中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2014年
2期
170-176
,共7页
曾忠友%吴鹏%陈国军%严卫锋%张建乔%裴斐%唐宏超%宋永兴%韩建福
曾忠友%吳鵬%陳國軍%嚴衛鋒%張建喬%裴斐%唐宏超%宋永興%韓建福
증충우%오붕%진국군%엄위봉%장건교%배비%당굉초%송영흥%한건복
脊柱损伤%骨折固定术,内%生物力学
脊柱損傷%骨摺固定術,內%生物力學
척주손상%골절고정술,내%생물역학
Spinal injuries%Fracture fixation,internal%Biomechanics
目的 对比腰椎双节段不同固定方式的力学稳定性. 方法 取6具正常成人甲醛固定腰椎标本(L2 ～S1),递进式采用不同固定方式行L3/4、L4/5固定并分为5组:A组(正常标本组)、B组(单侧椎板关节突螺钉固定+椎间融合器置入组)、C组(单侧椎弓根螺钉固定+椎间融合器置入组)、D组(单侧椎弓根螺钉联合对侧椎板关节突螺钉固定+椎间融合器置入组)和E组(双侧椎弓根螺钉固定+椎间融合器置入组).加载下分别测量、计算并对比每组固定节段的各向活动度、稳定指数、轴向位移和轴向刚度. 结果 相对正常标本组,4种固定方式均减少了固定节段L3/4和L4/5各向活动度,提高了脊柱的稳定性和刚度,但不同的固定方式间,其各向活动度和轴向位移的减少、稳定指数的提高和轴向刚度的增加不同,其中,B组与C组、D组与E组比较差异无统计学意义(P＞0.05),而D组分别与B组和C组、E组分别与B组和C组比较,差异有统计学意义(P＜0.01). 结论 单侧椎弓根螺钉联合对侧椎板关节突螺钉固定+椎间融合器置入可作为腰椎双节段固定融合的较好选择.
目的 對比腰椎雙節段不同固定方式的力學穩定性. 方法 取6具正常成人甲醛固定腰椎標本(L2 ～S1),遞進式採用不同固定方式行L3/4、L4/5固定併分為5組:A組(正常標本組)、B組(單側椎闆關節突螺釘固定+椎間融閤器置入組)、C組(單側椎弓根螺釘固定+椎間融閤器置入組)、D組(單側椎弓根螺釘聯閤對側椎闆關節突螺釘固定+椎間融閤器置入組)和E組(雙側椎弓根螺釘固定+椎間融閤器置入組).加載下分彆測量、計算併對比每組固定節段的各嚮活動度、穩定指數、軸嚮位移和軸嚮剛度. 結果 相對正常標本組,4種固定方式均減少瞭固定節段L3/4和L4/5各嚮活動度,提高瞭脊柱的穩定性和剛度,但不同的固定方式間,其各嚮活動度和軸嚮位移的減少、穩定指數的提高和軸嚮剛度的增加不同,其中,B組與C組、D組與E組比較差異無統計學意義(P＞0.05),而D組分彆與B組和C組、E組分彆與B組和C組比較,差異有統計學意義(P＜0.01). 結論 單側椎弓根螺釘聯閤對側椎闆關節突螺釘固定+椎間融閤器置入可作為腰椎雙節段固定融閤的較好選擇.
목적 대비요추쌍절단불동고정방식적역학은정성. 방법 취6구정상성인갑철고정요추표본(L2 ～S1),체진식채용불동고정방식행L3/4、L4/5고정병분위5조:A조(정상표본조)、B조(단측추판관절돌라정고정+추간융합기치입조)、C조(단측추궁근라정고정+추간융합기치입조)、D조(단측추궁근라정연합대측추판관절돌라정고정+추간융합기치입조)화E조(쌍측추궁근라정고정+추간융합기치입조).가재하분별측량、계산병대비매조고정절단적각향활동도、은정지수、축향위이화축향강도. 결과 상대정상표본조,4충고정방식균감소료고정절단L3/4화L4/5각향활동도,제고료척주적은정성화강도,단불동적고정방식간,기각향활동도화축향위이적감소、은정지수적제고화축향강도적증가불동,기중,B조여C조、D조여E조비교차이무통계학의의(P＞0.05),이D조분별여B조화C조、E조분별여B조화C조비교,차이유통계학의의(P＜0.01). 결론 단측추궁근라정연합대측추판관절돌라정고정+추간융합기치입가작위요추쌍절단고정융합적교호선택.
Objective To compare the biomechanical stability of different bisegment fixation methods for the lumbar spine.Methods Six adult cadaveric lumbar spines (L2-S1) were selected and fixed progressively with different fixation methods at L3/4-L4/5.The specimens were divided into five groups,Group A (normal specimen group),Group B (unilateral translaminar facet screw fixation + interbody cage fusion),Group C (unilateral pedicle screw fixation + interbody cage fusion),Group D (unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation + interbody cage fusion) and Group E (bilateral pedicle screw fixation + interbody cage fusion).After loading on the fixed segments in each group,range of motion (ROM),stability index,axial displacement as well as stiffness were measured and compared.Results Compared with normal specimen group,the four fixation modes reduced the ROM of L3/4-L4/5 in different directions and increased the stability and stiffness of the spine.Whereas,the reduced range of motion in different directions as well as axial displacement,increased stability index and enhanced stiffness varied among the groups.But in pair comparison,the difference was insignificant between Groups B and C and between Groups D and E (P ＞ 0.05).A significant difference was found in between Groups D and B,between Groups D and C,between Groups E and B and between Groups E and C (P ＜ 0.05).Conclusion Unilateral translaminar facet screw fixation combined with contralateral pedicle screw fixation + interbody cage fusion can be a favorable choice for bisegmental fixation and fusion of lumbar spine.
