儿童早发性脊柱侧凸滑槽钉生长棒系统研制及生物力学属性研究

Operation treatment of children with early-onset scoliosis is always a difficult problem in spinal surgery,there are many deficiencies in current orthopedic systems :early fusion fixation systems because of the existence of "crankshaft phenomenon" affect the growth and development of children,;non fusion orthopedic systems need repeated operations and orthopedic effect is difficult to maintain.By the basic research on the independent intellectual property rights,we study the sliding screw growing rod system with unique sliding device,and put forward the scientific hypothesis as follows: through the axial growth potential of the spine in children ,the system has excellent biomechanical properties of early correction,effective fixation and retaining spinal growth potential.We construct the animal model of early-onset scoliosis by Volkmann theory and carry out the animal experiment in early-onset scoliosis pigs in vivo according to orthopedic principle of non-fusion sliding screw growing rod system to correction and fixation.we study biomechanics property sequence, by using the biomechanical stability, elastic modulus, loading test and finite element analysis.At the same time we study correlated imaging, histopathologically and biocompatibility , combined with the discovery of the preliminary study on the clinical application and follow-up problem. we try to constantly improve the function of the orthotic device for providing the new oretical basis and treatment method for early effective treatment of severe early-onset scoliosis in children.

儿童早发性脊柱侧凸的手术治疗一直是脊柱外科的难题，现有的矫形系统存在明显不足：早期融合固定矫形系统因存在“曲轴现象”影响患儿生长发育，非融合矫形系统需多次手术切开延长且矫形效果难以维持。本课题在已有自主知识产权专利的基础上，研制带独特滑动装置的滑槽钉生长棒系统，并提出如下科学假设:“利用儿童脊柱自身轴向生长潜能，新的矫形系统具有早期矫形和有效固定，并保留脊柱生长潜能的优良生物力学属性”。拟运用volkmann理论构建早发性脊柱侧凸猪的动物模型，在模型猪的活体上按照矫形原理进行滑槽钉生长棒系统的动物实验。运用生物力学稳定性、弹性模量、跟随载荷测试及有限元分析等方法，开展生物力学属性序列研究，同时进行相关影像学、组织病理学和生物相容性研究，结合初步临床应用研究及随访中发现的问题，不断优化改进该矫形装置的功能，为早期有效治疗儿童早发性严重脊柱侧凸提供新的理论依据和治疗手段。

儿童早发性脊柱侧凸的手术治疗一直是脊柱外科的难题，现有的矫形系统存在明显不足：早期融合固定矫形系统因存在“曲轴现象”影响患儿生长发育；非融合矫形系统需多次手术切开延长且矫形效果难以维持；传统开放手术创伤大，结构破坏较多，自发融合概率高，影响患儿生长发育。基于此背景，本课题的研究工作从以下三方面开展：1）设计动物模型，进行自动导向生长棒系统对幼猪脊柱生长影响的实验研究；2）脊柱单向生长卡环的研制及其生物力学测试和初步临床应用；3）新型脊柱外固定器于传统内固定器装置对山羊脊旁肌手术损伤影响的动物实验对比及机制研究。研究发现导向滑动生长棒系统相比传统椎弓根螺钉能够显著减少对幼猪脊柱生长的阻滞；脊柱单向生长卡环能够实现单向滑动的作用，脊柱单向生长卡环在保持患者术后肩平衡中有一定的作用；微创置钉避免了术中广泛剥离导致的肌腱韧带复合体损伤，同时减少了术后由于内固定装置挤压和骚扰引发慢性炎性反应所导致的脊旁肌损伤。本课题改进了原有的脊柱矫形系统装置，可有效维持患儿的生长发育，微创下置钉可降低肌肉韧带复合体的破坏，新型脊柱矫形系统及微创下置钉可在临床上进一步推广。