椎板切除对腰椎融合后邻近节段生物力学的影响
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国家自然科学基金项目(11602172,11432016),福建省卫生系统中青年人才培养项目(2013-ZQN-ZD-19),福建省临床重点专科建设项目(闽卫科教[2012]149号)


Biomechanical Effect of Laminectomy on Adjacent Segment after Lumbar Interbody Fusion
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    摘要:

    目的 从生物力学角度研究后路不同程度椎板切除对腰椎融合手术后邻近节段的影响。方法 在完整腰椎有限元模型基础上,建立3种椎板切除程度不同的手术模型:双侧小关节切除(Bi-TLIF)、半椎板切除(PLIF)、全椎板切除(LAM-PLIF)。对不同模型在生理载荷下的生物力学响应进行研究,对比手术模型椎间活动度、椎间盘内压以及小关节接触力相对于正常模型的变化。生理载荷采用400 N随动载荷+7.5 N·m力矩的方式施加在L1节段上终板上,加载过程中对骶髂关节面上的6个自由度保持约束。结果 前屈状态下,手术组Bi-TLIF、PLIF、LAM-PLIF相邻节段L3~4生物力学变化明显,其椎间活动度比正常组依次增大1.0%、9.3%和24.5%,而椎间盘内压依次增大1.4%、4.3%、10.0%,在其他姿态下影响不明显。对于小关节接触力,Bi-TLIF、PLIF在L3~4节段有明显增加,而在L5~S1节段则不明显。结论 椎板切除会增加腰椎融合手术后的邻近节段椎间活动度、椎间盘内压以及小关节接触力,这些生物力学变化可能会增大邻近节段退变的风险。椎板切除范围越大,对邻近节段产生的影响越大。因此,更多地保留后部结构复合体,对于减少腰椎融合后邻椎病的发生具有积极的意义。

    Abstract:

    Objective To study the biomechanical influence of posterior laminectomy with varying extent on adjacent segment after lumbar interbody fusion. Methods Three finite element models of lumbar posterior fusion were developed based on the validated intact lumbar model. These models were: posterior fusion with bi-lateral incision of facet joint (Bi-TLIF),inferior partly incision of laminar (PLIF),total laminectomy (LAM-PLIF). The range of motion (ROM), intradiscal pressure (IDP), facet joint contact force (FJF) of adjacent segment of fusion models under various loading were compared with the intact model. The follower load of 400 N under 7.5 N·m torque was exerted on superior endplate of L1 segment. The 6-DOF (degree of freedom) of sacroiliac joint surface was constrained during loading. ResultsDuring flexion, obvious biomechanical changes of superior adjacent segment (L3-4) were found in Bi-TLIF, PLIF, LAM-PLIF surgery groups. Compared with the intact model, the ROM in Bi-TLIF, PLIF, LAM-PLIF group increased by 1.0%, 9.3%, 24.5%, respectively, while IDP in the above fusion groups increased by 1.4%, 4.3%, 10.0%,respectively. These changes were not obvious in other postures. For FJF, the Bi-TLIF and PLIF group showed obvious increasing effect on L3-4 segment, while almost had no effect on L5-S1 segment. Conclusions Laminectomy increased ROM, IDP and FJF of adjacent segment (especially superior adjacent segment) after posterior lumbar fusion, which might increase the risk of adjacent segment degeneration. This biomechanical effect was more obvious with the increase in incision range of laminar. Therefore, preserving more posterior complex during decompression has a positive effect on preventing adjacent segment degeneration (ASD) following lumbar fusion surgeries.

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黄云鹏,门玉涛,刘海英,都承斐.椎板切除对腰椎融合后邻近节段生物力学的影响[J].医用生物力学,2018,33(6):564-571

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  • 收稿日期:2018-01-23
  • 最后修改日期:2018-04-15
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  • 在线发布日期: 2018-12-26
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