腰椎管成形术的生物力学研究  

Biomechanic evaluation of lumbar laminoplasty in Vitro

作　　者：陈良[1,2] 陈其昕[1] 庞清江 张前法 张美超[3] 赵卫东[3] 

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009 [2]宁波第二医院骨科,宁波315010 [3]南方医科大学生物力学实验室,广州510515

出　　处：《中国临床解剖学杂志》2009年第6期716-719,共4页Chinese Journal of Clinical Anatomy

基　　金：宁波市科技局农业与社会发展科研攻关项目(2005C100115);宁波市医学科技计划项目(200522)

摘　　要：目的:研究单个椎板腰椎椎管成形术对腰椎三维运动稳定性的影响。方法:选用6具成人新鲜尸体腰椎(L1～5)标本(南方医科大学解剖教研室提供),采用不同的椎管成形椎板回植技术分为6组:即A正常对照组,B椎板回植后微型钛板固定组,C椎板回植后交叉克氏针固定组,D椎板回植后双股丝线固定组,E不保留后部韧带的椎板回植微型钛板固定组,F不保留后部韧带的椎管减压组,形成6种状态,通过脊柱三维运动试验机施加10Nm的载荷,使脊柱产生前屈/后伸,左/右侧屈和左/右轴向旋转运动,测量L3/4节段脊柱的相对运动范围。结果:六种状态下脊柱的屈伸活动分别为(7.03±2.24)°,(7.16±2.95)°,(7.4±2.47)°,(8.55±3.31)°,(11.1±2.81)°,(10.82±2.82)°,左右侧屈活动范围分别为(8.8±2.68)°,(8.81±2.42)°,(8.76±1.81)°,(9.55±3.15)°,(9.12±1.97)°,(9.49±2.78)°,左右旋转活动范围(3.96±2.03)°,(5.04±2.82)°,(4.99±2.60)°,(5.56±2.47)°,(6.03±2.62)°,(6.03±2.73)°保留后部韧带结构椎管成形不保留后部韧带及椎管减压组组相比能够显著增加脊柱稳定性,尤其在屈伸活动状态下(P<0.05),其中丝线固定同其他两种固定方式相比对脊柱三维稳定性影响最大(P<0.05),微形钛板成形及克氏针固定组对脊柱稳定性影响最小。结论:椎管成形后固定效果较为可靠的是微型钛板及克氏针固定,单纯骨性椎管成形不保留后部韧带和椎板切除椎管减压均显著降底脊柱初期稳定性,椎管成形术需可靠修复后部韧带复合体。Objective： To investigate reliability and immediate stability of single lumbar laminoplasty. Methods： 6 lumbar specimens from L4-5 were used in this study. 6 different models were made： A,control （intact）;B, laminoplasty fixation with titanium miniplate; C, laminoplasty fixation with cross Kirschner wire; D, laminoplasty fixation with double 1-0 suture silk;E, laminoplasty fixation with titanium miniplate, without the posterior ligament complex, and F, posterior vertebral canal decompression, without the posterior ligament complex, the specimens were placed on the 3-D spine motion test machine loaded with 10N to get the range of motion （ROM）of 6 freedom degrees（flexion and extension, left and right bending, left and right axial rotation） of L3-4 segments. Results： ROM of six models were 7.03±2.24,7.16 ±2.95,7.4 ±2.47,8.55±3.31,11.1 ± 2.81,10.82±2.82 for bending and extension, 8.8±2.68,8.81 ±2.42,8.76±1.81,9.55±3.15,9.12±1.97,9.49±2.78 for left and right bending, and 3.96±2.03, 5.04±2.82,4.99±2.6,5.56±2.47,6.03±2.62,6.03 ±2.73 for left and right rotation respectively. Laminoplasty without the posterior ligament complex and posterior decompression increased spine ROM compared with that of other three laminoplasty keeping the posterior ligament, especially for bending and extension status （P〈0.05）. Suture silk fixation increased the ROM of spine compared with that of control and other two fixation groups （P〈0.05）. Conclusions： Tatanium miniplate and cross Kirschner wire fixation during laminoplasty with keeping or repairing posterior ligaments can maintain the better spine stability compare to that of laminoplasty without keeping the posterior ligaments. [ Key words ] lumbar spine; laminoplasty ; biomechanics

关 键 词：腰椎 椎管成形 生物力学 

分 类 号：R681.5[医药卫生—骨科学] R318.01[医药卫生—外科学]