CAJ | 학술논문

目的评价置入腰椎棘突间动态稳定装置Coflex不同位置后的腰椎即刻生物力学稳定性,确定其最佳置入位置.方法采用6具新鲜成人尸体腰椎标本(L1～L5),将标本两端固定在生物力学测试系统上.选取L3～4节段为手术节段,L3、L4椎体各置入1枚钢体,附带4个标记点用以记录手术节段运动范围.分别对腰椎标本完整组(保留腰椎韧带及关节突关节)、部分失稳组(切除L3 ～4节段棘间韧带、黄韧带,切开双侧小关节囊,切除L3双侧下关节突50％的内侧骨性结构)、10 mm组(Coflex的U形顶端与硬脊膜之间距离为10 mm)、5 mm组(距离为5 mm)、0 mm组(距离为0 mm)分别加载8N·m的纯力矩进行前屈、后伸、左右侧弯、左右侧旋6个方向的生物力学测试,重复加载3次,于第3次加载时记录手术节段的运动范围.对5组标本在6个方向的手术节段运动范围分别行单个重复因素的重复测量方差分析,两两对比采用LSD检验.结果 5组标本在前屈、后伸、左右侧弯、左右侧旋6个方向的运动范围差异均有统计学意义(F=8.472、18.301、7.700、12.473、16.809、6.624,均P＜0.01).10 mm组较完整组在6个方向的运动范围显著增加(t=3.80、3.82、4.49、5.60、4.96、2.98,均P＜0.01),较失稳组差异无统计学意义(P＞0.05).5 mm组和0 mm组在前屈、后伸、左右侧旋4个方向的运动范围较完整组差异无统计学意义(P＞0.05),较部分失稳组显著减少(5 mm组:t =3.19、6.34、5.26、3.43,均P＜0.01；0 mm组:t=4.21、6.68、5.81、3.72,均P＜0.01)；在左右侧弯2个方向的运动范围较完整组显著增加(5 mm组:t=3.71和5.22,P＜0.01;0 mm组:t=3.44和4.95,P＜0.01),较部分失稳组差异无统计学意义(P＞0.05).结论腰椎棘突间动态稳定装置Coflex的U形顶端与硬脊膜的距离≤5 mm时,其能在前屈、后伸、左右侧旋4个方向将部分失稳标本恢复到完整标本状态,在左右侧弯2个方向不能恢复部分失稳标本的稳定性；≥10 mm时在6个方向均不能恢复部分失稳标本的稳定性. 目的評價置入腰椎棘突間動態穩定裝置Coflex不同位置後的腰椎即刻生物力學穩定性,確定其最佳置入位置.方法採用6具新鮮成人尸體腰椎標本(L1～L5),將標本兩耑固定在生物力學測試繫統上.選取L3～4節段為手術節段,L3、L4椎體各置入1枚鋼體,附帶4箇標記點用以記錄手術節段運動範圍.分彆對腰椎標本完整組(保留腰椎韌帶及關節突關節)、部分失穩組(切除L3 ～4節段棘間韌帶、黃韌帶,切開雙側小關節囊,切除L3雙側下關節突50％的內側骨性結構)、10 mm組(Coflex的U形頂耑與硬脊膜之間距離為10 mm)、5 mm組(距離為5 mm)、0 mm組(距離為0 mm)分彆加載8N·m的純力矩進行前屈、後伸、左右側彎、左右側鏇6箇方嚮的生物力學測試,重複加載3次,于第3次加載時記錄手術節段的運動範圍.對5組標本在6箇方嚮的手術節段運動範圍分彆行單箇重複因素的重複測量方差分析,兩兩對比採用LSD檢驗.結果 5組標本在前屈、後伸、左右側彎、左右側鏇6箇方嚮的運動範圍差異均有統計學意義(F=8.472、18.301、7.700、12.473、16.809、6.624,均P＜0.01).10 mm組較完整組在6箇方嚮的運動範圍顯著增加(t=3.80、3.82、4.49、5.60、4.96、2.98,均P＜0.01),較失穩組差異無統計學意義(P＞0.05).5 mm組和0 mm組在前屈、後伸、左右側鏇4箇方嚮的運動範圍較完整組差異無統計學意義(P＞0.05),較部分失穩組顯著減少(5 mm組:t =3.19、6.34、5.26、3.43,均P＜0.01；0 mm組:t=4.21、6.68、5.81、3.72,均P＜0.01)；在左右側彎2箇方嚮的運動範圍較完整組顯著增加(5 mm組:t=3.71和5.22,P＜0.01;0 mm組:t=3.44和4.95,P＜0.01),較部分失穩組差異無統計學意義(P＞0.05).結論腰椎棘突間動態穩定裝置Coflex的U形頂耑與硬脊膜的距離≤5 mm時,其能在前屈、後伸、左右側鏇4箇方嚮將部分失穩標本恢複到完整標本狀態,在左右側彎2箇方嚮不能恢複部分失穩標本的穩定性；≥10 mm時在6箇方嚮均不能恢複部分失穩標本的穩定性.
