兔腰椎前路融合术后邻近节段退变的生物力学研究  

Biomechanical study of adjacent segment degeneration after anterior lumbar spine fusion in rabbits

作　　者：叶福标[1] 尹晓明[1] 林飞跃[1] 徐杨[1] YE Fu-biao;YIN Xiao-ming;LIN Fei-yue;XU Yang(Department of Orthopaedics,Provincial Clinical Medical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院福建省立医院骨科

出　　处：《中国当代医药》2019年第30期11-14,共4页China Modern Medicine

基　　金：福建省卫计委中青年骨干人才培养项目（2017-ZQN-8）

摘　　要：目的探讨兔腰椎前路融合术后上下相邻节段生物力学稳定性。方法选取40只健康新西兰大白兔,随机将其分为假手术组(对照组,n=8)、单纯前路腰椎融合术组(单纯融合组,n=16)、前路腰椎融合加内固定术组(融合内固定组,n=16)。对照组只行前路剥离相应的软组织后即闭合伤口;单纯融合组经前路行L5椎体次全切,植入可植骨的椎体融合器,无附加内固定;融合内固定组经前路行L5椎体次全切除,置入可植骨的融合器附加前方内固定钢板。对已经判定融合成功的标本进行生物力学测试,比较各组融合术后上下邻近节段的运动范围(ROM)及中性区位移(NZ)。结果单纯融合组及融合内固定组近端邻近节段(L3~4)屈曲、过伸、左侧屈、右侧屈的ROM和NZ均高于对照组,差异有统计学意义(P<0.05);融合内固定组近端邻近节段(L3~4)屈曲、过伸、左侧屈、右侧屈的ROM、NZ均高于单纯融合组,差异有统计学意义(P<0.05)。三组远端邻近节段(L6~7)屈曲、过伸、左侧屈、右侧屈的ROM、NZ比较,差异无统计学意义(P>0.05)。结论无论是单纯融合术还是融合内固定术,均使近侧邻近节段活动度增加,导致不稳,而对远侧邻近节段的影响不明显。Objective To investigate the biomechanical properties of adjacent segments of lumbar spine after anterior lumbar spine fusion in rabbits.Methods Forty healthy New Zealand white rabbits were randomly divided into sham operation group(control group,n=8),anterior lumbar spine fusion without internal plate group(fusion without plate group,n=16),anterior lumbar spine fusion with internal plate group(fusion with plate group,n=16).The rabbits in control group received sham operation,the incision was closed after anterior paravertebral soft tissue dissection.In the fusion without plate group,the fusion cage filling with autograft was implanted after anterior L5 corpectomy decompression,without additional internal plate fixation.In the fusion with plate group,the fusion cage filling with autograft was implanted after anterior L5 corpectomy decompression then fixed with additional internal plate fixation.Biomechanical tests were performed on specimens that had been successfully fused,and the range of motion(ROM)and neutral zone(NZ)of the proximal and distal adjacent segments of each group after fusion were compared.Results The ROM and NZ of the proximal adjacent segment(L3-4)of the flexion,extension,left and right lateral bending in the fusion without plate group and the fusion with internal plate group were larger than those in the control group,with statistically differences(P<0.05).The ROM and NZ of the proximal adjacent segment(L3-4)of the flexion,extension,left and right lateral bending in the fusion with plate group were larger than those in the fusion without plate group,the differences were statistically significant(P<0.05).There were no significant differences of ROM and NZ among the three groups of distal adjacent segments(L6-7)in flexion,extension,left and right lateral bending(P>0.05).Conclusion Both anterior lumbar spine fusion without and with plate fixation can increase the activity of the proximal adjacent segment,resulting in instability,but this effect cannot be observed obviously on distal adjacent segme

关 键 词：前路腰椎融合 内固定器 邻近节段退变 动物模型 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]