臺灣博碩士論文加值系統

現今臨床上有許多治療脊椎之固定方式，以椎弓螺釘固定系統為最常使用。椎弓螺釘植入椎體後，可能因反覆承受負載力量等因素產生螺釘鬆動情形，導致需進行二次手術來增強脊椎穩定性。二次手術可分為直接植入椎弓螺釘與骨水泥加固兩種，然而目前固定方式於螺釘穩定效果之差異尚未明確，故本研究透過體外力學測試探討無/有骨水泥加固後椎弓螺釘之穩定效果並將椎體切片觀察螺釘與椎體間破壞情形。
本研究模擬脊椎二次手術固定方式，採用豬脊椎之胸椎第10節到第14節作為測試樣品與Stryker Xia系列之Ø 4.5 mm 單軸向椎弓螺釘進行樣品製備，參考法規ASTM F1717之架設方式進行力學測試，以50萬次循環負載次數模擬術後三個月脊椎受力情形，最後用顯微鏡觀察椎體內部與椎弓螺釘間界面破壞情形。
研究結果顯示無骨水泥組於70%(39.37 – 393.79 N)負載條件下通過500,000次；有骨水泥組於85%(47.81 – 478.18 N)負載條件下通過500,000次，在切片方面，無/有骨水泥加固組別皆於55%(30.94 - 309.41 N)負載條件下，椎體內部與椎弓螺釘間界面無產生空隙。由此可得知，有骨水泥組比無骨水泥組能承受較大的負載力量到達50萬次；而在切片方面兩組於55%負載條件下皆無破壞，兩者並無差異性。

There are many kinds of methods to treat spinal disease in clinical case. One of the methods is using pedicle screw system, becoming a common spinal surgery. The pedicle screw which is inserted into the vertebrae may be repeat sustain cyclic loading until loosening. It lead to the necessity of the secondary spinal surgery in clinical. There are two ways to enhance the stability of spinal, one is inserting pedicle screw, the other is injecting PMMA bone cement prior to screw insertion. However, the effects of pedicle screw fixation in two kinds of the secondary spinal surgery are not clear. Therefore, the aim of this study is to investigate the pedicle screw stabilization to compare with or without PMMA bone cement augmentation, via in-vitro biomechanical experiment and observe characteristics of pedicle screw at the bone-screw interface failure.
The specimen is simulated with the fixation method of secondary spinal surgery by porcine thoracic spine ranging from T10 to T14. Stryker Xia series of mono-axial pedicle screw with an outer diameter of 4.5 mm were used for testing. The experiment setting is based on ASTM F1717 standard fatigue test and the loading cycle is half million which is represented to the loading condition in postoperative 3 months. Finally, via microscope to examine the characteristics of pedicle screw at the bone-screw interface failure.
According to the results of this study, the group without bone cement passed fatigue loading at 70%, but the group with bone cement passed at 85%. However, in sliced part, failure has not happened in 55% fatigue loading in both groups. Both of groups were no significant difference.

致謝 I
中文摘要 III
Abstract IV
目錄 V
圖目錄 VIII
表目錄 XI
第一章、研究背景 1
1.1 緒論 1
1.1.1 脊椎解剖構造 1
1.1.2 脊椎常見疾病 4
1.1.3 手術治療方式 9
1.1.4 椎弓螺釘系統介紹 11
1.1.5 手術治療流程 13
1.1.6 椎弓螺釘系統螺釘鬆動 17
1.1.7 脊椎二次手術方式 18
1.2 研究動機 20
1.3 文獻回顧 21
1.3.1 二次手術 21
1.3.2 椎弓螺釘法規與測試方法查詢 22
1.3.3 椎弓螺釘力學測試 24
1.3.4 文獻總結 25
1.4 研究目的 26
第二章、材料與方法 27
2.1 研究流程概述 27
2.2 實驗樣品製備 29
2.2.1 實驗樣品處理 29
2.2.2 骨質密度分析 30
2.2.3 椎體分段處理 36
2.2.4 醫學影像拍攝 37
2.2.5 椎體尺寸量測 39
2.3 實驗樣品篩選 41
2.4 實驗樣品分組 41
2.5 生物力學測試 44
2.5.1 測試前包埋固定 44
2.5.2 靜態負載測試 45
2.5.3 動態疲勞測試 46
2.5.4 測試後包埋切片 47
2.6 試件探討 48
第三章、研究結果 49
3.1 椎體特徵尺寸 49
3.2 靜態負載測試結果 50
3.3 動態疲勞測試結果 52
3.4 測試樣品切片結果 56
第四章、研究討論 62
4.1 骨質密度探討 62
4.2 醫學影像量測探討 63
4.3 動態疲勞測試探討 65
4.4 動態疲勞後切片探討 67
4.5 研究限制 69
第五章、結論 70
參考文獻 71

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