腰椎双节段不同固定方式稳定性的生物力学研究  

Biomechanical stability of different bisegment fixation methods for lumbar spine

作　　者：曾忠友[1] 吴鹏[1] 陈国军[1] 严卫锋[1] 张建乔[1] 裴斐[1] 唐宏超[1] 宋永兴[1] 韩建福[1] 

机构地区：[1]武警部队骨科医学中心,武警浙江省总队医院骨二科,嘉兴314000

出　　处：《中华创伤杂志》2014年第2期170-176,共7页Chinese Journal of Trauma

基　　金：浙江省卫生厅科研资助项目（2010KYB112）

摘　　要：目的 对比腰椎双节段不同固定方式的力学稳定性. 方法 取6具正常成人甲醛固定腰椎标本（L2 ～S1）,递进式采用不同固定方式行L3/4、L4/5固定并分为5组：A组（正常标本组）、B组（单侧椎板关节突螺钉固定＋椎间融合器置入组）、C组（单侧椎弓根螺钉固定＋椎间融合器置入组）、D组（单侧椎弓根螺钉联合对侧椎板关节突螺钉固定＋椎间融合器置入组）和E组（双侧椎弓根螺钉固定＋椎间融合器置入组）.加载下分别测量、计算并对比每组固定节段的各向活动度、稳定指数、轴向位移和轴向刚度. 结果 相对正常标本组,4种固定方式均减少了固定节段L3/4和L4/5各向活动度,提高了脊柱的稳定性和刚度,但不同的固定方式间,其各向活动度和轴向位移的减少、稳定指数的提高和轴向刚度的增加不同,其中,B组与C组、D组与E组比较差异无统计学意义（P＞0.05）,而D组分别与B组和C组、E组分别与B组和C组比较,差异有统计学意义（P＜0.01）. 结论 单侧椎弓根螺钉联合对侧椎板关节突螺钉固定＋椎间融合器置入可作为腰椎双节段固定融合的较好选择.Objective To compare the biomechanical stability of different bisegment fixation methods for the lumbar spine. Methods Six adult cadaveric lumbar spines （ L2-S1 ） were selected and fixed progressively with different fixation methods at L3/a-L4/5. The specimens were divided into five groups, Group A （normal specimen group） , Group B （unilateral translaminar fac.et screw fixation ＋ in- terbody cage fusion）, Group C （unilateral pediele screw fixation ＋ interbody cage fusion）, Group D （u- nilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation ＋ interbody cage fusion） and Group E （ bilateral pedicle screw fixation ＋ interbody cage fusion）. After loading on the fixed segments in each group, range of motion （ ROM）, stability index, axial displacement as well as stiffness were measured and compared. Results Compared with normal specimen group, the four fixa- tion modes reduced the ROM of L3/4-L4/5 in different directions and increased the stability and stiffness of the spine. Whereas, the reduced range of motion in different directions as well as axial displacement, in- creased stability index and enhanced stiffness varied among the groups. But in pair comparison, the difference was insignificant between Groups B and C and between Groups D and E （P 〉 0.05 ）. A signifi- cant difference was found in between Groups D and B, between Groups D and C, between Groups E and B and between Groups E and C （P 〈 0.05 ）. Conclusion Unilateral translaminar facet screw fixation combined with contralateral pedicle screw fixation ＋ interbody cage fusion can be a favorable choice for bisegmental fixation and fusion of lumbar spine.

关 键 词：脊柱损伤 骨折固定术 内 生物力学 

分 类 号：R687.3[医药卫生—骨科学]