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Objective: To observe through biomechanical testing and clinical application of the upper thoracic pedicle outside into the internal fixation technology evaluation to explore the feasibility of the technique, effectiveness, and provide a basis for the clinical application. Method: a biomechanical experimental study: take four frozen adult upper section thoracic specimens (T1-T9) and connected for some ribs (long 5-6cm), retention wall pleura and intercostal soft tissue, exclude thoracic trauma, retreat degeneration disease tumor and spinal deformity. Before the test samples at room temperature to thaw naturally. The screw the transpedicular outer side of the vertebral body into the road placed 6.0 × 45 mm, contralateral transpedicular approach by conventional methods placed 4.5 × 40 mm screws on the the WD2000 electronic universal testing machine, respectively. Measuring maximum axial pullout strength of screws. Through biomechanical comparison to evaluate the in thoracic pedicle outside approach on fixed feasibility. 2 clinical applications: in clinical work, select appropriate cases underwent thoracic pedicle outside into Road fixation, select a total of 29 cases of patients, 18 males and 11 females, including seven cases of scoliosis, thoracic burst fractures cases of thoracic fracture dislocation of the eight cases, thoracic tuberculosis patients, thoracic primary tumor three cases, the thoracic yellow ligament and thoracic spinal cord injury with T7 subluxation cases of thoracic pedicle fixation cases. 9 cases of spinal cord injury ASIA grade A, B grade 3 cases, 3 cases of grade C, D grade six cases, E Class 8 cases. By measuring Cobb's angle, before and after surgery Spinal observe a fixed position within the postoperative ASIA grade line of spinal cord function, to evaluate the validity of the fixed upper thoracic pedicle approach. Results: a biomechanical evaluation: measuring 68 maximum axial screw pullout force, which the the pedicle outside into the 36 Road screws, pedicle into the road screws 32. The average maximum axial pedicle outside approach screw pullout force (798.32 ± 64.34) N, the average maximum axial pedicle approach screw pullout force (800.21 ± 106.33) N, the difference was not significant . 2 Clinical Applications Rating: 29 cases of patients with pedicle outside into the internal fixation screws 176 times, all successful, neurovascular injury, followed up for 6-18 months, no loose screws, pull out, fracture, no see the obvious loss of correction. Conclusion: internal fixation in the upper thoracic pedicle approach biomechanical testing showed that the mechanical properties of the surgical screws, with the clinical feasibility. Clinical application has obvious security advantages, select entrance point into the nail direction control operation is relatively simple and reliable. The technique can be used as the upper thoracic posterior internal fixation good choice, especially narrow pedicle scoliosis and other spinal deformities when complex morphology not suitable for fixed patients demonstrated the superiority of pedicle approach and practical value.
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