上胸椎前路逆向椎弓根钉板系统的设计及其相关力学与动物实验研究

The conduction force are mainly distributed in the anterior- and middle- column of the upper thoracic spine. some diseases causing the damaged of the anterior- and middle- column thoracic spine but the structural of the posterior column is integrity, for this situations ,the principles of surgical treatment are: anterior lesion clearance, vertebral canal decompression, restore spinal sequence and stability. At present the upper thoracic spinal internal fixation devices is rare. For that our department design an anterior upper thoracic single cortical plate titanium internal fixation system. It is superior than using anterior cervical screw-plate titanium internal fixation system on upper thoracic spinal internal fixation by biomechanical analysis. When the destruction of the vertebral body is obvious, however, the simple application of the single cortical screw-plate titanium internal fixation strength may can't meet the needs of internal fixation, For this situations, a more posterior internal fixation operation was recommend to increase the stability of the spine, and this will increase the surgical risk and burden of patients. Our team expect that by through reverse anterior pedicle screw for increases the stability of the anterior internal fixation, and may could avoid a more posterior internal fixation surgery. In our preliminary work it was confirmed that the technology of reverse pedicle screw is feasible in upper thoracic spine, but it is lack of special internal fixation devices. This study intends to design a suitable anterior upper thoracic spine reverse pedicle screw- plate internal fixation system, then evaluate it by mechanical mechanic, biomechanics and animal experiments for further improving the system and provide theoretical basis for clinical application.

上胸椎传导力主要分布在中、前柱，某些疾患引起上胸椎中前柱破坏而后柱结构完整时，手术治疗原则为前路病灶清除、椎管减压、恢复脊柱序列及稳定性。目前专用于上胸椎的内固定器械较少，本科室曾设计出上胸椎单皮质螺钉-钛板内固定系统，并通过生物力学分析其比使用颈椎前路钛板更优越。然而，当椎体骨质破坏明显时，单纯应用单皮质螺钉-钛板系统的固定强度已不能满足内固定的需要，此时，往往需要增加后路内固定手术以保证脊柱的稳定性，而这将增加患者的手术风险和费用负担。本课题组期望通过前路逆向椎弓根置钉方式以增加前路内固定的稳定性，而避免增加后路手术。我们通过前期工作证实逆向椎弓根置钉这一技术具有可行性，但尚缺乏专用的内固定器械。本研究拟设计出合适的上胸椎前路逆向椎弓根钉板系统，并通过机械力学、生物力学及动物实验对其进行分析，为后期改进器械及临床应用提供理论依据。

上胸椎传导力主要分布在中、前柱，某些疾患引起上胸椎中前柱破坏而后柱结构完整时，手术治疗原则为前路病灶清除、椎管减压、恢复脊柱序列及稳定性。当椎体骨质破坏明显时，单纯应用单皮质螺钉-钛板系统的固定强度不能满足内固定的需要，此时，往往需要增加后路内固定手术以保证脊柱的稳定性，而这将增加患者的手术风险和费用负担。本课题组提出通过前路逆向椎弓根置钉方式以增加前路内固定的稳定性，而避免增加后路手术，并在前期工作证实逆向椎弓根置钉这一技术具有可行性。在本课题中，我们通过放射解剖学，系统测量了上胸椎（T1-T4）解剖参数。根据所得参数设计出上胸椎逆向椎弓根钉板系统，然后通过有限元仿真测试其性能并进一步优化内固定系统。通过体外尸体标本对其进行生物力学分析，结果证实本内固定系统相对于单皮质椎体螺钉系统具有更好的生物力学稳定性，这为临床应用本内固定系统提供了理论基础。