腰椎间盘纤维环切口不同修复方法的生物力学研究  

Biomechanical evaluation of different annulus fibrosus closure techniques

作　　者：杨洋[1] 叶晓健[1] 杨成伟[1] 邓国英[1] 程自申[1] 余将明[1] 

机构地区：[1]第二军医大学附属长征医院骨科上海市凤阳路415号,200003

出　　处：《中国脊柱脊髓杂志》2014年第7期626-629,共4页Chinese Journal of Spine and Spinal Cord

基　　金：国家863计划项目(编号:2013AA032203);国家自然科学基金青年项目(编号:81301537)

摘　　要：目的:通过生物力学测试研究腰椎间盘纤维环切口不同修复方法的生物力学强度。方法:选取小牛腰椎标本制成50个脊柱功能节段,每个节段均在纤维环上作一10mm横切口。按照不同修复方法随机平均分为5组:粘合剂组(A组,选用DermaBond粘合切口)、简单缝合组(B组,采用常规U型缝合法处理切口)、MPSS组(C组,采用改良荷包缝合法处理切口)、粘合剂+简单缝合组(D组)及粘合剂+MPSS组(E组),然后进行纤维环抗静水压强度测试及疲劳测试,根据各组的泄露压力和极限转数来评价其修复效果。结果:A^E组的泄露压力分别为(0.76±0.11)MPa、(1.66±0.11)MPa、(1.84±0.15)MPa、(1.88±0.13)MPa、(2.16±0.24)MPa。E组泄露压力明显高于其他组,差异有显著性(P<0.05)。在疲劳测试中,从A^E组各组最后的极限转数分别为(4.42±0.59)万次、(8.06±0.75)万次、(8.44±1.01)万次、(9.76±0.23)万次、(9.88±0.21)万次。E组与D组比较差异无显著性(P>0.05),与其他各组比较差异均有统计学意义(P<0.05)。结论:应用粘合剂+改良荷包缝合法处理纤维环切口,具有较高的生物力学强度。Objectives： To evaluate the efficacy of different techniques of repairing annulus fibrosus through biomechanical testing method. Methods： 50 lumbar spinal segments were obtained from calves, and one 10mm incision was made in each segment. Segments were randomly assigned into 5 groups according to their respective anulus closure methods： cyanoacrylate glue（group A, DermaBond）, simple suture（group B, “U” suture）, MPSS suture （group C, modified pursestring suture）, cyanoacrylate glue＋simple suture （group D） and cyanoacrylate glue＋MPSS suture （group E）. Quantitative discomanometry and cyclic fatigue loading were then applied to compare their leakage pressure and loading cycles, as well as the parameter of disk integrity. Results： The leakage pressure in group A-E was 0.76 ±0.11MPa, 1.66 ±0.11MPa, 1.84 ±0.15MPa, 1.88 ±0.13MPa and 2.16±0.24MPa respectively, group E was significantly higher than the other groups（P〈0.05）. The number loading cycles in group A-E was 4.42±0.59, 8.06±0.75, 8.44±1.01, 9.76±0.23 and 9.88±0.21 ten thousand times respectively, except for group D, the difference between group E and the other groups was significant （P〈0.05）. Conclusions： Closing the anulus incision with suture or fibrin glue alone may not be appropriate, the best method is cyanoacrylate glue with MPSS suture.

关 键 词：纤维环 缝合 压力 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]