经椎间孔腰椎椎间融合结合不同椎弓根螺钉固定在单节段腰椎及邻近节段的生物力学特征  

Biomechanical characteristics of transforaminal lumbar interbody fusion combined with different pedicle screw fixation methods in single-segment lumbar spine and adjacent segments

作　　者：侯继春 曹杨[1] Hou Jichun;Cao Yang(Department of Orthopedics,First Affiliated Hospital of Harbin Medical University,Harbin 150001,Heilongjiang Province,China)

机构地区：[1]哈尔滨医科大学附属第一医院骨科,黑龙江省哈尔滨市150001

出　　处：《中国组织工程研究》2020年第27期4297-4304,共8页Chinese Journal of Tissue Engineering Research

基　　金：哈尔滨市科学技术局项目(2013AA3BS016),项目负责人:曹杨。

摘　　要：背景:对于腰椎退行性病变,早期给予有效固定达到椎间融合可重建脊柱稳定性,所以减压-固定-融合是脊柱外科手术的关键。目的:比较经椎间孔腰椎椎间融合术下双侧椎弓根螺钉固定、单侧椎弓根螺钉固定、单侧椎弓根螺钉固定联合经对侧椎板小关节固定融合节段与邻近节段的生物力学稳定性。方法:选用18具新鲜小牛L3-5标本,在经椎间孔腰椎椎间融合术下进行不同的固定形式,分成A组(完整标本)、B组(双侧椎弓根螺钉固定)、C组(单侧椎弓根螺钉固定)、D组(单侧椎弓根螺钉固定联合经对侧椎板小关节固定),分别测试邻近节段L3-4、融合节段L4-5在后伸、前屈、左侧弯、右侧弯、左旋转、右旋转6个方向上的活动范围值及融合节段L4-5的刚度值。结果与结论:①对于融合节段L4-5的活动范围,B组6个方向的稳定性最高;D组次之,并在旋转方面与B组有相似结果(P>0.05);C组右侧弯和左旋转的稳定性不足,关节活动度与A组比较差异无显著性意义(P>0.05);A组6个运动方向的活动度最大,稳定性最差;②对于融合节段L4-5的刚度值,B组6个方向的刚度值最大,与其他组比较差异均有显著性意义(P<0.05);C组和D组左、右旋转下的刚度值比较差异有显著性意义(P<0.05),A组6个运动方向的刚度值最低;③对于临近节段L3-4的活动范围,B组6个方向的活动范围最大,邻近节段承受负荷最大,同其他3组比较差异有显著性意义(P<0.05);D组除左、右旋转外其余方向的活动范围同C组、A组比较差异无显著性意义(P>0.05);C组和A组6个方向活动范围比较差异均无显著性意义(P>0.05);④结果表明,单侧椎弓根螺钉固定早期在右侧弯和左旋转方向的活动度大,接近于完整标本组,存在稳定性不足的缺点,临床中需要慎用并严格把握适应证。单侧椎弓根螺钉联合对侧经椎板关节突螺钉固定技术改进了单侧椎弓根螺钉不对称固�BACKGROUND:Decompression-fixation-fusion is the key to spinal surgery since early effective fixation to achieve intervertebral fusion can restore spinal stability in lumbar degenerative disease.OBJECTIVE:To compare biomechanical stability of fusion segment and adjacent segments of bilateral pedicle screw fixation,unilateral pedicle screw fixation and unilateral pedicle screw combined with contralateral translaminar facet screw fixation under transforaminal lumbar interbody fusion.METHODS:Eighteen fresh calf L3-5 specimens were selected.Different forms of fixation were conducted under transforaminal lumbar interbody fusion.The specimens were divided into group A(complete specimens)and group B(bilateral pedicle screws),group C(unilateral pedicle screws),and group D(unilateral pedicle screw combined with contralateral translaminar facet screw).The range of motion of adjacent segment L3-4 and fusion segment L4-5 in six directions of backward extension,forward bending,left bending,right bending,left rotation and right rotation and the stiffness of fusion segment L4-5 were tested.RESULTS AND CONCLUSION:(1)For the range of motion of fusion segment L4-5,the stability was highest in the group B in six directions,followed by group D,which showed similar results in rotation in the group B(P>0.05).The stability of right curvature and left rotation in group C was insufficient,and there was no significant difference in range of motion between group A and group C(P>0.05).The range of motion in group A was largest and the stability was worst in the six motion directions.(2)For the stiffness value of fusion segment L4-5,the stiffness value of group B was largest in six directions,which was significantly different from other groups(P<0.05).The stiffness values of group C and group D under left and right rotations were significantly different(P<0.05).The stiffness values of group A in the six motion directions were lowest.(3)For the range of motion of adjacent segment L3-4,the range of motion of six directions in group B was larges

关 键 词：生物力学 腰椎退行性疾病 椎弓根螺钉 双侧固定 单侧固定 经椎板关节突螺钉固定 邻近节段退变 经椎间孔腰椎间融合术 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]