下胸段经关节突入路椎间盘切除术对脊柱稳定性影响的观察  

Biomechanical comparision and clinical research of lower thoracic spinal stability after transarticularis T11/12 discectomy

作　　者：丁文元[1] 李华[1] 申勇[1] 董玉昌[1] 张为[1] 姚晓光[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,河北省石家庄市050051

出　　处：《中国脊柱脊髓杂志》2007年第10期773-776,共4页Chinese Journal of Spine and Spinal Cord

基　　金：河北省科技攻关项目资助(项目编号:0327619D-23)

摘　　要：目的:观察下胸段经关节突入路椎间盘切除术对脊柱稳定性的影响。方法:采用新鲜成人尸体下胸椎标本(T9～L1)6具,在T11～T12节段建立4种经关节突入路椎间盘切除模型:(1)单侧关节突切除+椎间盘摘除(ULF+D);(2)单侧关节突切除+全椎板减压+椎间盘摘除(ULF+L+D);(3)双侧关节突切除+全椎板减压+椎间盘摘除(BLF+L+D);(4)双侧关节突切除+全椎板减压+椎间盘摘除+单节段椎弓根钉棒固定T11～T12,于前屈,后伸,左、右侧曲和旋转6个方向进行加载,记录100N载荷下的ROM值。将4种模型ROM值分别与完整标本的ROM值按照配对t检验比较进行统计学分析。结果:与完整标本比较,ULF+D在旋转方向的ROM值有显著性差异,ULF+L+D和BLF+L+D在6个方向上的ROM值均有显著性差异(P<0.05);T11～T12椎弓钉棒系统固定后在轴向旋转和前屈方向的ROM值无显著性差异(P>0.05),在其他三个方向上存在显著性差异(P<0.01)。结论:ULF+L+D和BLF+L+D对脊柱下胸段6个方向上的稳定性均有显著性影响,辅以椎弓根钉固定相应节段,能够显著恢复脊柱稳定性。Objective：To observe the affection in stability of the lower thoracic spine undergoing trans-articularis approach operation.Method：The lower thoracic spine specimen of 6 fresh cadaver from T9 to L1 were obtained.Trans-articularis discectomy models were made following four different protocols in T11-T12 level. Separately, they are unilateral facetectomy＋discectomy （ULF＋D）, unilateral facetectomy＋laminectomy＋discectomy （ULF＋L＋D）,bilateral facetectomy＋laminectomy＋discectomy （BLF＋L＋D） and BLF＋L＋D plus T11-T12 fixation. Then all specimen were tested in six direction,separatedly,in flexion,extending,left and right rotation,left and right lateral bending.Paired t-test was used as statistics analysis method.Result：ROMs increased slightly in flexion,extension and lateral bending,while increasing significantly（P〈0.05） in axial rotation following ULF＋D and ULF＋L＋D.ROMs increased significantly（P〈0.01 ） in flexion,extension,lateral bending and axial rotation directions following ULF＋L＋D,BLF＋L＋D,respectively.Following decompression and T11-12 fixation,there were significant（P〈0.01 ） increase of stability in extension and lateral bending,and there were no significant difference in axial rotation and flexion-extention directions.Conclusion：In ULF＋L＋D and BLF＋L＋D models,the stability of lower thoracic spine in all six directions are damaged significantly which could be enhanced by proceeding of pedicle screw fixtion.

关 键 词：下胸椎 关节突关节 手术入路 稳定性 生物力学 

分 类 号：R681.5[医药卫生—骨科学]