不同棘突间撑开高度对融合椎上位椎间稳定性的生物力学作用研究
发布时间：2019-06-02 07:58
【摘要】：目的:腰椎间盘突出症是骨科的常见病、多发病之一,自1934年提出至今,发病率呈上升趋势。腰椎融合术在治疗腰椎退行性变方面疗效显著,其主要的远期并发症为邻近节段退变。棘突间动态稳定系统,作为一种腰椎后路的非融合技术具有手术创伤小,可进行二次手术等特点。棘突间动态固定系统常用于治疗间歇性跛行等轻度腰椎管狭窄而引起的症状。本研究主要探究棘突间动态固定系统在延缓邻近节段退变过程当中的生物力学作用,为临床应用提供实验依据。方法:选用新鲜羊腰椎脊柱(L1-L5)样本,剔除附着肌肉,两端(L1头端、L5尾端)进行牙托粉包埋固定。分为4组进行实验:正常对照组—(CG组)脊柱骨性结构及韧带结构完整;不稳定组—(IG组)行L3/4节段双侧关节突关节切除;置钉组—(FG组)行L3/4节段双侧关节突关节切除、L3/4后路椎弓跟钉固定;混合固定组—(HG组)在FG组干预基础上,行L2/3节段间不同撑开高度的棘突间撑开(6mm、8mm、10mm、12mm、14mm、16mm、18mm)。样本包埋后用X线片确认脊柱完整性,然后在关节突关节处贴电阻应变片,贴片位置选取脊柱运动时关节突关节应变最大处。贴片完成后,校准三维动态捕捉系统,定义空间三维坐标系和脊柱转动角度正负值,应用克式针把刚体与椎体相连接,并通过软件定义克式针针尖为刚体的运动中心,克式针植入椎体中心。此后把样本固定在多自由度脊柱力学试验机上,调整机器参数,设定运行程序,采用扭矩控制,每组动作重复3次测定脊柱屈伸、侧弯和扭转方向上的活动度。实验开始后,应用MTS多自由度力学试验机在最大扭矩为5N·M的工况下测量脊柱前屈、后伸、侧屈、轴向旋转的活动度,同时应用NDI三维动态捕捉系统获取单个腰椎节段(L2、L3、L4)的活动度变化,应用电阻应变片测量关节突关节的应力值变化。各实验组顺次进行。结果:(1)全腰椎活动度:后伸活动度、轴向旋转活动度组间有统计学差异。16mm、18mm HG组与CG组、IG组、FG组相比,后伸活动度有统计学差异;18mm HG组与10mm、12mm HG组相比,后伸活动度有统计学差异。IG组与FG组、HG组相比,轴向旋转活动度有统计学差异(P0.05)。(2)单节段椎体活动度:各组L2、L3、L4节段活动度在前屈、后伸、侧弯、轴向旋转方向上差异均无统计学意义(P0.05)。线性回归分析显示,前屈工况下L3活动度、后伸工况下L2活动度与撑开距离呈正相关(P0.05)。(3)关节突关节应变值:在前屈、同侧侧弯、对侧侧弯工况下时,18mm HG组L4下关节突关节应变值与其他各组有统计学差异(P0.05)。在轴向旋转时,18mm HG对侧组L2上关节突关节应变值与CG组和FG组及其他撑开距离HG组间差异有统计学意义(P0.05);IG组L2上关节突关节应变值与8mm、12mm HG组有统计学差异(图2.5,P0.05)。结论:(1)联合应用单节段椎弓根钉固定和棘突间撑开装置能够在后伸工况下限制脊柱的运动。较小的棘突间撑开距离不会影响全腰椎活动度,较大的撑开距离能够限制腰椎矢状面活动度,显著减少腰椎活动度。(2)联合应用单节段椎弓根钉固定和棘突间撑开装置能够使融合节段的头侧节段以及融合节段的上位节段的活动度随着撑开距离的不断增大而减小,有利于提高腰椎的稳定性。单节段固定组与完整组相比,在后伸工况下,椎弓根钉固定节段头侧段和上位节段活动度均增加且两者运动方向相反,而固定节段的尾侧段活动度减少,这些都会加速上位邻近节段退变的发生。(3)联合应用单节段椎弓根钉固定和棘突间撑开装置,能够使邻近节段的关节突关节应力减小、减少非融合装置上位节段的应力,从而延缓邻近节段退变。临床工作中选择合适的撑开器,能够限制腰椎运动的同时减轻固定节段邻近节段以及撑开节段头侧节段的应力。(4)联合应用单节段椎弓根钉固定和棘突间撑开装置能够改变腰椎关节突关节的应力分布,限制某些节段的活动,进而延缓邻近节段退变。
[Abstract]:Objective: The protrusion of the lumbar intervertebral disc is one of the common diseases in the department of orthopedics, and the incidence of lumbar disc herniation has been on the rise since 1934. The major long-term complications of the lumbar interbody fusion in the treatment of lumbar degenerative changes are the degeneration of the adjacent segments. The dynamic stabilization system between the spinous processes has the characteristics of small operation wound and secondary operation and the like as a non-fusion technique of the posterior lumbar vertebra. The dynamic fixation system of interspinous processes is commonly used for the treatment of the symptoms caused by the narrow lumbar spinal stenosis such as intermittent claudication. The purpose of this study is to explore the biomechanical function of the interspinous dynamic fixation system in the process of delaying the degeneration of the adjacent segment, and to provide the experimental basis for clinical application. Methods: The specimens of the lumbar spine (L1-L5) of the fresh sheep were selected to remove the attached muscle and the two ends (the end of the L1 and the L5) were embedded and fixed. Four groups were divided into four groups: the normal control group (CG), the bony structure of the spinal column and the structure of the ligament, and the two-sided joint resection of the L3/4 segment in the non-stable group (IG group). The interspinous process (6 mm,8 mm,10 mm,12 mm,14 mm,16 mm,18 mm) was performed on the base of the FG group. The integrity of the spine was confirmed with x-rays after the sample was embedded, and then the strain gauge was applied to the joint of the articular process, and the joint strain at the joint was the largest at the location of the patch. After the patch is completed, the three-dimensional dynamic capturing system is calibrated, the three-dimensional coordinate system of the space and the rotation angle of the spinal column are positive and negative values are defined, the rigid body is connected with the vertebral