新型人工髓核置换对邻近上节段三维运动与椎间盘内压影响的实验研究  

Effect of new nucleus pulposus replacement on the flexibility motion and intradiscal pressure at the adjacent level

作　　者：姚女兆[1] 王文军[1] 金大地[2] 

机构地区：[1]南华大学附属第一医院脊柱外科,衡阳421001 [2]南方医科大学第三附属医院骨科,广州510630

出　　处：《医用生物力学》2011年第1期81-86,共6页Journal of Medical Biomechanics

摘　　要：目的评价果胶/聚乙烯醇复合水凝胶人工髓核植入对腰椎稳定性的影响;并通过与腰椎前路融合比较,探讨其对邻近节段运动范围和椎间盘内压的影响。方法采用6具新鲜人体腰椎标本(L3～L5)在机器人脊柱测试机上进行生物力学测试。观察正常椎间盘、CoPP人工髓核置换和腰椎前路cage植入3种状态下L4/5和L3/4的运动范围以及L3/4椎间盘内压的变化情况。结果在L4/5手术节段,CoPP组与完整椎间盘组的角位移除左侧屈运动方向差异有显著性外(P<0.05),其他方向两者之间差异均无显著性(P>0.05)。而cage组与完整椎间盘组或CoPP组之间,在所有的运动方向均有显著性差异(P<0.05)。而在相邻上节段L3/4,CoPP组与完整椎间盘组的运动范围除左侧屈运动方向差异有显著性外(P<0.05),其他方向两者之间差异均无显著性(P>0.05)。而cage组与完整椎间盘组或CoPP组之间,在所有的运动方向,L3/4运动范围的差异均有显著性(P<0.05)。CoPP组与完整椎间盘组的椎间盘内压在所有的运动方向两者之间的差异无显著性(P>0.05),而cage组与完整椎间盘组或CoPP组的椎间盘内压在前屈后伸及左右侧屈运动方向两者之间差异有显著性(P<0.05),而在轴向旋转方向,两者之间差异无显著性(P>0.05)。结论 CoPP人工髓核植入能保留手术节段的运动功能,稳定脊柱;相对腰椎融合手术,CoPP对相邻节段运动范围和椎间盘内压无明显影响,从而可降低或避免相邻节段退变的发生率。Objective To evaluate the biomechanical stability of pectin/polyvinyl alcohol composite（CoPP）hydro-gel and to assess the range of motion（ROM） and intradiscal pressure（IDP） changes at the above adjacent seg-ment after the anterior implantation of CoPP hydrogel and cage.Method Six fresh cadaveric lumbar spine spec-imens（L3 ～ L5）were biomechanically tested on the robotic testing machine.ROM at L3 /4 and L4 /5 and intradis-cal pressure at L3/4 were measured.All measurements were made with initially intact and followed by both CoPPand cage implantations.Results At the implanted level（L4/5）,the CoPP spine showed no significant changein the other five motion directions except left lateral bending motion compared with the intact spine（P〉0.05）,whereas the cage spine decreased significantly in all motion directions when compared with the intact spine orCoPP spine（P〈0.05）.At the above adjacent level of L3/4,the CoPP revealed a minor change in all motion di-rections except left lateral bending motion compared with the intact spine（P〉0.05）,whereas the ROM of cagespine significantly increased in all motion directions compared with the intact spine（P0.05）.The IDP of theCoPP spine did not increase under any condition compared with the intact spine（P〉0.05）.While the IDP ofcage spine significantly increased in flexion/extension and left/right lateral bending compared with the intact spineor CoPP spine（P〈0.05）.There was no significant increase in axial rotation compared with the intact spine orCoPP spine（P〉0.05）.Conclusions The implantation of CoPP prosthetic nucleus can preserve the motionfunction at the operated level and maintain the lumbar stability.Compared with the lumbar fusion,the nucleus re-placement has no significant effect on the ROM and IDP at adjacent level,which may decrease or avoid the adja-cent segment degeneration.

关 键 词：果胶/聚乙烯醇复合水凝胶 人工髓核 生物材料 生物力学 椎间盘内压 

分 类 号：R318.01[医药卫生—生物医学工程]