Iborra M,et al.The protective role of dynamic stabilization on the adjacent disc to a rigid instrumented level.An in vitro biomechanical analysis[J].Archives Orthop Trauma Surg,2013,133(4):443-448.
• [11]Yamanaka K,Mori M,Yamazaki K,et al.Analysis of the Fracture Mechanism of Ti-6Al-4V Alloy Rods That Failed Clinically After Spinal Instrumentation Surgery[J].Spine,2015,40(13):767-773.
• [12]Kurtz SM,Devine JN.PEEK biomaterials in trauma,orthopedic,and spinal implants[J].Biomaterials,2007,28(32):4845-4869.
• [13]Walsh WR,Pelletier MH,Bertollo N,et al.Does PEEK/HA Enhance Bone Formation Compared With PEEK in a Sheep Cervical Fusion Model[J].Clin Orthop,2016,474(11):2364-2372.
• [14]黄伟敏,于秀淳,梁进,等.聚醚醚酮棒椎弓根螺钉内固定系统在下腰椎退行性疾病中的应用[J].中华骨科杂志,2016,36(12):761-769.
• [15]Karakoyun DO,?zkaya M,Okutan VC,et al.Biomechanical comparison of unilateral semi-rigid and dynamic stabilization on ovine vertebrae[J].Proceedings of the Institution of Mechanical Engineers,Part H:Journal of Engineering in Medicine,2015,229(11):778-785.
• [16]杨红军,樊勇,吴子祥,等.新型PEEK棒半刚性固定系统应用于腰椎退变性疾病手术治疗的临床疗效[J].中国脊柱脊髓杂志,2015,25(9):826-831.
• [17]林周胜,黄志平,陈建庭,等.棒直径对椎弓根螺钉固定稳定性和脊柱承载影响的生物力学研究[J].实用医学杂志,2013,29(1):1-3.
• [18]Wang N,Xie H,Xi C,et al.A study to compare the efficacy of polyether ether ketone rod device with titanium devices in posterior spinal fusion in a canine model[J].J Orthop Surg Res,2017,12(1):40.
• [19]Yoshihara H,Passias PG,Errico TJ.Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws[J].J Neurosurg Spine,2013,19(5):614-623.
• [20]Wilke HJ,Wenger K,Claes L.Testing criteria for spinal implants:recommendations for the standardization of in vitro stability testing of spinal implants[J].Eur Spine J,1998,7(2):148-154.
• [21]De Vries NA,Gandhi AA,Fredericks DC,et al.Biomechanical analysis of the intact and destabilized sheep cervical spine[J].Spine,2012,37(16):957-963.
• [22]Moon S,Ingalhalikar A,Highsmith JM,et al.Biomechanical rigidity of an all-polyetheretherketone anterior thoracolumbar spinal reconstruction construct:an in vitro corpectomy model[J].Spine J,2009,9(4):330-335.
• [23]Meakin LB,Price JS,Lanyon LE.The contribution of experimental in vivo models to understanding the mechanisms of adaptation to mechanical loading in bone[J].Frontiers Endocrinol,2014,5:154.
• [24]万岷,张春才,许硕贵.持续应力对松质骨骨折愈合影响的超微结构观察[J].中华创伤骨科杂志,2011,13(8):758-761.