单节段椎弓根螺钉固定联合上方棘突间Coflex置入的生物力学评价  

Biomechanical evaluation for single-level rigid fixation combined with Coflex implantation

作　　者：车武[1] 姜允琦[1] 马易群[1] 袁维[1] 周晓岗[1] 李熙雷[1] 董健[1] 

机构地区：[1]复旦大学附属中山医院骨科,上海市200032

出　　处：《中国脊柱脊髓杂志》2015年第1期62-66,共5页Chinese Journal of Spine and Spinal Cord

基　　金：2012年上海市科委医学重点项目(12411951300);2012年上海市卫生局局级科研项目(2012289);上海市市级医院新兴前沿技术联合攻关项目(SHDC12014102)

摘　　要：目的：对腰椎单节段椎弓根螺钉固定联合上节段使用棘突间Coflex置入手术（Topping-off手术）进行生物力学评价。方法：采用6具男性L3～S1节段的人脊柱标本,建立L4/5椎弓根螺钉坚强固定（后路腰椎体间融合术,PLIF）模型及L4/5椎弓根螺钉固定联合L3/4棘突间Coflex置入（Topping-off手术）的模型。每具标本均进行完整、坚强固定和联合固定3种状态的生物力学测试。分别比较完整标本（A组）、L4/5坚强固定（B组）、联合固定（C组）中L3/4和L5/S1节段活动度及椎间盘内压差异。结果：B组L3/4节段平均活动度较A组显著增加（P〈0.05）（分别比A组前屈增大0.54°,后伸增大0.34°,侧弯增大0.30°,旋转增大0.19°）;B组L5/S1活动度亦比A组增加,但无统计学意义（P〉0.05）。C组L3/4节段的活动度与B组相比,后伸方向显著减小（P〈0.05）（比B组减小0.32°）,而前屈、侧弯、旋转减小不明显（P〉0.05）;与A组相比,后伸及旋转无显著增大（P〉0.05）,前屈及侧屈有显著增大（P〈0.05）（分别比A组前屈增大0.38°,侧屈增大0.28°）。C组L5/S1活动度与B组相比,除前屈方向外均有增大趋势,但无统计学意义（P〉0.05）;与A组比较,均有增大,但无统计学意义（P〉0.05）。与A组相比,B组L3/4椎间盘内压显著增加（P〈0.05）（分别比A组前屈增大0.78k Pa,后伸增大0.88k Pa,侧弯增大1.84k Pa,旋转增大1.45k Pa）;L5/S1椎间盘内压也显著增加（P〈0.05）（分别比A组前屈增大1.21k Pa,后伸增大0.94k Pa,侧弯增大0.70k Pa,旋转增大0.81k Pa）。与B组相比,C组L3/4椎间盘内压减小（分别比B组前屈减小0.29k Pa,后伸减小1.39k Pa,侧弯减小0.13k Pa,旋转减小0.10k Pa）,但仅后伸减小有统计学意义（P〈0.05）;C组L5/S1椎间盘内压分别比B组前屈减小0.39k Pa,后伸减小0.10k Pa,侧弯增大0.15k Pa,旋转增加0.18k Pa,但无统计学意义（P〉0.05）。与A组相比,C组L3/4椎�Objectives： To evaluate the biomechanical effect of topping-off operation with Coflex interspinous dynamic device combined with adjacent monosegmental rigid fixation by pedical screw in lumbar spine.Methods： 6 fresh frozen human cadaveric lumbar spine specimens（6 males） were tested. Models of L4/5 rigid fixation by pedical screw（posterior lumbar interbody fusion, PLIF） and models of L4/5 rigid fixation by pedical screw combined with L3/4 Coflex were established. On each specimen, range of segmental motion（ROM） and intradiscal pressure（IDP） of L3/4 and L5/S1 were tested in the condition of intact（group A）, rigid fixation（L4/5）（group B） and combined with Coflex（L3/4）（group C）, respectively. Results： The L3/4 ROM of group B was higher than that of group A significantly（P〈0.05）. The L3/4 ROM of group B in flexion, extension, lateral bending and axial rotation increased by 0.54°, 0.34°, 0.30° and 0.19°, respectively. The L5/S1 ROM of group B increased with no statistical significance（P〉0.05）, compared with group A. The L3/4 ROM of group C was lower than that of group B（P〈0.05） only in the extension, while the decreases were not significant in other directions. Compared with group A, the L3/4 ROM of group C did not increase significantly in the extension and axial rotation（P〉0.05）, while it increased significantly in flexion（0.38°） and lateral bending（0.28°）,respectively. Compared with group B, the L5/S1 ROM of group C had a increasing trend in extension, lateral bending and axial rotation, but no statistical significance（P〉0.05）. Compared with group A, the L5/S1 ROM of group C had a increasing trend in all directions（P〈0.05）. The L3/4 IDP of group B was higher than that of group A（P〈0.05）. The L3/4 IDP of group B in flexion, extension, lateral bending and axial rotation increased by 1.82 k Pa, 1.88 k Pa, 1.84 k Pa and 1.45 k Pa, respectively. The L5/S1 IDP of group B in flexion, extension,lateral bending and axial rotatio

关 键 词：腰椎坚强固定 棘突间装置 生物力学 

分 类 号：R684.705[医药卫生—骨科学]