融合与非融合稳定方式对损伤性腰椎活动影响的对比  

Comparison study of the effect of fusion and non-fusion fixation on the movement of injured lumbar spine

作　　者：宋红芳[1,2] 张雯 张强 刘志成[1,2] 

机构地区：[1]首都医科大学生物医学工程学院,北京市100069 [2]首都医科大学临床生物力学应用基础研究北京市重点实验室,北京市100069 [3]中国医学科学院阜外医院,北京市100037 [4]首都医科大学附属北京地坛医院骨外科学系,北京市100015

出　　处：《中国组织工程研究》2017年第31期4963-4968,共6页Chinese Journal of Tissue Engineering Research

基　　金：北京市教育委员会科技发展计划面上项目(KM201410025012);首都医科大学基础临床合作重点项目(16JL08)~~

摘　　要：背景:腰椎退行性病变是腰椎自然老化、退化的生理病理过程,严重影响着患者的生活质量。传统的手术方式会带来一些并发症,棘突间动态固定Coflex临床效果不错,但是缺乏实验数据的支持。目的:研究腰椎稳定方式对其运动影响,从生物力学角度为临床手术提出参考意见。方法:选取新鲜的猪腰椎制备实验模型5组:分别为正常状态(A组)、损伤状态(B组)、L_3-L_4Coflex固定(C组)、L_3-L_4Coflex固定+减压(D组)、L_3-L_4椎间融合固定(E组)。运用机器人手臂系统对每具标本5种模型进行前屈/后伸、左/右侧弯、左/右轴向旋转6个方向的生物力学加载;通过多方向力矩传感器采集加载力矩,配合三维动作捕捉系统记录手术节段及整体腰椎的运动范围,分析稳定方式对腰椎运动的影响。结果与结论:(1)4个实验组(B、C、D、E)中,腰椎手术节段(L_3-L_4)的三维角度变化范围与正常状态相比,Coflex固定组与正常状态组间差异较小,而损伤状态组、融合组与正常状态组差异较大;(2)融合组虽然可以恢复损伤后的腰椎活动度,但其活动角度与Coflex固定组相比小了很多;(3)结果表明,Coflex固定后可以将损伤状态的活动角度恢复到正常状态,维持腰椎稳定性的同时,还保留了一定的活动度。腰椎失稳后用Coflex弹性内固定较融合固定更好,固定后性能更接近正常腰椎。BACKGROUND： Degenerative change in lumbar spine is the natural physiological and pathological process with ageincreasing, which seriously affects the patients’ quality of life. Conventional surgical treatments may bring about somecomplications. Interspinous stabilization Coflex demonstrates good clinical outcomes, while there is lack of experimentalevidence.OBJECTIVE： To investigate the effect of fixation methods on the movement of lumbar vertebrae, and to providereference for clinical operation from the aspect of biomechanics.METHODS： Five fresh specimens of pig cadaveric lumbar spine were selected and divided into five groups： blank controlgroup （group A）, injury group （group B）, L3-L4 Coflex fixed （group C）, L3-L4 Coflex fixed plus decompression （group D）,and L3-L4 intervertebral fusion fixed （group E）. The biomechanical performance of the five lumbar specimens was testedin six loading directions of flexion/extension, left/right lateral bending, and left/right axial rotation driven by a robot system.The motion range of the operation segments （L3-L4） and the whole lumbar spine was observed by a multi-directionaltorque sensor combined with a three-dimensional motion capture system. Finally, the influence of lumber fixationmethods on the spinal movement was explored.RESULTS AND CONCLUSION： （1） For the range of three-dimensional angle at the operation segments （L3-L4）, it wasfound that groups C and D were similar to group A, and groups B and E were quite different from group A. （2） Group Ecould restore the motion range of the injured segments, but the motion angle was much smaller than that in the groups Cand D. （3） These results indicate that the motion angle of the injured spine treated with Coflex can restore to the normalstate, with long-term stability. For unstable lumbar spine, interspinous Coflex is better than transforaminal lumbarinterbody fusion, which can induce similar biomechanical properties to normal lumbar spine after operation.

关 键 词：骨科植入物 脊柱植入物 生物力学 动态固定 椎体间融合术 

分 类 号：R318[医药卫生—生物医学工程]