목적 평개치입요추극돌간동태은정장치Coflex불동위치후적요추즉각생물역학은정성,학정기최가치입위치.방법 채용6구신선성인시체요추표본(L1～L5),장표본량단고정재생물역학측시계통상.선취L3～4절단위수술절단,L3、L4추체각치입1매강체,부대4개표기점용이기록수술절단운동범위.분별대요추표본완정조(보류요추인대급관절돌관절)、부분실은조(절제L3 ～4절단극간인대、황인대,절개쌍측소관절낭,절제L3쌍측하관절돌50％적내측골성결구)、10 mm조(Coflex적U형정단여경척막지간거리위10 mm)、5 mm조(거리위5 mm)、0 mm조(거리위0 mm)분별가재8N·m적순력구진행전굴、후신、좌우측만、좌우측선6개방향적생물역학측시,중복가재3차,우제3차가재시기록수술절단적운동범위.대5조표본재6개방향적수술절단운동범위분별행단개중복인소적중복측량방차분석,량량대비채용LSD검험.결과 5조표본재전굴、후신、좌우측만、좌우측선6개방향적운동범위차이균유통계학의의(F=8.472、18.301、7.700、12.473、16.809、6.624,균P＜0.01).10 mm조교완정조재6개방향적운동범위현저증가(t=3.80、3.82、4.49、5.60、4.96、2.98,균P＜0.01),교실은조차이무통계학의의(P＞0.05).5 mm조화0 mm조재전굴、후신、좌우측선4개방향적운동범위교완정조차이무통계학의의(P＞0.05),교부분실은조현저감소(5 mm조:t =3.19、6.34、5.26、3.43,균P＜0.01；0 mm조:t=4.21、6.68、5.81、3.72,균P＜0.01)；재좌우측만2개방향적운동범위교완정조현저증가(5 mm조:t=3.71화5.22,P＜0.01;0 mm조:t=3.44화4.95,P＜0.01),교부분실은조차이무통계학의의(P＞0.05).결론 요추극돌간동태은정장치Coflex적U형정단여경척막적거리≤5 mm시,기능재전굴、후신、좌우측선4개방향장부분실은표본회복도완정표본상태,재좌우측만2개방향불능회복부분실은표본적은정성；≥10 mm시재6개방향균불능회복부분실은표본적은정성.
Objective To evaluate the optimal insertion position of the Coflex lumbar interspinous dynamic stabilization device.Methods Six fresh adult human cadaveric lumbar spine specimens (L1-L5) were mounted in a materials testing machine by embedding to clamps with L1 and Ls vertebrae.L3-4 motion segment of each specimen was operated by selective decompression and Coflex interspinous device insertion.The L3 and L4 vertebrae was inserted one needle attached with four marker points respectively,which were used to record the range of motion (ROM).Each lumbar spine specimen was tested according to the loading sequence at 5 groups:intact (keeping lumbar ligamenta and facet joints intact) group,partial destabilized (resection of L3-4 interspinous ligamenta,ligamentum flavum,facet capsule,and bilateral resection 50％ of L3 inferior facets)group,10 mm insertion (distance between apex of U-shaped Coflex and dural sac was 10 mm) group,5 mm insertion (distance was 5 mm) group,and 0 mm insertion (distance was 0 mm) group.Each lumbar spine specimen was tested repeatedly 3 times according to a loading sequence consisting of flexion,extension,left/right lateral bending,left/right axial rotation,loaded with pure moments of 8 N · m,and was recorded the ROM of operative segment at the third time.ROM of 5 groups in 6 directions respectively were analyzed with one-way ANOVA test and multiple comparisons were based on LSD method.Results The means ROM of 5 groups were not all equal in flexion,extension,left/right lateral bending,left/right axial rotation (F =8.472,18.301,7.700,12.473,16.809,6.624 ; all P ＜ 0.01).The 10 mm insertion group had significant high ROM in 6 directions than the intact group(t =3.80,3.82,4.49,5.60,4.96,2.98,all P ＜ 0.01),but it was no difference comparing with the partial destabilized group (P ＞0.05).The ROM of the 5 mm and 0 mm insertion group were no significant differences comparing with the intact group in flexion,extension,left/right axial rotation (P ＞ 0.05),but it were significant differences comparing with the partial destabilized group in the same directions(5 mm insertion group:t =3.19,6.34,5.26,3.43,all P ＜0.01 ;0 mm insertion group:t =4.21,6.68,5.81,3.72,all P ＜ 0.01).There were significant differences in the ROM of left/right lateral bending between the 5mm/0mm insertion groups and the intact group(5 mm insertion group:t =3.71 and 5.22,all P ＜ 0.01 ; 0 mm insertion group:t =3.44 and 4.95,all P ＜ 0.01),but there were no differences comparing with the partial destabilized group in the same directions (P ＞ 0.05).Conclusions The insertion of Coflex interspinous dynamic stabilization device can maintain the stability of a partially destabilized specimen back to an intact one in flexion,extension and axial rotation when distance between apex of U-shaped Coflex and dural sac was ≤ 5 mm,but can't return the stability in lateral bending.The Coflex can't return the stability of a partially destabilized specimen back to an intact one in 6 directions when distance between apex of U-shaped Coflex and dural sac was ≥ 10 mm.