L4、L5经椎间孔椎体间融合混合内固定的生物力学稳定性研究  

Biomechanical evaluation of hybrid internal fixation for transforaminal lumbar interbody fusion at level 4 -5

作　　者：范煜昕 陈宏亮[2] 井贵龙 吕游[1] 郭开今[2] 袁峰[2] 

机构地区：[1]徐州医学院研究生学院,江苏徐州221002 [2]徐州医学院附属医院骨科,江苏徐州221006

出　　处：《徐州医学院学报》2015年第1期42-44,共3页Acta Academiae Medicinae Xuzhou

摘　　要：目的比较腰椎完整标本和3种L4、L5节段的经椎间孔椎体间融合（TLIF）内固定的生物力学稳定性。方法用成人新鲜腰椎标本（L2～S1）6具，分别于完整状态、左侧TLIF同侧椎弓根螺钉（PS）固定、左侧TLIF同侧Ps＋对侧经椎板关节突螺钉（TLFS）固定、左侧TLIF双侧PS固定下，测定前屈／后伸、左／右侧弯及左／右轴向旋转6种运动状态下运动范围（ROM）并进行比较。结果各固定方式的ROM值均小于完整状态（P〈0．05）。双侧PS固定在各状态下ROM值最低，与同侧PS固定相比差异有统计学意义（P〈0．05）；与同侧PS＋对侧TLFS固定相比，前屈、后伸及左／右侧弯状态下2种固定方式差异无统计学意义（P〉0．05），左／右旋转状态下2种方式差异有统计学意义（P〈0．05）。结论TLIF同侧PS＋对侧TLFS固定的稳定性与TLIF双侧Ps固定相似，该种腰椎融合混合内固定方式可作为微创手术治疗的优先备选方案。Objective To compare the biomechanical stability of lumbar spine specimens after three internal fixations for transforaminal lumbar interbody fusion （TLIF） at L4-5. Methods Six fresh human cadaveric lumbar spine specimens at L2 to SI were collected to undergo range of motion （ROM） testing in flexion/extension, lateral bending, and axial rotation after left TLIF with homolateral pedicle screw （PS） insertion, left TLIF with homolateral PS and eontralateral translaminar facet screw （TLFS） insertions, and left TLIF with bilateral PS insertion. Results The values of ROM after each fixation were remarkably smaller in comparison with corresponding preoperative levels （ P 〈 0.05 ）. Bilateral PS insertion could result in the smallest values of ROM which were significantly different from those after homolateral treatment （P 〈 0.05 ）. Statistical differences were seen between bilateral PS insertion and homolateral PS plus contralateral TLFS in axial rotation rather than flexion/extension, lateral bending （ P 〈 0.05 ）. Conclusion TLIF with homolateral PS and contralateral TLFS insertion provides stability comparable to that of TLIF with bilateral PS insertion, which can be used as an alternative scheme in minimal invasive surgery.

关 键 词：腰椎 椎体间融合术 经椎板关节突螺钉 生物力学 

分 类 号：R687.32[医药卫生—骨科学]