body by using a gram-type needle, and a movement center of a rigid body is defined by a software-defined gram-type needle tip, and a gram-type needle is implanted into the vertebral body center. After that, the sample was fixed on the multi-degree-of-freedom spinal mechanical testing machine, the parameters of the machine were adjusted, the running procedure was set, and the torque control was adopted, and the motion of the spine in the flexion extension, the lateral bending and the torsion direction was repeated 3 times in each group. After the experiment, the range of motion of the anterior and posterior, lateral and axial rotation of the spine was measured with the MTS multi-degree-of-freedom mechanical testing machine at the maximum torque of 5 N 路 M, and the range of motion of the single lumbar segment (L2, L3, L4) was obtained by using the NDI three-dimensional dynamic capture system. The stress value of the articular process joint was measured by using a resistance strain gauge. The experimental groups were carried out in sequence. Results: (1) There was a statistical difference between the range of motion of the whole lumbar spine and the range of motion in the axial direction. Compared with the group of FG and HG, there was a significant difference in the range of axial rotation (P <0.05). (2) The range of motion of the single-segment vertebral body: the range of motion of L2, L3 and L4 in each group was not statistically significant in the anterior and posterior, lateral and axial directions (P0.05). The linear regression analysis showed that there was positive correlation between the range of activity of L2 and the distance of distraction under the pre-bending condition (P0.05). (3) Joint strain value of the joint process: the joint strain value of the articular process at the L4 lower joint of the 18 mm HG group was significantly different from the other groups (P0.05). At the time of axial rotation, there was a significant difference between the strain value of the articular process joint on the side group (L2) of the 18 mm HG group (P <0.05) and the difference between the group of CG and the group of FG (P <0.05), and the joint strain value of the articular process on the L2 of the IG group was significantly different from that in the group of 8 mm and 12 mm (Fig. 2.5, P0.05). Conclusion: (1) The fixation of the single-segment pedicle screw and the distraction device of the interspinous process can limit the movement of the spinal column under the post-extension condition. The distance between the smaller spinous processes does not affect the full-lumbar motion, and the larger distraction distance can limit the range of motion of the lumbar sagittal plane and significantly reduce the range of motion of the lumbar vertebra. And (2) the joint application of the single-segment pedicle screw fixation and the interspinous process distraction device can reduce the range of motion of the head-side segment of the fusion segment and the upper segment of the fusion segment with the increasing of the distraction distance, and is beneficial to the improvement of the stability of the lumbar vertebra. Compared with the whole group in the single-segment fixation group, the range of motion of the head and the upper segment of the pedicle screw in the post-extension condition is increased and the motion direction of the two segments is opposite, and the range of motion of the caudal segment of the fixed segment is reduced, which can accelerate the occurrence of the degeneration of the upper adjacent segment. And (3) the joint application of the single-segment pedicle screw fixation and the interspinous process distraction device can reduce the stress of the joint process joint of the adjacent