腰椎单侧椎弓根螺钉固定与单纯开窗减压后对侧小关节突生物力学变化的比较

发布时间：2018-02-02 14:54

本文关键词： 单侧椎弓根螺钉固定关节突椎间融合开窗减压生物力学　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：建立单边内固定椎间融合与否及单纯开窗减压的离体实验模型。探讨不同腰椎术式对对侧关节突生物力学的影响及其临床意义，为临床腰椎退行性疾病手术适应症的把握、合理的术式及内固定器械的选择提供生物力学基础。方法：取6具T12-L5小牛新鲜脊柱标本，模拟腰4、5退变先后制作单纯开窗减压（同侧内1/3关节突切除）、单纯单侧椎弓根内固定（间盘及同侧关节突切除）和单侧椎弓根固定椎间融合模型。分别测量各标本在不同方式处理前后前屈、后伸载荷应力情况下对侧关节突周围不同测点（L3下关节突、L4上关节突、L4下关节突、L5上关节突）的应变值，以单向虎克定律计算各测点的应力值。结果采用统计学分析，通过使用SPSS16.0软件包（SPSS,Chicago，IL,USA）进行数据分析，计算其标准差、平均差，各组间数据差异的比较采用Sceffe法进行比较。（P＜0.05为差异有显著性意义）。结果：单侧内固定组在前屈后伸负荷下手术节段对侧关节突周围应力均大于单纯开窗组及对照组，差异显著。单侧固定椎间融合组在前屈后伸负荷下手术节段对侧关节突周围应力明显小于开窗组及对照组，差异显著。各组前屈后伸负荷下上位邻近节段关节突周围应力均无统计学差异。结论：小关节突稳定性对完整脊柱及术后脊柱稳定性具有重要意义，，小关节突破坏后单纯单侧内固定难以有效重建脊柱稳定性，单侧内固定椎间融合在前屈后伸状态下能够提供足够的生物力学稳定性。
[Abstract]:Objective: to establish an experimental model of unilateral intervertebral fusion and decompression with fenestration, and to explore the effect of different lumbar vertebrae on the biomechanics of contralateral articular process and its clinical significance. To provide biomechanical basis for clinical lumbar degenerative disease operation indication, reasonable operation method and choice of internal fixation instrument. Methods: 6 fresh spinal specimens of T12-L5 calves were taken and decompressed by fenestration (ipsilateral 1/3 articular process resection). Simple unilateral pedicle internal fixation (disc and ipsilateral arthrodesis) and unilateral pedicle fixation intervertebral fusion model were used to measure the anterior flexion of each specimen before and after treatment in different ways. Strain value of L3 inferior articular process L4 upper articular process L4 inferior articular process L5 upper articular process under extension stress. The stress values of each measuring point were calculated by using one-way Hook's law. Results the data were analyzed by using SPSS16.0 software package SPSS Chicagosil USA. The standard deviation and average deviation were calculated and the difference of data among groups was compared by Sceffe method (P < 0. 05). Results: the stress around the contralateral articular process in unilateral internal fixation group was higher than that in single fenestration group and control group. The stress around the contralateral articular process in the unilateral fixation fusion group was significantly lower than that in the windowed group and the control group under the load of anterior flexion and extension. There was no significant difference in periarticular stress between the upper and adjacent segments under the load of flexion and extension. Conclusion: the stability of facet process is of great significance to the stability of the whole spine and the postoperative spine. It is difficult to reconstruct the stability of the spinal column by unilateral internal fixation after the destruction of the facet process. Unilateral intervertebral fusion can provide enough biomechanical stability under flexion and extension.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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