融合与非融合稳定方式对损伤性腰椎活动影响的对比

发布时间：2018-05-27 20:53

  本文选题：生物力学 + 椎间盘退化　； 参考：《中国组织工程研究》2017年31期

【摘要】：背景:腰椎退行性病变是腰椎自然老化、退化的生理病理过程,严重影响着患者的生活质量。传统的手术方式会带来一些并发症,棘突间动态固定Coflex临床效果不错,但是缺乏实验数据的支持。目的:研究腰椎稳定方式对其运动影响,从生物力学角度为临床手术提出参考意见。方法:选取新鲜的猪腰椎制备实验模型5组:分别为正常状态(A组)、损伤状态(B组)、L_3-L_4Coflex固定(C组)、L_3-L_4Coflex固定+减压(D组)、L_3-L_4椎间融合固定(E组)。运用机器人手臂系统对每具标本5种模型进行前屈/后伸、左/右侧弯、左/右轴向旋转6个方向的生物力学加载;通过多方向力矩传感器采集加载力矩,配合三维动作捕捉系统记录手术节段及整体腰椎的运动范围,分析稳定方式对腰椎运动的影响。结果与结论:(1)4个实验组(B、C、D、E)中,腰椎手术节段(L_3-L_4)的三维角度变化范围与正常状态相比,Coflex固定组与正常状态组间差异较小,而损伤状态组、融合组与正常状态组差异较大;(2)融合组虽然可以恢复损伤后的腰椎活动度,但其活动角度与Coflex固定组相比小了很多;(3)结果表明,Coflex固定后可以将损伤状态的活动角度恢复到正常状态,维持腰椎稳定性的同时,还保留了一定的活动度。腰椎失稳后用Coflex弹性内固定较融合固定更好,固定后性能更接近正常腰椎。
[Abstract]:Background: lumbar degenerative disease is a natural aging and degenerative physiological and pathological process of lumbar vertebrae, which seriously affects the quality of life of patients. Traditional surgical methods can bring some complications, dynamic interspinous process fixation Coflex clinical effect is good, but the lack of experimental data support. Objective: to study the effect of lumbar stabilization mode on its motion, and to provide reference for clinical operation from biomechanical point of view. Methods: five experimental models of fresh porcine lumbar vertebrae were selected: normal group A, injury group B group L3-L4Coflex fixed and C group L3-L4Coflex fixed and D group L3-L4Coflex fixed decompression and D group L3-L4 intervertebral fusion fixation and fixation E group. The robot arm system is used to carry out the biomechanical loading in 6 directions of forward flexion / extension, left / right bending, left / right axial rotation to each specimen, and the loading moment is collected by multi-direction torque sensor. The motion range of the whole lumbar vertebrae and the operation segment were recorded with 3D motion capture system to analyze the influence of the stabilization mode on the lumbar vertebrae motion. Results and conclusion in the four experimental groups, the range of three dimensional angle changes of L3-L4) in the four experimental groups was smaller than that in the normal group and the Coflex fixation group, but the injury state group. The results showed that there was no significant difference between the Coflex fixation group and the normal group, but there was no significant difference between the Coflex fixation group and the normal group in the L3-L4). Although the fusion group can recover the lumbar vertebrae motion after injury, there is a great difference between the fusion group and the normal state group. But its activity angle was much smaller than that of Coflex fixation group. The results showed that Coflex fixation could restore the activity angle of injured state to normal state, maintain the stability of lumbar vertebrae, and at the same time retain a certain range of motion. Coflex elastic internal fixation is better than fusion fixation after lumbar instability, and its performance is closer to that of normal lumbar spine.
【作者单位】： 首都医科大学生物医学工程学院;首都医科大学临床生物力学应用基础研究北京市重点实验室;中国医学科学院阜外医院;首都医科大学附属北京地坛医院骨外科学系;
【基金】：北京市教育委员会科技发展计划面上项目(KM201410025012) 首都医科大学基础临床合作重点项目(16JL08)~~
【分类号】：R687
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本文编号：1943708