椎间盘不对称切除对小关节压力及腰椎稳定性的影响  

Effects of asymmetric lumbar discectomy on facet joint force and stability of lumbar spine

作　　者：刘湘[1,2] 黄志平[1] 朱青安[1] 周若舟[1] 季伟[1] 吴秀华[1] 王吉兴[1] 

机构地区：[1]南方医科大学南方医院脊柱骨科,广州510515 [2]佛山市禅城区中心医院脊柱外科,佛山528031

出　　处：《医用生物力学》2016年第3期261-265,共5页Journal of Medical Biomechanics

基　　金：广东省科技计划项目(2014A020212723);广东省自然科学基金项目(2015A030313276);国家自然科学基金项目(81472084)

摘　　要：目的探讨腰椎间盘不对称切除对小关节压力及腰椎稳定性的影响。方法采用7具人体脊柱标本（L2-3）,制备完整椎间盘组、1/4椎间盘切除组、1/2椎间盘切除组,对标本施加7.5 N·m的屈伸、侧弯和轴向旋转方向的纯力偶矩,记录腰椎运动范围（range of motion,ROM）和小关节压力。结果后伸方向,1/4椎间盘切除状态下非切除侧小关节压力显著性增大;侧弯方向,1/2椎间盘切除状态下的两侧小关节压力均有显著性增大;轴向旋转方向,1/2椎间盘切除状态下仅切除侧小关节压力显著性增大。1/4椎间盘切除、1/2椎间盘切除状态下的ROM均大于完整椎间盘,但前屈方向各组间ROM无差别,各组间侧弯和轴向旋转的ROM在左、右侧无差别。结论腰椎间盘不对称切除导致腰椎除前屈方向外稳定性下降和小关节压力不对称性增大,提示腰椎间盘不对称退变引起腰椎不稳和小关节压力增大可产生腰痛。Objective To investigate the effect of asymmetric lumbar discectomy on facet joint force and stability of lumbar spine. Methods Seven human cadaver specimens（ L2-3 segment） were selected to make intact,1 /4discectomy and 1 /2 discectomy status and applied with pure moment of 7. 5 N·m. The range of motion（ ROM）and facet joint force of L2-3 segment during flexion / extension,lateral bending and axial rotation were recorded,respectively. Results During extension,a significant increase in facet joint force was found under 1 /4 discectomy status at the remained side. During lateral bending,the facet joint force at both sides under 1 /2 discectomy status increased significantly than that under intact status. During axial rotation,facet joint force increased significantly only at the side without discectomy under 1 /2 discectomy status. Except flexion,ROM under 1 /4 discectomy and1 /2 discectomy status were larger than that under intact status in all the other motion directions（ P〈0. 05）.There was no significant difference in ROM between both sides during lateral bending and axial rotation direction.Conclusions The asymmetric lumbar discectomy can increase the ROM in all motion directions except flexion,and can enlarge the facet joint force asymmetrically,which indicate that instability of lumbar spine and facet joint force increasing resulted from asymmetric degeneration of the disc might lead to backache.

关 键 词：腰椎间盘 腰椎 切除 小关节压力 稳定性 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]