TLIF后路单双侧椎弓根螺钉骨水泥强化方式的生物力学对比研究
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1.上海中医药大学附属光华医院;2.上海健康医学院附属浦东新区人民医院

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基金项目:

上海市卫生和计划生育委员会面上项目(编号:201840361);上海市长宁区科学技术委员会重点项目(编号:CNKW2017Z05)


A comparative biomechanical study of transforaminal lumbar interbody fusion by unilateral or bilateral pedicle screws cement augmentation
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Affiliation:

1.Guanghua Hospital, Shanghai 2.University of Traditional Chinese Medicine;3.Pudong New Area People'4.'5.s Hospital,Shanghai University of Medicine and Health Sciences

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Shanghai Municipal Health Bureau (201840361);Shanghai Changning District Science & Technology Association (CNKW 2017Z05)

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    摘要:

    [目的] 比较后路经腰椎间孔椎间融合术(transforaminal lumbar interbody fusion, TLIF)结合单、双侧椎弓根螺钉骨水泥强化的稳定性。[方法] 采用6具老年脊柱标本(L1-5),在生物力学试验机上分别完成每具标本手术前、TLIF后路单侧椎弓根螺钉骨水泥强化术后、TLIF后路双侧椎弓根螺钉骨水泥强化术后前屈、后伸、左右侧弯及轴向加压测试,利用CCD摄像机采集标本形变图像,基于Image J软件,采用数字标记点质心跟踪法测量冠状面上固定节段的垂直位移来反应标本的稳定性,并进行统计学处理。[结果] TLIF后路单、双侧椎弓根螺钉骨水泥强化术后5种加载模式下的稳定性均高于术前,差异有统计学意义(P<0.05)。与TLIF后路双侧椎弓根螺钉骨水泥强化相比,单侧椎弓根螺钉骨水泥强化在轴向加压、前屈、后伸、右侧弯(强化侧)4种状态下的稳定性差异无统计学意义(P>0.05)。在左侧弯状态下的稳定性差异有统计学意义(P<0.05)。[结论] 两种不同椎弓根螺钉骨水泥强化方式的稳定性相当, TLIF后路单侧椎弓根螺钉骨水泥强化是一种值得推荐的手术方式。

    Abstract:

    [Objective] To analyze the biomechanical stability of transforaminal lumbar interbody fusion (TLIF) with unilateral and bilateral pedicle screws cement augmentation. [Method] Six lumbar samples (L1-5 spinal units)of fresh corpses were tested. These lumbar samples were tested by experimental machine under axial compression, flexion, extension, right and left lateral bending state before and after different fixations. Images of the forward and lateral views were obtained using two CCD cameras. Using Image J software, we calculated the vertical displacement of fixed segments in the lateral view by measuring the marker’s movement. Then the data were statistically processed. [Results] The stability of 5 loading modes after TLIF with bilateral pedicle screws cement augmentation and unilateral pedicle screws cement augmentation improved compared to preoperative state, and the difference was statistically significant(P<0.05). Compared with TLIF by bilateral pedicle screws cement augmentation, significant difference exists under left lateral bending state (P<0.05) and no differences showed up under flexion, extension, right (augmentation side) lateral bending state (P>0.05). [Conclusion] The stability obtained by the two ways of pedicle screw cement augmentation is almost the same. TLIF combined with unilateral pedicle screw cement augmentation is recommendable in clinical work.

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  • 收稿日期:2020-03-03
  • 最后修改日期:2020-03-03
  • 录用日期:2020-03-24
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