医学论文-L5S1前路椎间融合生物力学稳定性实验研究.docVIP

医学论文-L5S1前路椎间融合生物力学稳定性实验研究 ????????????????? 作者：唐树杰，苗军，张继东 ，夏群，金鸿宾，王志彬，王爱国 【摘要】? ［目的］对腰椎完整标本、单纯腰椎前路椎间融合术（ALIF）、ALIF分别行椎弓根钉固定及经椎板关节突螺钉固定4种状态进行测试，比较生物力学稳定性。［方法］采用新鲜腰椎标本8具，分别于完整状态、L5S1前路植以Cage、L5S1前路Cage分别行椎弓根钉固定及经椎板关节突螺钉固定下，测定前屈、后伸、侧弯及扭转运动下运动范围并进行比较。［结果］单纯ALIF标本同完整标本相比，其后伸运动范围增大（P＜0.01），而前屈、侧弯、扭转运动范围减小（P＜0.01）；而ALIF经椎弓根钉固定或经椎板关节突螺钉固定后各方向运动范围均小于完整标本及单纯ALIF标本（P＜0.01）。［结论］L5S1单纯行ALlF后伸稳定性差，为增加其稳定性，经椎板关节突螺钉应当是首选的内固定??械。 【关键词】? 腰椎前路椎间融合术； 椎弓根钉； 经椎板关节突螺钉； 生物力学稳定性 ??? Abstract：［Objective］To evaluate the biomechanical stability of lumbar intact specimen,anterior lumbar interbody fixation(ALIF)specimen,ALIF specimen fixed with pedicle screw and ALIF specimen fixed with translaminar facets screw.［Method］Each of eight adult fresh cadaver specimen of lumbarsacral segmcnts was analyzed in four states（groups）:intact,L5S1 ALIF,L5S1 ALIF fixed with pedicle screw or fixed with translaminar facets screw,test and compare its range of motion（ROM）in flexion,extension,lateral bending and axial rotation.［Result］The ROM of ALIF specimen in extension was larger than that of intact specimen（P＜0.01）,while its ROM in flexion,lateral bending,axial rotation was less than that of intact specimen（P＜0.01）,the ROM of ALIF specimen fixed with pedicle screw or translamlnar facets screw was less than that of ALIF specimen or intact speclmen（P＜0.01）.［Conclusion］The stability of L5S1 ALIF specimen in extension is less than that of intact specimen,and ALIF combined with translaminar facets screw is the most ideal internal fixation to enhance its biomechanical stability of ALIF specimen. ??? Key words：anterior lumbar interbody fixation(ALIF);? pedicle screw;? translaminar facet screw;? biomechanical stability ??? 腰椎前路椎间融合术（ALIF）自OBrien〔1〕报道以来，随着临床应用，人们对其认识日渐深入，目前已成为一种椎间融合的标准技术，广泛应用于椎体滑脱、椎间盘源性疼痛、脊柱失稳等病症的治疗。腰椎前路椎间融合术，保存腰椎后柱结构完整性，缩短手术时间，减少失血量，避免椎管内瘢痕形成，同时切除间盘组织彻底，椎间融合面积大，提高融合率，并利于恢复椎间高度及腰椎生理曲度，具有许多其他腰椎融合术所没有的优势。 ??? 然而，随着临床实践的深入，ALIF的一些缺陷也逐渐暴露出来，其中很重要的一点即单纯ALIF术后出现椎间高度的丢失，椎间融合器的下沉、移位而影响融合率等。对此情况，多数学者认为，单纯腰椎椎间