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腰椎棘突间动态稳定装置Coflex最佳置入位置的生物力学研究

The optimal insertion position of the lumbar interspinous dynamic stabilization device (Coflex) : a biomechanical evaluation

摘要:

目的 评价置入腰椎棘突间动态稳定装置Coflex不同位置后的腰椎即刻生物力学稳定性,确定其最佳置入位置.方法 采用6具新鲜成人尸体腰椎标本(L1~L5),将标本两端固定在生物力学测试系统上.选取L3~4节段为手术节段,L3、L4椎体各置入1枚钢体,附带4个标记点用以记录手术节段运动范围.分别对腰椎标本完整组(保留腰椎韧带及关节突关节)、部分失稳组(切除L3 ~4节段棘间韧带、黄韧带,切开双侧小关节囊,切除L3双侧下关节突50%的内侧骨性结构)、10 mm组(Coflex的U形顶端与硬脊膜之间距离为10 mm)、5 mm组(距离为5 mm)、0 mm组(距离为0 mm)分别加载8N·m的纯力矩进行前屈、后伸、左右侧弯、左右侧旋6个方向的生物力学测试,重复加载3次,于第3次加载时记录手术节段的运动范围.对5组标本在6个方向的手术节段运动范围分别行单个重复因素的重复测量方差分析,两两对比采用LSD检验.结果 5组标本在前屈、后伸、左右侧弯、左右侧旋6个方向的运动范围差异均有统计学意义(F=8.472、18.301、7.700、12.473、16.809、6.624,均P<0.01).10 mm组较完整组在6个方向的运动范围显著增加(t=3.80、3.82、4.49、5.60、4.96、2.98,均P<0.01),较失稳组差异无统计学意义(P>0.05).5 mm组和0 mm组在前屈、后伸、左右侧旋4个方向的运动范围较完整组差异无统计学意义(P>0.05),较部分失稳组显著减少(5 mm组:t =3.19、6.34、5.26、3.43,均P<0.01;0 mm组:t=4.21、6.68、5.81、3.72,均P<0.01);在左右侧弯2个方向的运动范围较完整组显著增加(5 mm组:t=3.71和5.22,P<0.01;0 mm组:t=3.44和4.95,P<0.01),较部分失稳组差异无统计学意义(P>0.05).结论 腰椎棘突间动态稳定装置Coflex的U形顶端与硬脊膜的距离≤5 mm时,其能在前屈、后伸、左右侧旋4个方向将部分失稳标本恢复到完整标本状态,在左右侧弯2个方向不能恢复部分失稳标本的稳定性;≥10 mm时在6个方向均不能恢复部分失稳标本的稳定性.

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abstracts:

Objective To evaluate the optimal insertion position of the Coflex lumbar interspinous dynamic stabilization device.Methods Six fresh adult human cadaveric lumbar spine specimens (L1-L5) were mounted in a materials testing machine by embedding to clamps with L1 and Ls vertebrae.L3-4 motion segment of each specimen was operated by selective decompression and Coflex interspinous device insertion.The L3 and L4 vertebrae was inserted one needle attached with four marker points respectively,which were used to record the range of motion (ROM).Each lumbar spine specimen was tested according to the loading sequence at 5 groups:intact (keeping lumbar ligamenta and facet joints intact) group,partial destabilized (resection of L3-4 interspinous ligamenta,ligamentum flavum,facet capsule,and bilateral resection 50% of L3 inferior facets)group,10 mm insertion (distance between apex of U-shaped Coflex and dural sac was 10 mm) group,5 mm insertion (distance was 5 mm) group,and 0 mm insertion (distance was 0 mm) group.Each lumbar spine specimen was tested repeatedly 3 times according to a loading sequence consisting of flexion,extension,left/right lateral bending,left/right axial rotation,loaded with pure moments of 8 N · m,and was recorded the ROM of operative segment at the third time.ROM of 5 groups in 6 directions respectively were analyzed with one-way ANOVA test and multiple comparisons were based on LSD method.Results The means ROM of 5 groups were not all equal in flexion,extension,left/right lateral bending,left/right axial rotation (F =8.472,18.301,7.700,12.473,16.809,6.624 ; all P < 0.01).The 10 mm insertion group had significant high ROM in 6 directions than the intact group(t =3.80,3.82,4.49,5.60,4.96,2.98,all P < 0.01),but it was no difference comparing with the partial destabilized group (P >0.05).The ROM of the 5 mm and 0 mm insertion group were no significant differences comparing with the intact group in flexion,extension,left/right axial rotation (P > 0.05),but it were significant differences comparing with the partial destabilized group in the same directions(5 mm insertion group:t =3.19,6.34,5.26,3.43,all P <0.01 ;0 mm insertion group:t =4.21,6.68,5.81,3.72,all P < 0.01).There were significant differences in the ROM of left/right lateral bending between the 5mm/0mm insertion groups and the intact group(5 mm insertion group:t =3.71 and 5.22,all P < 0.01 ; 0 mm insertion group:t =3.44 and 4.95,all P < 0.01),but there were no differences comparing with the partial destabilized group in the same directions (P > 0.05).Conclusions The insertion of Coflex interspinous dynamic stabilization device can maintain the stability of a partially destabilized specimen back to an intact one in flexion,extension and axial rotation when distance between apex of U-shaped Coflex and dural sac was ≤ 5 mm,but can't return the stability in lateral bending.The Coflex can't return the stability of a partially destabilized specimen back to an intact one in 6 directions when distance between apex of U-shaped Coflex and dural sac was ≥ 10 mm.

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作者: 祖丹 [1] 海涌 [1] 鲁世保 [1] 杨晋才 [1] 刘玉增 [1] 刘铁 [1] 孟祥龙 [1] 周立金 [1] 逄川 [1]
第一作者: 祖丹
期刊: 《中华外科杂志》2014年52卷3期 179-183页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2014.03.006
发布时间: 2014-04-01
基金项目:
北京市自然科学基金资助项目
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