缝合修复椎间孔镜术后破损纤维环模型对椎间盘力学特性的影响

发布时间：2018-02-16 06:54

  本文关键词： 椎间孔镜下髓核摘除术 椎间盘修复 缝合 Maxon缝线　出处：《南京中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：椎间孔镜髓核摘除术治疗腰椎间盘突出症是脊柱十分常见有效的手术,可是伴随而来的髓核再突出和椎间盘退化加速这两个并发症又十分棘手,大多数学者认为椎间盘完整性破坏是原位再突出的主要原因。Cauthen研究证明直接缝合重建纤维环结构可以防止髓核突出,但是缺乏实验数据证明纤维环是否有力学特性改变或是改善椎间盘退变情况。本实验通过针刺苏中猪腰椎间盘来建立纤维环破损的模型,通过负荷测试来比较复杂缝合组和其他分组对破损纤维环修复后的产生的力学变化。目的(1)模拟椎间孔镜下髓核摘除术(PELD)术后椎间盘破损模型,离体及活体实验观测缝合纤维环生物力学改变及纤维环愈合情况。(2)观测一种新缝合方法是否可以促进术后破损椎间盘愈合和生物力学改变,将简单缝合的方法与复杂情况进行比较,观察它们的差异。根据结果分析微创器械下一针简单缝合是否具有理论意义。方法选择六头九月龄雌性苏中猪,对L2-6共婴个椎间盘随机分为四组：空白组(A组)、对照组(B组)、复杂缝合组(C组)、简单缝合组(D组)。B、C、D组在暴露椎管结构后,根据出口神经位置确定椎间盘位置,插入2.5mm克氏针,刺入深度控制12mm,停留时间3分钟后拔出克氏针,A组暴露后不破坏纤维环结构,作为假手术组。B组造模后不处理破损的纤维环结构,C组使用自行设计的改良铰合法缝合纤维环,D组使用普通外科缝合方式一针缝合破损纤维环缺口。C、D组均使用电子万能实验机固定缝线两端,在50N均匀拉力下完成四个外科结,保证打结齐同性。将四组处理完的样本固化后,使用电子万能机测量记录负荷下的受力-位移数据,使用分析软件测量泄漏压力情况,判断四组情况下力学特点。结果(1)加载负荷后,B、C、D组均可见从造模形成的破损纤维环缺损处泄漏的髓核组织,A组可见椎间盘高度丢失,髓核从挤压破裂的纤维环四周溢出。(2)加载负荷后,C、D组未见缝合线的断裂或滑结,缝线外观良好。(3)力学检测显示空白组(A组)、对照组(B组)、复杂缝合组(C组)、简单缝合组(D组)均在髓核漏出时发生明显的曲线陡峭,可以使用软件确定泄漏时的负荷压力值。(4)通过统计分析发现,复杂缝合组(C组)、简单缝合组(D组)与对照组(B组)组间配对T检验均有显著性差异(P0.05),泄漏压力明显高于B组。(5)简单缝合组(D组)与空白组(A组)组间配对T检验均有显著性差异(P0.05),泄漏压力明显小于生理状况下纤维环破损时压力；复杂缝合组(C组)与空白组(A组)组间配对T检验均无显著性差异(P0.05),虽不能说明改良式缝合方式与生理状况纤维环泄漏压力相当,当数值上明显优于剩余两组。(6)复杂缝合组(C组)和简单缝合组(D组)组间配对T检验均有显著性差异(P0.05),C组原位破损纤维环再破裂的负荷压力值明显高于D组。结论(1)纤维环损伤会导致轻微负荷情况下椎间盘内髓核的突出。(2)改良式铰合法可以为椎间盘提供更好的力学稳定性,与简单缝合组相比能抵抗更高的轴向负荷而不破裂。(3)简单缝合方式也能明显改善椎间盘的生物力学特性,且操作更加方便。(4)两种缝合情况下均未出现缝线断裂或滑结,单股聚甘醇碳酸可吸收缝线可用于维持缝合纤维环上的遗留缺损。
[Abstract]:Percutaneous transforaminal endoscopic discectomy for treatment of lumbar disc herniation is very common and effective spinal surgery, but accompanied by the nucleus pulposus of intervertebral disc degeneration and protrusion and accelerate the two complications is very difficult, most scholars believe that the integrity of intervertebral disc damage is the main reason to highlight the.Cauthen study demonstrated that in situ direct suture reconstruction fiber ring structure can prevent the nucleus pulposus, but the lack of experimental data to prove whether there is change in mechanical properties of fiber ring or improvement of intervertebral disc degeneration. The experiments of acupuncture in porcine lumbar disc Jiangsu to establish fiber ring damage model, through the load test to more complex suture group and other group produces damage mechanics change of fiber ring after repair. (1) simulated transforaminal endoscopic discectomy (PELD) postoperative intervertebral disc damage model in vitro and in vivo experimental observation of fiber ring suture Biomechanical changes and fiber ring healing. (2) to observe whether a new suture method can promote the postoperative healing of damaged intervertebral disc and biomechanical changes, the method is simple and complex suture were compared, observe their differences. According to the results of analysis of minimally invasive devices whether has the theoretical significance. Methods six simple suture needle head 9 month old female in pigs, for L2-6 common infant intervertebral disc were randomly divided into four groups: control group (A group) and control group (B group), complex suture group (C group), simple suture group (D group).B, C, D in the group exposed spinal structure, according to the determined disc the position of outlet nerve position, insert the 2.5mm Kirschner wire penetration depth control 12mm, residence time of 3 minutes after the Kirschner wire was removed after exposure, without destroying the fibrous ring structure of A group, sham operation group.B group after the model does not handle the breakage of the fiber ring structure, designed by modified C group Good hinge suture fiber ring, general surgery, D group using suture stitch broken fiber ring gap.C, D group were using the electronic universal testing machine and the fixed suture ends, the completion of the four surgical knot in the 50N uniform tension, to ensure homogeneity. Four groups of knotted processed samples fixed after using electronicuniversal measuring and recording machine load force displacement data, using the analysis software to measure leakage pressure, determine the mechanical characteristics of four groups of cases. Results (1) after loading, B, C, D groups were seen from the model of formation damage and the leakage of fiber ring defect of the nucleus pulposus of intervertebral, A group disc height loss, nucleus pulposus extruding from the rupture of the fibrous ring around the overflow. (2) loading, C, fracture group D no suture or suture knot, good appearance. (3) the mechanical test showed that the blank group (A group) and control group (B group), group C (complex suture simple suture group (group D). 缁，

本文编号：1514920