腰椎间融合单、双侧内固定术的生物力学分析  

Biomechanics Analysis of Lumbar Interbody Fusion with Unilateral Versus Bilateral Transpedicle Screws

作　　者：吴占勇 吴华荣 赵桂群 韩长岭[2] 

机构地区：[1]邢台矿业集团总医院脊柱外科,河北邢台054000 [2]河北医科大学第三医院,河北石家庄050051

出　　处：《实用骨科杂志》2011年第10期905-909,共5页Journal of Practical Orthopaedics

摘　　要：目的通过4种力学模型,比较不同状态下腰椎的稳定性,探讨单侧椎弓根内固定椎间自体骨融合术的稳定性。方法选用20具猪的脊柱标本,标本依序进行不同处理并分组:a)正常组(A组);b)左侧L4下关节突切除加椎间盘摘除组(B组);c)腰椎左侧椎间植骨融合附加同侧椎弓根螺钉固定组(C组);d)腰椎左侧椎间植骨融合双侧椎弓根螺钉固定组(D组)。将标本固定于特制的夹具上,用生物力学测试仪进行轴向压缩、前屈、后伸和左右侧屈,获得载荷-位移曲线,对所得数据进行分析。结果轴向压缩测试D组强度最高,C组强度次之,均高于A组。B组强度最小,A、C、D组之间没有统计学意义,A、C、D组与B组均有统计学意义(P<0.01)。前屈测试D组获得最高强度,C组与A组没有差别,明显小于D组,B组强度最小。A组与C组没有统计学意义,A、C组与D组、B组均有统计学意义。后伸测试与前屈测试相似,D组获得最高强度,C组低于D组。他们强度都高于A组,B组明显低于其他组。A组与C组没有统计学意义,A、C组与D组、B组有统计学意义。左侧屈测试D组和C组是两个强度最高组,明显高于完整A组,B组是强度最低。D组与C组没有统计学意义,D、C组与B组、A组有统计学意义。右侧屈测试D组强度最高,C组强度次之,高于完整A组,B组强度最低。D组与C组没有统计学意义,D、C组与B组、D组与A组、C组与A组均有统计学意义。结论单侧椎弓根内固定椎间自体骨融合术生物力学测试,其强度高于或等同于完整组,符合人体生物力学要求,在治疗腰椎间盘突出症伴腰椎不稳时,可以成为取代双侧椎弓根内固定椎间自体骨融合术的一种新术式,对临床工作有一定指导意义。Objective Through four different mechanical models to compare the stability of the lumbar spine under different conditions to explore the unilateral pedicle screw fixation and interbody fusion with autologous bone stability.Methods 20 pig spine specimens,specimen processing and sequentially for different groups：a） normal group（A）;b） under the left L4 facet resection and discectomy group（B）;c） additional left lumbar interbody fusion unilateral pedicle screw fixation group（C）;d） the left lumbar interbody fusion with bilateral pedicle screw fixation group（D）.Specimens were fixed in a special fixture,and with the biomechanical testing device for axial compression,flexion,extension and lateral bending left and right,get the load-displacement curve for the data analysis.Results Axial compression test results;D intensity of the highest group,C group,followed by strength,higher than the A group.minimum strength of group B,A,C,D groups was not statistically significant,A,C,D group and B group was statistically significant（P0.01）.Flexion test;D group of the highest intensity,C is almost the same in group A,significantly less than the D group,B group strength minimum.A group and C group was not statistically significant,A,C group and D group（P0.01）,B group（P0.05） was statistically significant.Extension test;and flexion tests similar,D to obtain the highest intensity group,C group was lower than D.Their intensity is than in group A,B group was significantly lower than other groups.A group and C group was not statistically significant,A,C group and D group（P0.01）,B group（P0.05） was statistically significant.Left bend test;D and C are the two highest intensity group was significantly higher than the full group A,B group is the strength of the lowest group.Group D and Group C was not statistically significant,D,C group and B group（P0.01）,A group（P0.05） was statistically significant.Right side of the bend test;D intensity of the highest group,C group,followed by strength,high

关 键 词：单侧椎弓根固定 椎间盘突出症 腰椎不稳 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]