三种单纯腰椎椎间融合术加用双侧椎弓根螺钉内固定后生物力学比较的实验研究
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Biomechanical comparison of the initial stability after anterior,posterior and transforaminal interbody fusion with and without posterior pedicle instrumentation
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    摘要:

    目的比较前路椎间融合术(ALIF)、后路椎间融合术(PLIF)、椎间孔入路椎间融合术(TLIF)加用双侧椎弓根螺钉内固定后腰椎即刻稳定性的差异。方法选用15具新鲜小牛腰椎标本,模拟临床建立三种椎间融合术模型,在脊柱三维运动测试机上测试三种模型加用双侧椎弓根螺钉固定前后生物力学特性的变化。结果(1)与正常标本组相比,单纯椎间融合术的ALIF(Ⅰ)组的平均应变和应力明显增加;ALIF(Ⅰ)、PLIF(Ⅰ)、TLIF(Ⅰ)组的平均轴向刚度和水平剪切刚度分别下降28.3%、18.4%、11.5%(P<0.05)和21.6%、17.5%、5.9%(P<0 05);扭矩强度分别依次下降38.6%、49.1%、27.2%(P<0.05)。(2)附加双侧椎弓根螺钉固定后,与单纯椎间融合组的相应术式比较,ALIF(Ⅱ)、PLIF(Ⅱ)、TLIF(Ⅱ)三组的平均应变和应力分别减小了21.4%、12.3%、24.5%(P<0.05)和21.4%,22.3%,24.5%(P<0.05);平均轴向刚度和水平剪切刚度分别增加了87.8%、77.9%、75.9%(P<0.05)和60.6%、68.1%、63.1%(P<0.05);平均扭转强度分别增加了95.1%、110.9%、87.6%(P<0 05)。结论行单纯椎间融合术后,腰椎的稳定性较正常对照组均有明显下降,在加用双侧椎弓根螺钉内固定后能有效地提高其稳定性能。在三种椎间融合术中,TLIF的腰椎即刻稳定性能最优。

    Abstract:

    Objective To compare the stability of the lumbar intervertebral segmental stiffness after three types of interbody fusion(ALIF,PLIF and TLIF)with or without lateral transpedicular screws fixation.Methods Fifteen bovine lumbers were divided into 7 groups,with each performed nondestructive tests.Results(1)Comparing with the intact group,the mean axis compression stiffness decreased by 28.3%,18.4%,11.5% (P<0.05),respectively;the mean anteroposterior shear stiffness decreased by 21.6%,17.5%,5.9% (P<0.05),respectively in ALIF(1) 2PLIF(1)and TLIF(1)group;the axial rotational stiffness decreased by 38.6%,49.1%,27.2%,respectively(2)By applying internal fixation,comparing with the non-internal fixation interbody fusion group,their mean axis compression stiffness and anteroposterior were separately increased by 87.8%,77.9%,75.9%(P<0.05)and 60.6%,68.1%,63.1%(P<0.05), respectively;Their axial rotational stiffness increased by 95.1%,110.9%,87.6% (P<0.05),respectively.Conclusion (1)Three types of Lumbar interbody fusion without additional internal fixation showed less stable than the normal intact lumbar.Only when transpedicular screws fixation applied,their stability could increased greatly and become much more stable than normal intact lumbar.(2)TLIF is the most stable one in the three types.

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张烽,陈兵乾,居建文,王素春,段广超,王以进.三种单纯腰椎椎间融合术加用双侧椎弓根螺钉内固定后生物力学比较的实验研究[J].医用生物力学,2007,22(3):302-305

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