臺灣博碩士論文加值系統

椎體壓迫性骨折是一種常見的脊椎骨折病例，這些病例常發現於患有骨質疏鬆及骨質鬆軟的病患上，尤其常見於中年人及停經後的婦女。椎體成形術是利用骨水泥注入壓迫受損的椎體以填補骨折之空間並增強椎體的結構強度。然而在臨床上發現，當骨水泥注入受損椎體時，骨水泥可能會流出椎體外而產生滲漏的現象，而滲漏出來的骨水泥會穿透脊椎終板流至受損椎體與下方鄰近節椎體間的椎間盤部分，導致原本脊椎的力學行為改變，可能產生應力集中及應力不匹配的情況，導致鄰近節椎體產生再崩塌的現象。首先本研究將以6支豬脊椎腰椎以準靜態壓力試驗壓迫脊椎試體，再以臨床上所使用之聚甲基丙烯酸甲脂進行，並分別以正常椎體、椎體成形術之椎體及椎體成形術後骨水泥滲漏之椎間盤椎體之實驗條件觀察於鄰近椎節之生物力學特性。由結果顯示於鄰近椎節之緻密骨於不同條件的應變量並無明顯趨勢。由於豬脊椎疏鬆骨與骨水泥在生物力學特性上有明顯差異，推測當試體遭受壓力傳遞時，力量可能將由骨水泥承擔，故於鄰近椎節之緻密骨的應變值無明顯上的變化。

Vertebral compression fracture is a common vertebra complication, which are usually happened on the patients with osteoporosis and osteopenia, especially in the population of aged patients and menopause woman. Percutaneous vertebroplasty was used in order to restore the functional ability to support weight by injecting bone cement into the fracture site of the vertebral body. Clinically it is risky that if the cement leaked to the adjacent intervertebral disc. The pattern of the force transformation could be altered due to the stiffness variation of entire spine. The objective of this study was to evaluate the biomechanical behavior of the cement leakage after vertebroplasty. This study used six porcine lumbar spines to excute quasi-static compression test, and followed with PMMA augmentation. The specimens were randomly divided into intact, vertebroplasty, and cement leakage after vertebroplasty groups to investigate the adjacent vertebral biomechanical behavior. Results indicated that the cortical bone of adjacent vertebral has no significant different from the differences treatment conditions. When vertebral body under the compression loading after vertebroplasty, the force transfer to the augmentation bone cement cause no significant difference to the adjacent cortical bone.

謝誌I
中文摘要II
英文摘要III
目錄V
圖目錄VII
表目錄IX
第一章 緒論1
1-1 研究背景1
1-1-1 脊椎解剖構造簡介1
1-1-2 椎間盤之生物力學特性6
1-1-3 脊椎韌帶8
1-1-4 小面關節之生物力學特性10
1-1-5 功能性脊椎單元11
1-2 脊椎常見疾病與治療方式12
1-2-1 下背痛12
1-2-2 骨質疏鬆症14
1-2-3 脊椎骨折17
1-2-4 椎體壓迫性骨折治療方式22
1-3 文獻回顧25
1-3-1 椎體壓迫性骨折25
1-4 研究目的29
第二章 材料與方法30
2-1 實驗試件與儀器準備30
2-2 實驗流程37
2-3 椎體之疏鬆骨試件42
2-4 PMMA試件製備44
第三章 結果46
3-1 L2椎體幾何外型47
3-2 豬隻腰椎勁度之比較48
3-3 豬隻腰椎鄰近椎節之緻密骨表面應變52
3-4 豬隻椎體疏鬆骨力學測試54
3-5 PMMA力學測試56
第四章 討論58
4-1 豬脊椎與人類脊椎探討58
4.2 脊椎試體再現性61
4.3 臨床與實驗條件差異63
4-4 豬脊椎勁度於不同試體條件65
4-5 L3鄰近椎節之緻密骨應變66
4-6 豬脊椎疏鬆骨與PMMA之生物力學特性67
第五章 結論69
參考文獻70
附錄76
自述92
表目錄
表1-1 骨質密度水平對於骨質疏鬆症的分級方式16
表2-1 PMMA單體及共聚物成分32
表3-1 L2椎體幾何外型量測數值47
表3-2 各椎節於不同條件下之勁度51
表3-3 各量測位置及各實驗條件之L3應變值(均為壓應變)52
表3-4 疏鬆骨各試件之力學特性54
表3-5 PMMA各試件之力學特性56
表4-1 本研究與Belkoff et al.勁度比較65
表4-2 本研究豬脊椎疏鬆骨比較於其他研究之力學特性67
圖目錄
圖1-1 脊椎解剖結構(a)前視；(b)後視；(c)側視2
圖1-2 各椎節外型構造3
圖1-3 脊椎功能性區分4
圖1-4 椎間盤構造(a)縱切面；(b)立體視角7
圖1-5 纖維環中纖維排列角度，θ角約65° 7
圖1-6 脊椎韌帶之構造9
圖1-7 功能性脊椎單元11
圖1-8 依據Magerl/AO分類Type A之骨折種類18
圖1-9 楔形壓迫性骨折19
圖1-10 Eastell et al.椎體塌陷程度分類20
圖1-11 Genant et al.椎體塌陷程度分類21
圖1-12 經皮椎體成形術過程(a)第二節為塌陷之椎體；(b)套針管由椎弓根處進入；(c)套針管進入至椎體前緣1/3處；(d)將PMMA注入至椎體內23
圖1-13 經皮球囊椎體成形術過程(a)球囊由椎弓根處進入椎體；(b)球囊撐開塌陷椎體；(c)將塌陷椎體復位並取出球囊；(d)將PMMA注入至椎體內之空腔24
圖1-14 骨水泥滲漏之情形27
圖1-15 骨水泥滲漏至硬皮內膜及硬皮外膜27
圖2-1 應變規黏貼示意圖31
圖2-2 Osteobond 32
圖2-3 材料試驗機33
圖2-4 本實驗中使用之應變規34
圖2-5 惠斯頓電橋35
圖2-6 資料擷取器35
圖2-7 精密切割機36
圖2-8 豬脊椎單一椎節幾何外型位置定義39
圖2-9 楔型缺口切除示意圖39
圖2-10 骨水泥補塊39
圖2-11 椎間盤缺口40
圖2-12 骨水泥注射入椎間盤處41
圖2-13 疏鬆骨塊之試件尺寸42
圖2-14 疏鬆骨塊試件切取之示意位置43
圖2-15 PMMA試件製備44
圖3-1 單一脊椎於Intact條件之力量位移關係48
圖3-2 單一脊椎於VP條件之力量位移關係49
圖3-3 單一脊椎於VPL條件之力量位移關係49
圖3-4 勁度定義範圍；δ為位移量，F為力量50
圖3-5 L3鄰近椎節於1500牛頓下不同應變量測位置之應變值53
圖3-6 L3鄰近椎節於1500牛頓下不同試體條件之應變值53
圖3-7 疏鬆骨質試件勁度比較55
圖3-8 PMMA試件勁度比較57
圖4-1 豬脊椎L2椎節外型(a)上視圖；(b)立體視圖60
圖4-2 脊椎試體再現性62
圖4-3 各實驗條件壓迫次數之勁度比較62

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