segment and reduce the stress of the upper segment of the non-fusion device, thereby delaying the degeneration of the adjacent segment. The proper distractor is selected in clinical work, and the stress of the adjacent segment of the fixed segment and the segment head-side segment can be reduced while the lumbar motion is limited. And (4) the joint application of the single-segment pedicle screw fixation and the interspinous process distraction device can change the stress distribution of the lumbar joint process joint, limit the activity of certain segments, and further delay the degeneration of the adjacent segment.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
[Abstract]:Objective: The protrusion of the lumbar intervertebral disc is one of the common diseases in the department of orthopedics, and the incidence of lumbar disc herniation has been on the rise since 1934. The major long-term complications of the lumbar interbody fusion in the treatment of lumbar degenerative changes are the degeneration of the adjacent segments. The dynamic stabilization system between the spinous processes has the characteristics of small operation wound and secondary operation and the like as a non-fusion technique of the posterior lumbar vertebra. The dynamic fixation system of interspinous processes is commonly used for the treatment of the symptoms caused by the narrow lumbar spinal stenosis such as intermittent claudication. The purpose of this study is to explore the biomechanical function of the interspinous dynamic fixation system in the process of delaying the degeneration of the adjacent segment, and to provide the experimental basis for clinical application. Methods: The specimens of the lumbar spine (L1-L5) of the fresh sheep were selected to remove the attached muscle and the two ends (the end of the L1 and the L5) were embedded and fixed. Four groups were divided into four groups: the normal control group (CG), the bony structure of the spinal column and the structure of the ligament, and the two-sided joint resection of the L3/4 segment in the non-stable group (IG group). The interspinous process (6 mm,8 mm,10 mm,12 mm,14 mm,16 mm,18 mm) was performed on the base of the FG group. The integrity of the spine was confirmed with x-rays after the sample was embedded, and then the strain gauge was applied to the joint of the articular process, and the joint strain at the joint was the largest at the location of the patch. After the patch is completed, the three-dimensional dynamic capturing system is calibrated, the three-dimensional coordinate system of the space and the rotation angle of the spinal column are positive and negative values are defined, the rigid body is connected with the vertebral body by using a gram-type needle, and a movement center of a rigid body is defined by a software-defined gram-type needle tip, and a gram-type needle is implanted into the vertebral body center. After that, the sample was fixed on the multi-degree-of-freedom spinal mechanical testing machine, the parameters of the machine were adjusted, the running procedure was set, and the torque control was adopted, and the motion of the spine in the flexion extension, the lateral bending and the torsion direction was repeated 3 times in each group. After the experiment, the range of motion of the anterior and posterior, lateral and axial rotation of the spine was measured with the MTS multi-degree-of-freedom mechanical testing machine at the maximum torque of 5 N 路 M, and the range of motion of the single lumbar segment (L2, L3, L4) was obtained by using the NDI three-dimensional dynamic capture system. The stress value of the articular process joint was measured by using a resistance strain gauge. The experimental