后路椎间融合对不同程度小关节切除腰椎稳定性的影响  

The effects of the posterior fusion on the stabilization of lumbar spine in conditions of bilateral graded facetectomy

作　　者：李春海[1] 叶伟[1] 李鉴轶[2] 黄东生[1] 刘尚礼[1] 张硕凌[1] 

机构地区：[1]中山大学附属第二医院骨科,广州510120 [2]南方医科大学广东省医学生物力学重点实验室,广州510515

出　　处：《中国临床解剖学杂志》2009年第1期93-95,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的:探讨后路椎间融合对不同程度小关节切除腰椎稳定性的影响。方法:采用6具无脊柱疾患的尸体脊柱标本(L1～S5),利用最大载荷为10Nm的力偶对其中L4～5节段的完整状态、腰椎不稳状态、双侧小关节切除1/3、1/2、全切除+Cage固定或全切除+Cage+TSRH等6种状态进行前屈、后伸,左、右侧弯和左、右轴向旋转运动试验,而后进行统计学处理。结果:对于L4～5节段,双侧小关节切除1/3、1/2或全切除后,加后路椎间融合器后前屈、左右侧弯运动范围较完整均显著降低,分别为4.50±2.43、2.61±0.82、3.21±1.41,4.70±1.47、3.43±0.75、4.13±0.81,5.98±2.67、3.89±0.70、4.53±1.33(P<0.01);另外,加用TSRH内固定组后该节段的前屈、后伸、左右侧弯及右轴向旋转运动范围分别下降至1.49±0.58,1.60±0.98,1.21±0.34,1.29±0.41,1.60±0.87,1.53±0.98(P<0.01)。结论:单纯后路椎间融合器可增加不同程度小关节切除节段的稳定性,且小关节切除越少,脊柱稳定性越好。对于小关节切除太多者,可加用椎弓根内固定增加其稳定性。Objectives： To probe the effects of the posterior fusion cage on the stabilization of lumbar spine in conditions of bilateral graded facetectomy. Methods： Six fresh adult cadaver specimens of lumbosacral segments （L1-S5） were used for biomechanical evaluation of posterior fusion cage on stabilization of lumbar spine in conditions of bilateral graded facetectomy. A three-dimensional movement device with the maximum load of 10N.M were applied to produce six kinds of pure moment of force and to create six kinds movement of the lumbar spine in flexion, extension, left and right lateral bendings as well left and right axial rotations. Measurements were done in turn on each specimen for six conditions： intact condition, unstable condition, bilateral medial 1/3 facetectomy with cages, bilateral medial 1/2 facetectomy with cages, bilateral complete facetectomy with cages and bilateral complete facetectomy with cages and TSRH. Analysis of the changes of the range of movement （ROM） in different conditions was performed. Results： Under bilateral medial 1/3, 1/2 and complete facetectomy, posterior fusion cage could always significantly decrease the ROM of L4-L5 segment in flexion （4.50±2.43, 2.61 ±0.82, 3.21 ±1.41）, left （4.70±1.4, 3.43 ±0.75, 4.13±0.81） and right （5.98± 2.67, 3.89±0.70, 4.53±1.33 ） lateral bendings （P〈0.01）. Bilateral complete facetectomy with cages and TSRH significantly increased the ROM in flexion （1.49±0.58）, extension （1.60±0.98）, left （1.21 ±0.34） and right （1.29±0.41） lateral bendings as well left （1.60±0.87） and right （1.53±0.98） axial rotations （P〈0.01）. Conclusions： Posterior fusion cage can improve the stability of lumbar spine with bilateral graded facetectomy. The stability of lumbar spine will be weakened by resection of the facet. Once the facet resects too much, the transpediclar fixation should be performed to improve the stability of lumbar spine.

关 键 词：腰椎 椎间融合器 生物力学 小关节 应力 

分 类 号：R318.01[医药卫生—生物医学工程]