后部不同结构切除对胸椎稳定性的影响.docVIP

后部不同结构切除对胸椎稳定性的影响 何 斌，胡侦明，郝 杰，王大武，钟小明 （400016 重庆，重庆医科大学附属第一医院骨科） [摘要] 目的 研究后部不同结构对胸椎脊柱稳定性中的作用。方法 选用9具带有8cm肋骨的湿润成人尸体胸椎标本（T7～T10），依次对同一标本T8～T9节段进行单侧小关节突关节及半椎板切除、单侧肋椎关节切除、后部韧带复合切除体及全椎板切除、双侧关节突关节切除、双侧肋椎关节切除共5种切除模型，对标本进行生物力学实验测试并记录各模型在5N·m载荷下于前屈/后伸、左右侧弯、轴向旋转6个方向的运动范围（ROM），将各模型ROM值分别与完整标本ROM值进行配对t检验比较。结果 与完整胸椎标本比较，单侧小关节突关节及半椎板切除后在前屈/后伸、左右侧弯、轴向旋转方向上的ROM值无显著性差异（P＞0.05），但双侧小关节突关节切除后，前屈/后伸、左右侧弯、轴向旋转方向上以上运动方向的ROM值有显著性差异（P＜0.05，P＜0.01），后部韧带复合体切除后在前屈/后伸及轴向旋转方向上的ROM值有显著性差异（P＜0.05，P＜0.01），切除双侧肋椎关节后胸椎在6个方向上的ROM值均有显著性差异（P＜0.01）。结论 在胸椎，小关节突关节在前屈/后伸和轴向旋转功能稳定性上起到了重要作用，但单侧小关节突关节及半椎板切除后对稳定性的影响并不显著，后部韧带复合体在前屈/后伸时的稳定性中起到了控制作用，肋椎关节是胸椎脊柱功能单位机械性能中最为重要的后部稳定因素之一。 [关键词] 胸椎；后部不同结构；稳定性；生物力学 [中图法分类号] [文献标志码] A Biomechanical Role of the Posterior different structure in the Stability of the Thoracic Spine He Bin, Hu Zhenming, Hao Jie, Wang Dawu, Zhong Xiaoming (Department of Orthopedics, Affiliated First Hospital of Chongqing Medical University, Chongqing 400016,China) [Abstract] Objectives To investigate the role of the posterior different structure in the stability of the thoracic spine. Methods The thoracic spine specimen of 9 cadaver from T7 to T10, consisting of the sixth to ninth ribs, were used. After testing the intact specimen, resection of the T8-9 posterior stabilizers was conducted incrementally in the following manner: 1) Total unilateral facentectomy with unilateral laminectomy (Group 1), 2) resection of the unilateral costoverebral joint (Group 2), 3) resection of the posterior ligamentous complex with laminectomy (Group 3)，4) bilateral total facetectomy (Group 4), 5) resection of the bilateral costoverebral joints (Group 5). All specimen were tested in six direction. Paired t-test was used as statistics analysis method. Results Total unilateral facentectomy with unilateral laminectomy did not significantly increase the range of motion in cadaveric thoracic spines (P＞0.05), however, a large increase in the range of motion wa