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节段开窗髓核摘除对腰椎稳定性的影响 |
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阮狄克 吕维加 费正奇 陆瓞骥 沈根标
【摘要】目的本研究观察了腰椎椎板节段开窗髓核摘除对腰椎稳定性的影响。方法7具新鲜腰骶椎标本头尾端固定，模拟人体行屈曲、侧弯和旋转活动，随后顺序进行L3～S1椎板节段开窗及4-5、L5S1髓核摘除，对比观察术前和多节段椎板双侧开窗及髓核摘除术后腰椎各节段在三维空间的位移变化。结果单纯多节段开窗后于屈曲活动时L4，5前后水平和轴向位移分别增加18％和16％，L5S1则分别增加19％和45％。椎板开窗加髓核摘除后，屈曲活动时L4，5前后水平和轴向位移分别增加28％和71％，L5S1则分别增加14％和166％。统计学结果表明轴向位移差异有显著性意义，而在侧弯及旋转活动时差异均无显著性意义。腰椎的整体刚度术前、术后无明显变化。结论多节段椎板开窗髓核摘除对腰椎屈曲活动有影响，而对侧弯和旋转活动无明显影响。
【关键词】腰椎 开窗术 椎间盘切除术 生物力学
Stability of the Lumbar Spine After Segemental Fenestrations and Discectomies
RUAN Dike*，L Weijia,FEI Zhengqi,et al.
*Department of Orthopaedic Surgery,Navy General Hospital,Beijing 100037
【Abstract】 Objective To investigate the effects of graded fenestrations and discectomies on the whole lumbar spine,including segment stiffness, horizontal sagittal and vertical translation.Methods Seven fresh human cadaver specimens from lumbar 1 to sacrum were used in this study.The graded fenestrations and discectomies consisted of L4-5 bilateral fenestrations,L5S1 bilateral fenestration,L3-4 bilateral fenestration,L4-5 discectomy and L5S1 discectomy.Three kinds of loads,flexion,lateral bending and axial rotation(torsion),were applied.The ranges of motion(ROM) were determined in three-dimensions by the Elite system with two infrared-cameras.Results After the multiple fenestrations,the sagittal ranges of motion at L4-5 increased by 18％ in AP,and 16％ in vertical translation under the flexion loads.At L5S1,the motion increased by 19％ and 45％ respectively.After both fenestration and discectomies,the ranges of motion in the sagittal plane increased by 28％(horizontally) and 71％(vertically) at L4-5; 14％ and 166％ at L5S1.The motion increases were statiscally significant (P＜0.05)in vertical translations.However,after the graded surgeries,no significant motion were found in the lumbar segments during lateral bending as well as axial rotation.Conclusion The present results demonstrate that multilevel fenestrations and [1] [2] 下一页
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