内镜下腰椎椎间融合:单侧椎弓根螺钉联合对侧椎板关节突螺钉固定的生物力学稳定性  

Biomechanical stability of endoscopic transforaminal lumbar interbody fusion with unilateral pedicle screw combined with contralateral translaminar facet screw fixation

作　　者：林博颖 沈茂 Lin Boying;Shen Mao(Clinical College of Guizhou Medical University,Guiyang 550000,Guizhou Province,China;Department of Orthopedics,Affiliated Hospital,Guizhou Medical University,Guiyang 550000,Guizhou Province,China)

机构地区：[1]贵州医科大学临床医学院,贵州省贵阳市550000 [2]贵州医科大学附属医院骨科,贵州省贵阳市550000

出　　处：《中国组织工程研究》2022年第3期329-333,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:内镜下经椎间孔腰椎椎间融合是有效治疗腰椎退变性疾病的突破性前沿技术,具有创伤小、恢复快、出血少、水介质视野清晰、直视下神经根减压、直视下处理终板提高融合率等优势,目前基于全内镜下腰椎融合的内固定方式研究较少。目的:观察单侧椎弓根螺钉、单侧椎弓根螺钉联合对侧椎板关节突螺钉、双侧椎弓根螺钉3种固定方式对内镜下腰椎椎间融合生物力学的影响,验证单侧椎弓根螺钉联合对侧椎板关节突螺钉技术的可靠性和有效性。方法:通过建立内镜下经椎间孔腰椎椎间融合后腰椎有限元模型,分析单侧椎弓根螺钉、单侧椎弓根螺钉联合对侧椎板关节突螺钉、双侧椎弓根螺钉3种固定方式下对脊柱模型整体位移、椎间融合器应力、钉棒系统应力及邻近椎间盘应力的影响。结果与结论:(1)与单侧椎弓根螺钉联合对侧椎板关节突螺钉固定相比,单侧椎弓根螺钉固定的模型整体位移、钉棒系统应力、椎间融合器应力明显增大;(2)双侧椎弓根螺钉组与单侧椎弓根螺钉+对侧椎板关节突螺钉组在6种工况下的模型整体位移、钉棒系统应力、椎间融合器应力值基本一致;(3)3种固定方式下的邻近椎间盘应力无明显差异,其变化趋势基本一致;(4)提示内镜下腰椎椎间融合过程中单侧椎弓根螺钉联合对侧椎板关节突螺钉的固定方式具有良好的生物力学特性。BACKGROUND:Endoscopic transforaminal lumbar interbody fusion is a breakthrough technique for effective treatment of lumbar degenerative diseases.It has the advantages of less trauma,fast recovery,less bleeding,clear vision of water medium,decompression of nerve roots under direct vision,and treatment of the endplate under direct vision to increase the fusion rate.At present,there are few researches on the internal fixation based on endoscopic transforaminal lumbar interbody fusion.OBJECTIVE:To observe the effect of unilateral pedicle screw combined with contralateral translaminar facet screw fixation,unilateral pedicle screw fixation,and bilateral pedicle screw fixation on the biomechanics of lumbar vertebra after endoscopic transforaminal lumbar interbody fusion and to verify the reliability and effectiveness of unilateral pedicle screw combined with contralateral translaminar facet screw fixation.METHODS:By establishing an element model of endoscopic transforaminal lumbar interbody fusion,the effects of unilateral pedicle screw combined with contralateral translaminar facet screw fixation,unilateral pedicle screw fixation,and bilateral pedicle screw fixation on the overall displacement of the model,stress of intervertebral fusion cage and pedicle screw,and stress-strain of adjacent discs were analyzed.RESULTS AND CONCLUSION:(1)Compared with unilateral pedicle screw combined with contralateral translaminar facet screw fixation,overall displacement,screw and rod system stress,and intervertebral cage stress were significantly increased in models with unilateral pedicle screw fixation.(2)Overall displacement,screw and rod system stress,and intervertebral cage stress were basically the same under six operating conditions between the bilateral pedicle screw fixation and unilateral pedicle screw combined with contralateral translaminar facet screw fixation.(3)There was no significant difference in the stress of the adjacent intervertebral disc under the three fixation methods,and the change trend was basically the sam

关 键 词：椎板关节突螺钉 内镜 经椎间孔腰椎椎间融合 单侧固定 双侧固定 有限元分析 

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