groups were carried out in sequence. Results: (1) There was a statistical difference between the range of motion of the whole lumbar spine and the range of motion in the axial direction. Compared with the group of FG and HG, there was a significant difference in the range of axial rotation (P <0.05). (2) The range of motion of the single-segment vertebral body: the range of motion of L2, L3 and L4 in each group was not statistically significant in the anterior and posterior, lateral and axial directions (P0.05). The linear regression analysis showed that there was positive correlation between the range of activity of L2 and the distance of distraction under the pre-bending condition (P0.05). (3) Joint strain value of the joint process: the joint strain value of the articular process at the L4 lower joint of the 18 mm HG group was significantly different from the other groups (P0.05). At the time of axial rotation, there was a significant difference between the strain value of the articular process joint on the side group (L2) of the 18 mm HG group (P <0.05) and the difference between the group of CG and the group of FG (P <0.05), and the joint strain value of the articular process on the L2 of the IG group was significantly different from that in the group of 8 mm and 12 mm (Fig. 2.5, P0.05). Conclusion: (1) The fixation of the single-segment pedicle screw and the distraction device of the interspinous process can limit the movement of the spinal column under the post-extension condition. The distance between the smaller spinous processes does not affect the full-lumbar motion, and the larger distraction distance can limit the range of motion of the lumbar sagittal plane and significantly reduce the range of motion of the lumbar vertebra. And (2) the joint application of the single-segment pedicle screw fixation and the interspinous process distraction device can reduce the range of motion of the head-side segment of the fusion segment and the upper segment of the fusion segment with the increasing of the distraction distance, and is beneficial to the improvement of the stability of the lumbar vertebra. Compared with the whole group in the single-segment fixation group, the range of motion of the head and the upper segment of the pedicle screw in the post-extension condition is increased and the motion direction of the two segments is opposite, and the range of motion of the caudal segment of the fixed segment is reduced, which can accelerate the occurrence of the degeneration of the upper adjacent segment. And (3) the joint application of the single-segment pedicle screw fixation and the interspinous process distraction device can reduce the stress of the joint process joint of the adjacent segment and reduce the stress of the upper segment of the non-fusion device, thereby delaying the degeneration of the adjacent segment. The proper distractor is selected in clinical work, and the stress of the adjacent segment of the fixed segment and the segment head-side segment can be reduced while the lumbar motion is limited. And (4) the joint application of the single-segment pedicle screw fixation and the interspinous process distraction device can change the stress distribution of the lumbar joint process joint, limit the activity of certain segments, and further delay the degeneration of the adjacent segment.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
【参考文献】
相关期刊论文 前9条
1 袁一;孔超;鲁世保;张美超;;人工腰椎间盘置换术后上位关节突关节内应力变化的研究[J];中国临床解剖学杂志;2014年01期
2 罗宇;谭家昌;肖奇攀;;小切口TLIF结合单侧钉棒及对侧关节突螺钉治疗腰椎退变性疾病[J];实用骨科杂志;2013年12期
3 曾忠友;严卫锋;陈国军;汤永华;吴鹏;宋永兴;金才益;张建乔;王斌;唐宏超;;单侧椎弓根螺钉联合对侧经皮椎板关节突螺钉固定治疗下腰椎病变的临床观察[J];中华骨科杂志;2011年08期
4 刘观q，
本文编号：2490946
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/2490946.html
最近更新
教材专著
