基于生物力学研究腰椎间盘突出手术对腰椎节段的矢状面的稳定性基础研究  

A basic biomechanical study on the stability of sagital plane after the operation of lumbar intervertebral disc

作　　者：孙习辉 李克鹏[1] 李亚锋[1] SUN Xi - hui LI Ke -peng LI Ya -feng(Department of Orthopedics, The Second Central Hospital of Hebei of Baoding, Baoding, Hebei 072750 , China)

机构地区：[1]河北省保定市第二中心医院骨科,河北保定072750

出　　处：《临床和实验医学杂志》2017年第9期916-919,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的基于尸体腰椎采用生物力学试验,研究腰椎间盘突出手术对腰椎矢状面稳定性的影响,对今后腰椎间盘术在临床中的改进提供有力依据。方法选取2015年8月份经确诊且已出具死亡证明的4例新鲜尸体进行试验,纳入的4例尸体腰椎均在患者死亡后24 h内获取。采用生物力学实验观察不同负荷下标本因素和手术因素对位移的影响,比较不同负荷下各种手术方法的位移。结果 4个腰椎阶段均在生理应力范围内数据显示:单纯减压腰椎节段与正常椎间盘位移对比发现,单纯减压腰椎节段与正常椎间盘位移水平无显著差异(P>0.05);试验数据显示,刮除软骨板与髓核摘除在递增负荷的情况下可提高水平位移的几率,刮除软骨板与髓核摘除位移与正常椎间盘发生位移的情况对比,差异具有统计学意义(P<0.05)。结论造成矢状面出现腰椎节段不平稳的主要因素为单节段腰椎间盘髓核摘除术负荷增加,术中摘除椎间盘组织过多,从而影响腰椎矢状面失去稳定性。研究数据表明,单节段腰椎间盘髓核摘除术在生理负荷范围内进行就不会出现腰椎节段矢状面不稳的情况。Objective To study the stability of lumbar intervertebral disc by biomechanical test on the basis of lumbar spines,and to provide a strong basis for the improvement of lumbar intervertebral disc surgery for the future. Methods Four fresh corpses with death certificate in this hospital in August 2015 and their lumbar spines were obtained after the death of these patients within 24 h. Results According to the data of physiological range of strain,4 lumbar stages were in the physiological range of strain,there was no significant difference between simple decompression of lumbar segments and normal level of intervertebral disc displacement of lumbar segments（ P〈0. 05）. Experimental data showed that the scraping cartilage plate and discectomy in incremental case can improve the chance of horizontal displacement,scraping comparison of cartilage plate displacement and discectomy displacement and normal intervertebral disc,the difference was statistically significant（ P〈0. 05）. Conclusion The results showed that the main factors caused by sagittal lumbar segment instability of lumbar discectomy load increasing,excessively intraoperative removal of intervertebral disc tissue,thus affecting the stability of lumbar sagittal plane. The study data show that the extraction of nucleus pulposus of single segment lumbar disc will not appear the instability of sagital plane in the range of physiological load.

关 键 词：腰椎间盘突出 生物力学 矢状面 稳定性 

分 类 号：R687.3[医药卫生—骨科学]