Objectives. To estimate macroscopically the strength, rigidity and limit of elasticity in the “spinal segments – transpedicular fixator” system. versus similar characteristics of the intact spine under dislocating rotational loads. Material and Methods. Еxperiments with anatomic specimens of Th12–L2 segments were performed. Unstable damages of L1 and transpedicular fixation with 4 screw transpedicular spinal system were imitated. All specimens were exposed to the testing rotational load in universal test machine Zwick 1464. Results. It is established that under rotational load general strength of the injured Th12–L1–L2 spinal segments fused with transpedicular fixator is 20 % lower than that in a corresponding intact spine segment. Rigidity parameters of fused segments are 17.5 % lower than those of intact segments. Destabilization of «spinal segments – transpedicular fixator» system under rotational loads is caused by the compression of a bone substance in Th12 and L2 bodies with screws and a turn of screws around longitudinal rods due to a rod slip in anchoring elements. Conclusion. The performed study may serve a basis for following data analysis from a viewpoint of metal resistance and for development of optimal rehabilitation loads to the injured spine during postoperative period.
Objective. To analyze clinical efficiency of transpedicular single-segment osteosynthesis for treatment of thoracic and lumbar spine injuries. Material and Methods. Surgical treatment of 46 patients with thoracic or lumbar spine injuries was performed. Patients were operated on within 2 days to 7.5 months after trauma. Twostage surgical treatment was applied. The first stage included transpedicular osteosynthesis at one level with internal spinal fixation system. The second stage included anterior fusion of the injured motion segments of the spine. Cases of delayed seeking for medical assistance required application of original authors' technique of intraoperative spine reposition or preliminary reposition with external transpedicular fixation device.Results. The applied treatment approach allowed achieving good (82.6 %) and satisfactory (15.2 %) Unsatisfactory result in one patient (2.2 %) was caused by osteosynthesis destabilization due to osteoporosis, and required reosteosynthesis. Conclusion. Transpedicular single-segment osteosynthesis has a high clinical efficiency and may be applied for the treatment of spinal injury with one destabilized motion segment, when preserved vertebral bone mass is sufficient for proper screw insertion. Key Words: spine, injury, transpaedicular osteosynthesis.Hir. Pozvonoc. 2010;(2):16-21.Цель исследования. Анализ клинической эффективнос-ти моносегментарного транспедикулярного остеосинтеза (ТПО) при лечении повреждений грудного и поясничного отделов позвоночника. Материал и методы. Проведено хирургическое лечение 46 пациентов с повреждениями грудного или пояснично-го отделов позвоночника. Пациенты оперированы в сроки от 2 дней до 7,5 мес. с момента травмы. Применяли двух-этапное хирургическое лечение. Первый этап -моносег-ментарный ТПО внутренней спинальной системой, второй -передний корпородез травмированных позвоночно-дви-гательных сегментов (ПДС). В случаях поздних обраще-ний за хирургической помощью применяли авторский способ интраоперационной репозиции позвоночника или предварительную репозицию внешним транспедикуляр-ным устройством. Результаты. Применяемая тактика лечения позволила по-лучить 82,6 % хороших и 15,2 % удовлетворительных ре-зультатов. Неудовлетворительный результат (2,2 %) свя-зан с дестабилизацией остеосинтеза у одной пациентки при остеопорозе и необходимостью реостеосинтеза. Заключение. Моносегментарный ТПО имеет высокую клиническую эффективность и может применяться в слу-чаях повреждений, сопровождающихся дестабилизацией одного ПДС при условии сохранения в фиксируемых поз-вонках костного массива, достаточного для корректной имплантации винтов. Ключевые слова: позвоночник, травма, транспедикуляр-ный остеосинтез.А.А. Афаунов, д-р мед. наук, проф. кафедры ортопедии, травматологии и ВПХ; А.И. Афаунов , д-р мед. наук, проф., зав. той же кафедрой; П.П. Васильченко, травматолог-ортопед, ст. лаборант той же кафедры; А.В. Кузьменко, врач-нейрохирург, зав. нейрохирургическим отделением; П.Б. Нестеренко, травматолог-ортопед того же отделения.
Study of T9—L3 spinal segment blocks using anatomic preparations has showed that in instable injury of T12 the rigidity of T11—L1 segments under conditions of transpedicular osteosynthesis with four screws spinal system is on average 25% and 14.7% lower than the normal rigidity of the intact T11—L1 segments in relation to bending kyphotic loads and lateral bending loads, respectively. The rigidity of synthesized spinal segments to lateral bending loads is 1.9 times lower than the rigidity to sagittal bending loads. With use of metalwork the rigidity indices of the synthesized spinal segments are on average 1.2 times higher as compared with the rigidity of the intact spine.
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