CAJ | 학술논문

目的评价应用聚醚醚酮(poly-ether-ether-ketone,PEEK)椎间融合器行前路腰椎椎间融合的即刻生物力学稳定性.方法采用6具成人尸体腰椎标本,均来源于男性,X线榆查排除腰椎疾患和明显退行性改变,双能X线骨密度检查证实所有标本骨密度均处于正常范围.截取L4～S2节段腰椎,用自凝型聚甲基丙烯酸甲酯将标本两端固定在夹具内.沿腰椎轴线加载500N的预负荷后,分别在生物力学试验机上检测以下三种状态的前屈、后伸及侧屈各方向活动的即刻稳定性:完整腰椎标本,L5S1椎间盘切除、PEEK椎间融合器植入,辅以后路椎弓根螺钉系统固定.结果 L5S1椎间单纯椎间融合器植入后前屈、后伸、左侧屈方向的活动范围较完整腰椎标本分别减少76.9%、66.6%与81.1%;辅以后路惟弓根螺钉系统固定后,前屈、后伸、左侧屈方向的活动范围较完整腰椎标本分别减少93.9%、90%与86.6%.完整腰椎标本的空白对照组L4,5椎间前屈、后伸与左侧屈活动度分别为4.16°±0.33°、4.02°±0.30°、3.48°±0.34.;L5S1单纯椎间融合器组则分别为5.82°±0.36°、5.38°±0.30°、4.96°±0.29°;L5S1椎间融合器辅助椎弓根螺钉固定组则分别为4.82°±0.26°、5.76°±0.31°、3.98°±0.29°.L5S1椎间单纯椎间融合器植入及附加椎弓根螺钉崮定后,L4,5椎间相对活动度显著增加,各组间差异有统计学意义(P=0.000).结论单纯应用PEEK椎间融合器的前路腰椎椎间融合术即刻稳定性优于完整腰椎标本.辅以后路椎弓根螺钉系统固定后融合节段稳定性得到显著增强.
목적 평개응용취미미동(poly-ether-ether-ketone,PEEK)추간융합기행전로요추추간융합적즉각생물역학은정성.방법 채용6구성인시체요추표본,균래원우남성,X선유사배제요추질환화명현퇴행성개변,쌍능X선골밀도검사증실소유표본골밀도균처우정상범위.절취L4～S2절단요추,용자응형취갑기병희산갑지장표본량단고정재협구내.연요추축선가재500N적예부하후,분별재생물역학시험궤상검측이하삼충상태적전굴、후신급측굴각방향활동적즉각은정성:완정요추표본,L5S1추간반절제、PEEK추간융합기식입,보이후로추궁근라정계통고정.결과 L5S1추간단순추간융합기식입후전굴、후신、좌측굴방향적활동범위교완정요추표본분별감소76.9%、66.6%여81.1%;보이후로유궁근라정계통고정후,전굴、후신、좌측굴방향적활동범위교완정요추표본분별감소93.9%、90%여86.6%.완정요추표본적공백대조조L4,5추간전굴、후신여좌측굴활동도분별위4.16°±0.33°、4.02°±0.30°、3.48°±0.34.;L5S1단순추간융합기조칙분별위5.82°±0.36°、5.38°±0.30°、4.96°±0.29°;L5S1추간융합기보조추궁근라정고정조칙분별위4.82°±0.26°、5.76°±0.31°、3.98°±0.29°.L5S1추간단순추간융합기식입급부가추궁근라정고정후,L4,5추간상대활동도현저증가,각조간차이유통계학의의(P=0.000).결론 단순응용PEEK추간융합기적전로요추추간융합술즉각은정성우우완정요추표본.보이후로추궁근라정계통고정후융합절단은정성득도현저증강.
Objective To evaluate the instant biomechanical stability of anterior lumbar interbody fusion(ALIF)with a poly-ether-ether-ketone(PEEK)cage.Methods Six male human lumbar spines were collected; X-ray examination was performed to exclude pathology and obvious degenerative changes of the spines.Bone mineral densities of these spines were normal,identified by LUNAR DPX-L X-ray Bone Den-sitometer.L4-S2 segment were prepared and embedded to clamps.Preloads of 500 N was applied to speci-mens through longitudinal axis of the spine.Then the specimens were tested on the following 3 modes in flexion,extension and lateral bending: 1)intact lumbar spine; 2)stand alone ALIF on L5S1; 3)ALIF aug-mented with pedicle screw system.Results The range of motion(ROM)of stand alone ALIF decreased76.9%,66.6%,81.1% in flexion,extension and lateral bending respectively.The ROM of ALIF augmented with pedicle screw system further decreased 93.9%,90%,86.6% in flexion,extension and lateral bending respectively.The ROM of L4,5 increased significantly after stand alone ALIF alone and ALIF augmented with pedicle screw system in L5S1.Conclusion The instant stabilities of stand alone ALIF with PEEK cage are much better than intact lumbar spine.Pedicle screw system fixation can reinforce stability of ALIF signifi-cantly.