CAJ | 학술논문

背景:椎间融合术按照手术入路主要有前路椎间融合术、后路椎间融合术和椎间孔入路椎问融合术.3种融合术术中切除的结构不同,融合器置入的部位不同,其腰椎即刻稳定性也存在差异.目的:比较前路椎间融合术、后路椎间融合术、椎间孔入路椎间融合术加用双侧椎弓根螺钉内固定后腰椎即刻稳定性的差异.设计:对比观察.材料:腰椎标本来自新鲜小牛15具.方法:模拟临床手术建立前路椎间融合术、后路椎间融合术、椎间孔入路椎间融合术3种椎间融合术模型,先将所有标本作为正常对照组进行测试,然后将标本随机分为3组,每组5个标本,制成单纯椎间融合组,分别采用3种椎间融合术测试后,在此基础上再附加双侧椎弓根螺钉内固定进行测试.主要观察指标:脊柱三维运动测试机上测试3种模型加用双侧椎弓根螺钉固定前后腰椎生物力学特性的变化.结果:行3种单纯椎间融合后,腰椎的稳定性能明显下降,附加了双侧椎弓根螺钉固定后,腰椎的各项稳定性指标均增强,包括扭转力学指标也得到了很大增强,有效增加了腰椎的刚度.椎间孔入路椎间融合术各项稳定性指标都明显优于其他两种方法,说明椎间孔入路椎间融合术的即刻稳定性能在3者中最有优势.后路椎间融合术的刚度明显强于前路椎间融合术,应变和应力也较前路椎间融合术有优势,但是其扭转稳定性却不如前路椎间融合术.结论:行单纯椎间融合术后,腰椎的稳定性较正常对照组均宵明显下降,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3种椎间融合术中,椎间孔入路椎间融合术的腰椎即刻稳定性能最优.
배경:추간융합술안조수술입로주요유전로추간융합술、후로추간융합술화추간공입로추문융합술.3충융합술술중절제적결구불동,융합기치입적부위불동,기요추즉각은정성야존재차이.목적:비교전로추간융합술、후로추간융합술、추간공입로추간융합술가용쌍측추궁근라정내고정후요추즉각은정성적차이.설계:대비관찰.재료:요추표본래자신선소우15구.방법:모의림상수술건립전로추간융합술、후로추간융합술、추간공입로추간융합술3충추간융합술모형,선장소유표본작위정상대조조진행측시,연후장표본수궤분위3조,매조5개표본,제성단순추간융합조,분별채용3충추간융합술측시후,재차기출상재부가쌍측추궁근라정내고정진행측시.주요관찰지표:척주삼유운동측시궤상측시3충모형가용쌍측추궁근라정고정전후요추생물역학특성적변화.결과:행3충단순추간융합후,요추적은정성능명현하강,부가료쌍측추궁근라정고정후,요추적각항은정성지표균증강,포괄뉴전역학지표야득도료흔대증강,유효증가료요추적강도.추간공입로추간융합술각항은정성지표도명현우우기타량충방법,설명추간공입로추간융합술적즉각은정성능재3자중최유우세.후로추간융합술적강도명현강우전로추간융합술,응변화응력야교전로추간융합술유우세,단시기뉴전은정성각불여전로추간융합술.결론:행단순추간융합술후,요추적은정성교정상대조조균소명현하강,재가용쌍측추궁근라정내고정후능유효지제고기은정성능.재3충추간융합술중,추간공입로추간융합술적요추즉각은정성능최우.
BACKGROUND:Operative approaches of lumbar interbody fusion include anterior (ALIF),posterior (PLIF) and transforaminal lumbar interbody fusion (TLIF).The resected structures and cage implantation sites are different,and the initial stability of lumbar spine is varied.OBJECTIVE:To compare the initial stability of lumbar spine following ALIF,PLIF or TLIF in combination with bilateral pedicle screw fixation.DESIGN:Comparative observation.MATERIALS:Fifteen samples of fresh calf lumbar spine were used.METHODS:Models ofALIE PLIF and TLIF were simulated.After examination as normal group,the samples were randomly divided into three groups (n=5).Besides anterior,posterior and transforaminal lumbar interbody fusion include anterior,bilateral pedicle screw fixation was performed.MAIN OUTCOME MEASURES:Biomechanical characteristics of the lumbar spine before and after ALIF,PLIF or TLIF in combination with bilateral pedicle screw fixation.RESULTS:Following three approaches of lumbar interbody fusion,the stability of lumbar spine was significantly reduced,which was enhanced after bilateral pedicle screw fixation (torsion indexes were also increased).In addition,rigidity of the lumbar spine was enhanced.The stability indexes of lumbar spine following TLIF were significantly greater than the other approaches,indicating the initial stability of TLIF was the best.The rigidity,stress,and swain of lumbar spine following PLIF were greater than ALIE but torsion indexes were smaller than ALIE CONCLUSION:The stability of lumbar spine following lumbar interbody fusion was significantly reduced compared with normal sample.But bilateral pedicle screw fixation greatly increases the stability.Among three types of lumbar interbody fusion,the initial stability of lumbar spine following TLIF is the best.