中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (4): 620-624.doi: 10.3969/j.issn.1673-8225.2011.04.012

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

后纵韧带生物力学测试评价胸腰段脊柱前路减压后的稳定性

陈向东1,张  烽1,董士奎1,王以进2   

  1. 1南通大学附属医院骨科,江苏省南通市226001
    2上海大学生物力学研究所,上海市    200400
  • 收稿日期:2010-07-14 修回日期:2010-10-18 出版日期:2011-01-22 发布日期:2011-01-22
  • 通讯作者: 张烽,主任医师,教授,南通大学附属医院骨科,江苏省南通市226001 zhf1017@ hotmail.com
  • 作者简介:陈向东★,男,1970年生,江苏省海门市人,汉族,1993年南通医学院毕业,硕士,副主任医师,副教授,主要从事脊柱外科、创伤外科研究。 cxd8966@sina. com

A biomechanical test evaluates the stability of posterior longitudinal ligament following thoracolumbar anterior decompression  

Chen Xiang-dong1, Zhang Feng1, Dong Shi-kui1, Wang Yi-jin2   

  1. 1Department of Orthopaedics, Nantong University Affiliated Hospital, Nantong  226001, Jiangsu Province, China
    2Biomechanics Institute of Shanghai University, Shanghai  200400, China
  • Received:2010-07-14 Revised:2010-10-18 Online:2011-01-22 Published:2011-01-22
  • Contact: Zhang Feng, Chief physician, Professor, Department of Orthopaedics, Nantong University Affiliated Hospital, Nantong 226001, Jiangsu Province, China
  • About author:Chen Xiang-dong★, Master, Associate chief physician, Associate professor, Department of Orthopaedics, Nantong University Affiliated Hospital, Nantong 226001, Jiangsu Province, China cxd8966@sina.com

摘要:

背景:到目前为止,对于后纵韧带在胸腰段脊柱前路减压术式中所发挥的生物力学稳定作用的研究未见文献报道。
目的:通过生物力学测试,评价胸腰段脊柱后纵韧带在椎管前方减压自体髂骨植骨+Kaneda内固定过程中的作用。
方法:采用7具新鲜小牛胸腰段脊柱(T11~L3)标本,采用前后对照方法,按操作过程标记为:正常组→后纵韧带完整组(椎管前方减压植骨内固定,保留后纵韧带组)→后纵韧带切除组,应用实验应力方法测试各组的生物力学特性。模拟临床手术行L1椎体切除椎管前方减压自体髂骨植骨+Kaneda内固定,在脊柱WE-10A万能材料实验机上进行非破坏性生物力学测试,并计算应变、刚度、轴向压缩强度、扭转强刚度等数据,通过F检验分析数据。
结果与结论:胸腰椎椎管前方减压植骨+Kaneda内固定,局部切除后纵韧带使胸腰椎的稳定性在旋转、轴压、前屈、后伸、侧弯各运动状态下降,其中以前屈时最为明显,差异具有显著性意义(P < 0.05)。提示在胸腰段脊柱椎管前方减压过程中,局部切除后纵韧带将使术后脊柱稳定性在前屈状态时下降,不利于提高脊柱的融合率。因此应尽可能保留正常的后纵韧带。

关键词: 胸腰段脊柱, 后纵韧带, 生物力学, 内固定, 稳定性

Abstract:

BACKGROUND: Up to now, it is scarcely reported that the biomechanical stability of the thoracolumbar posterior longitudinal ligament (PLL) in anterior decompression.
OBJECTIVE: This biomechanical study was undertaken to determine the role of thoracolumbar PLL following anterior decompression and interbody iliac bone graft fixed with Kaneda instrumentation.
METHODS: A total of seven fresh calf thoracolumbar spines (T11-L3) following the trial procedure were noted as normal group (the PLL was intact without decompression and internal fixation), intact PLL group (the PLL was intact with decompression, bone graft and internal fixation), resected PLL group (the PLL was cut with decompression, bone graft and internal fixation). The biomechanical property was determined with experimental stress methods. L1 vertebra excision, anterior decompression and interbody iliac bone graft + Kaneda internal fixation were performed. Nondestructive biomechanical tests were performed with WE-10A testing machines. The data of strain, stress, axis compression stiffness, rotational rigidity were recorded and calculated, then analyzed by F test.
RESULTS AND CONCLUSION: Following thoracolumbar anterior decompression and bone graft + Kaneda internal fixation, when the PLL was cut, the stability of the specimen tended to decrease at rotation, axial compression, flexion, extension and lateral bending. The decrease at flexion was the most remarkable with significant differences (P < 0.05). During the thoracolumbar anterior decompression and internal fixation, the resection of the PLL may lead to the instability of spine cord at flexion, which is bad for bone graft fusion. So the normal PLL should be protected.

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