腰椎经椎间孔椎体间融合不对称内固定的生物力学稳定性实验研究  

Biomechanical evaluation of asymmetrical posterior internal fixation for transforaminal lumbar interbody fusion with transfacetopedicular screws

作　　者：敖俊[1] 靳安民[1] 赵卫东[2] 张辉[1] 闵少雄[1] 于博[1] 陈伟义 

机构地区：[1]南方医科大学珠江医院骨科,广东广州510282 [2]南方医科大学解剖学教研室,广东广州510515

出　　处：《南方医科大学学报》2009年第5期959-961,965,共4页Journal of Southern Medical University

基　　金：广东省科技厅重大专项基金(2006A36001003-08)

摘　　要：目的比较腰椎完整标本和3种L3～4节段的经椎间孔椎体间融合(TLIF)内固定的生物力学稳定性。方法采用成人新鲜腰椎标本7例,分别于L3～4节段完整状态、左侧TLIF同侧椎弓根螺钉(PS)固定、左侧TLIF同侧PS+对侧经关节突椎弓根螺钉(TFPS)固定、左侧TLIF双侧PS固定下,测定10Nm扭矩时前屈/后伸、左/右侧弯及左/右轴向旋转等6种运动下运动范围(ROM)并进行比较。结果在前屈、后伸及左、右侧弯等4种运动状态下,L3～4节段标本完整组ROM明显大于其他3种融合内固定组,均有显著性差异(P<0.05)。左、右轴向旋转时,标本完整状态与TLIF同侧PS固定组角位移无显著性差异,明显大于另外2个内固定组,有显著差异(P<0.05)。前屈、左侧弯和左旋时,TLIF同侧PS固定与PS+对侧TFPS固定组角位移有显著性差异(P<0.05);6种运动状态下TLIF同侧PS固定的ROM明显大于双侧PS固定组,均有显著性差异(P<0.05)。而PS+对侧TFPS固定、双侧PS固定组间ROM均无明显差异。结论TLIF同侧PS+对侧TFPS固定的稳定性与TLIF双侧PS固定相似,该种腰椎融合不对称内固定方式可作为微创手术治疗的优先备选方案。Objective To assess the biomechanical stability of asymmetrical posterior internal fixation for transforaminal lumbar interbody fusion （TLIF） with transfacetopedicular screws （TFPS）. Methods Range of motion （ROM） testing was performed in 7 fresh-frozen human cadaveric lumbar spine motion segments in flexion/extension, lateral bending, and axial rotation using 10.0 Nm torques at the L3-4 motion segment. The sequential test configurations included intact motion segment, TLIF and ipsilateral pedicle screw （PS）, TLIF and ipsilateral PS plus contralateral TFPS according to Boucher technique, and TLIF and bilateral PS. The ROM was determined to assess the construct stability. Results In fiexion/extension, lateral bending, and axial rotation, no measureable difference was found in the ROM between the standard bilateral pedicle screw and the novel asymmetric posterior internal fixation after TLIF. After TLIF, the ipsilateral PS construct provided less segment stability than the novel asymmetric construct with TFPS in flexion, left bending and left rotation. In rotation, the novel asymmetric construct allowed for significant off-axial rotation motions detrimental to the stability and fusion. Conclusion Ipsilateral PS placement plus contralateral TFPS provides stability comparable to that of TLIF with bilateral PS, and can be an alternative in minimal invasive surgery.

关 键 词：腰椎 脊柱融合术 椎弓根螺钉 关节突固定 生物力学 

分 类 号：R687.3[医药卫生—骨科学]