腰椎微创棘突间撑开系统的实验研究

发布时间：2018-11-22 09:11

【摘要】：目的:1.评估腰椎微创棘突间撑开系统对于置入节段及临近节段的活动度等生物力学性能的影响2.评价腰椎微创棘突间撑开系统应用于动物模型的可行性、安全性及有效性。方法:1.利用一名成年健康志愿者的CT数据,建立正常腰椎有限元模型及L4,5置入微创棘突间撑开系统的有限元模型,施加400N的轴向载荷以及前屈/后伸/侧弯/扭转等4个方向上1ON·m的扭矩载荷,对比L4,5和邻近节段的活动度及椎间盘最大应力变化,观察L4,5棘突和撑开器应力分布情况。2.应用腰椎微创棘突间撑开系统于4具新鲜腰椎尸体标本(L2-S1),固定在MotionAnalysis光学动作捕获系统中,施加前屈/后伸/侧弯/旋转等4个方向的纯扭矩8N·m,对比L4,5节段及邻近节段活动度的变化。3.应用腰椎微创棘突间撑开系统于8头巴马小型猪(25-30kg) L4,5棘突间隙,对比置入前后L4,5椎间孔直径、椎间孔横径、椎间盘前高度和椎间盘后高度等参数,观察撑开系统的置入过程、术后血液化验结果及小型猪有无神经功能异常。结果:1.腰椎微创棘突间撑开系统有限元模型中,后伸运动时L4,5节段活动度和椎间盘最大应力分别减少71.4%和83.4%,前屈/侧弯/旋转运动的活动度和椎间盘最大应力均无显著变化,邻近节段4个方向上各参数均无显著变化;后伸运动时L4棘突达最大应力56.8 Mpa,L5棘突达最大应力36.5 Mpa,撑开系统达最大应力36.0Mpa。2.新鲜尸体腰椎标本植入微创棘突间撑开系统,后伸运动时L4,5节段活动度显著减小(t=-3.444, P=0.009),前屈/侧弯/扭转运动时两组间的活动度差异均无统计学意义(P0.05);邻近节段4个方向上活动度差异均无统计学意义(P0.05) 。3. 8例巴马小型猪模型均成功置入腰椎微创棘突间撑开系统;术后L4,5椎间孔直径显著增大(t=-2.214,P=0.044),椎间孔横径显著增大(t=-1.824, P=0.012),椎间盘后高度显著增大(t=-2.441,P=0.029),椎间盘前高度差异无统计学意义(t=-0.691,P=0.501);血液化验正常,活动良好并无神经异常症状。结论:腰椎微创棘突间撑开系统的应用是安全可行的,有效地限制置入节段后伸运动,增加该节段椎间孔直径、横径和椎间盘后高度等解剖学参数,具有减轻腰椎退变性疾病临床症状的疗效。
[Abstract]:Objective: 1. To evaluate the effect of lumbar minimally invasive interspinous process distraction system on biomechanical properties of implanted and adjacent segments. To evaluate the feasibility, safety and effectiveness of lumbar minimally invasive interspinous process distraction system in animal models. Methods: 1. Using CT data of a healthy adult volunteer, a finite element model of normal lumbar vertebrae and a minimally invasive interspinous protruding system were established. The axial load of 400N and the torque load of 1ON m in four directions of forward flexion / extension / lateral bending / torsion were applied to compare the range of motion and maximum stress of intervertebral disc between L4C5 and adjacent segments, and observe the stress distribution of spinous process and distractor of L4C5. 2. Four fresh lumbar vertebrae cadavers (L2-S1) were immobilized in the MotionAnalysis optical motion capture system with a minimally invasive spinous process protruding system. The pure torque of 8N m was applied in the four directions of flexion / extension / lateral bending / rotation. The changes of the activity of L4 ~ (5) segment and adjacent segment were compared with that of L4 ~ (5) segment and adjacent segment. 3. The intervertebral foramen diameter, transverse diameter of intervertebral foramen, anterior height of intervertebral disc and posterior height of intervertebral disc were compared in 8 25-30kg miniature pigs (25-30kg) by lumbar minimally invasive interspinous process protruding system in the intervertebral foramen diameter, transverse diameter of intervertebral foramen, anterior height of intervertebral disc and posterior height of intervertebral disc. To observe the procedure of placement of distraction system, the results of blood test after operation and the neurological abnormality in miniature pigs. Results: 1. In the finite element model of lumbar minimally invasive interspinous process distraction system, the range of motion and the maximum stress of intervertebral disc decreased by 71.4% and 83.4%, respectively. There was no significant change in the range of motion and the maximum stress of intervertebral disc in the flexion / lateral bending / rotation motion, and no significant change in the parameters in the four directions of adjacent segments. The maximum stress of L _ 4 spinous process is 56.8 Mpa,L5 and the maximum stress is 36.5 Mpa, during extension. The maximum stress is 36.0Mpa.2. Fresh cadaveric lumbar vertebrae specimens were implanted with a minimally invasive interspinous process distraction system, and the activity of L4L 5 segments decreased significantly during extension (t = -3.444, P = 0.009). There was no significant difference in activity between the two groups during flexion / lateral bending / torsion (P0.05). There was no significant difference in the activity of adjacent segments in four directions (P0.05). Eight Bama miniature pig models were successfully implanted into the lumbar spine minimally invasive interspinous process distraction system. After operation, the diameter of intervertebral foramen in L4 / 5 was significantly increased (t = 2.214), the transverse diameter of intervertebral foramen was significantly increased (t = 1.824, P = 0.012), and the height of intervertebral disc was significantly increased (t = 2.441U, P = 0.029). There was no significant difference in anterior intervertebral disc height (t = 0.691P = 0.501). Normal blood test, good activity and no neurological symptoms. Conclusion: the application of lumbar minimally invasive interspinous process distraction system is safe and feasible. It can effectively limit the extension motion of the inserted segment and increase the anatomical parameters such as the diameter of intervertebral foramen, transverse diameter and the height of the intervertebral disc. It can reduce the clinical symptoms of lumbar degenerative disease.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

【相似文献】