【作者】 张振山；

【导师】 李健；

【作者基本信息】 广州医学院 ， 外科学， 2011， 硕士

【摘要】 第一部分自体骨腰椎椎间融合器的制备及其生物力学研究研究目的本研究通过进行体外动物模型生物力学实验,模拟使用自行研发的器械(自体骨椎间融合成形器),制备自体骨腰椎椎间融合器,比较自体骨腰椎椎间融合器内固定与PEEK(聚醚醚酮)椎间融合器内固定的生物力学即刻稳定性,为临床上自体骨腰椎椎间融合器内固定术的应用及相关器械改良提供理论依据和实验指导。材料与方法1.选取12具健康成年猪的腰段均一脊柱标本(L1-L4),排除骨病后随机分为两组:自体骨腰椎椎间融合器结合椎弓根螺钉内固定组(实验组),PEEK椎间融合器结合椎弓根螺钉内固定组(对照组),每组6只。2.利用树脂包埋法及腰椎后路附件逐级破坏、椎间盘切除术制作腰椎不稳模型。实验组标本采用自体骨腰椎椎间融合器椎弓根螺钉内固定,对照组标本采用PEEK椎间融合器椎弓根螺钉内固定。使用脊柱三维运动测试模拟机对两组标本在正常、不稳、融合3个状态下进行前屈、后伸、左右侧屈、左右旋转等各个活动的生物力学测试。记录不同载荷下不稳节段的运动范围(Range ofmotion,ROM),并用SPSS16.0软件对数据进行比较分析。3.待两组标本三维运动逐一测量完毕后,再依次将标本置于MTS858材料试验机上进行拔出实验。记录每个样本的最大拔出力,并用SPSS16.0软件对数据进行比较分析。结果1.在正常及不稳状态下,实验组与对照组两组间比较各稳定度指标无统计学差异(P>0.05);两组内不稳状态各稳定度指标明显差于正常状态(P<0.05);融合后两组间L2-3节段椎间各稳定度指标无统计学差异(P>0.05)。2.在进行融合器最大拔出力测试中,实验组(自体骨椎间融合器)的最大拔出阻力为111.83±9.11N,对照组(PEEK椎间融合器)的最大拔出阻力为118.173±8.17N,两组最大拔出力比较无统计学差异(P>0.05);结论本研究所制备的自体骨腰椎椎间融合器,植入椎间后,结合椎弓根内固定,具有较好的生物力学即刻稳定性,为临床应用提供了力学基础。第二部分后路自体颗粒骨打压植骨椎间融合内固定术治疗下腰椎退变性不稳目的探讨后路自体颗粒骨打压植骨椎间融合内固定术治疗下腰椎退变性不稳的可行性及临床疗效。方法2007年1月至2010年1月收治下腰椎退变性不稳并神经根管狭窄患者60例。随机分为实验组和对照组各30例30节段。其中实验组行后路自体颗粒骨打压植骨椎间融合内固定术,对照组行椎间融合器植骨融合内固定术。两组患者术前一般资料比较差异无统计学意义(P >0.05)。比较两组患者手术资料、影像学结果及临床疗效。结果两组手术时间、术中出血量、下地时间差异无统计学意义(P >0.05);两组JOA及ODI评分均较术前改善(P<0.05),两组间差异无统计学意义(P >0.05);采用Macnab标准评价临床结果实验组优良率为90.0%,对照组为93.3%,两组间差异无统计学意义(P >0.05);两组术后一个月与术前相比椎间隙高度、椎间孔高度得到恢复(P<0.05),末次随访椎间隙高度、椎间孔高度均有丢失,但两组差异无统计学意义(P >0.05)。末次随访时实验组融合率为90%,对照组为93.3%,两组间差异无统计学意义(P >0.05);结论后路自体颗粒骨打压植骨腰椎椎体间融合术结合椎弓根螺钉系统固定可达到彻底减压、神经根松解、腰椎稳定性的重建、满意植骨合率的目的,具有并发症少的优点,是治疗下腰椎退变性不稳的安全、有效方法之一,值得推广应用。更多还原

【Abstract】 PartⅠPreparation and Biomechanical Research of Autogeneous Bone Lumbar Interbody Fusion CageObjectiveThe research made animal model building with pig spine. To produce autogeneous bone lumbar interbody fusion cage made by special instrument. To analyze and compare the biomechanical initial stability properties of the lumbar interbody fusion cage with vertebral pedicle screw fixation, PEEK cage with vertebral pedicle screw fixation, so as to provide theoretical basis and experiment guidance in clinical use of autogeneous bone lumbar interbody fusion cage with vertebral pedicle screw fixation in PLIF.Methods1. 12 fresh adult pigs separated the lumbarvertebrae involved 4 vertebrae segments (L1-L4) were obtained. To take the posteroanterior and lateral radiograph, removing muscles tissue carefully with the ligament and disc reserved. Randomly divided these specimens into 2 groups: autogeneous bone lumbar interbody fusion cage with vertebral pedicle screw fixation (experimental group), PEEK cage with vertebral pedicle screw fixation (control group). 2.Resin embedding method and graded facetectomy and discectomy were made to model the types of Spinal Instability. Experimental group used autogeneous bone lumbar interbody fusion cage with vertebral pedicle screw fixation; control group used PEEK cage with vertebral pedicle screw fixation. The 3-dimensional motion of specimens were tested in intacted state, instability state and fusion state, which the flexion, extension, bilateral bending and axial rotation loading were applied to the specimens and the range of motion(ROM) were determined by the 3-dimensional laser scanner. Analyzed the data with SPSS 16.0 software.3. After the 3-dimensional motional stability test finished, the specimens were measured on the MTS testing system.The pullout test was performed on MTS testing system. Recorded the largest pullout force and analyzed data with SPSS 16.0 software.Results1. There was no significant difference in all stability index between two groups in intact state (P>0.05). Compare with intact state,there was significant difference in all stability index in instable state in both groups(P<0.05). After PLIF,there was no significant difference in all stability index between two group(P>0.05).2. In the largest pullout force test of lumbar interbody fusion cage, the mean force of the experimental group was 111.83±9.11N,weaker than 118.173±8.17N that of control group(P>0.05).ConclusionThe produced autogeneous bone lumbar interbody fusion cage with vertebral pedicle screw fixation can provide the good biomechanical initial stability properties. PartⅡApplication of Posterior Lumbar Interbody Fusion(PLIF) with Autogenous Morselized Bone Graft Impaction in Degenerated Lumbar InstabilityObjective:To investigate the clinical feasibility and outcomes of patients for degenerated lumbar instability with foraminal stenosis treated by PLIF with autogenous morselized bone graft impaction.MethodsBetween January 2007 and January 2010,60 consecutive patients seeking PLIF treatment for degenerated lumbar instability with foraminal stenosis in our department were included in this study. All patients were randomized to autogenous morselized bone graft impaction fusion group (n=30) and to PEEK cage fusion group (n=30). There was no significant difference in preoperative general condition between two groups.The imaging and clinical outcome in the two groups were compared.Results:There was no significant difference in operative time , blood loss and walking time between two groups (P>0.05). there were significant difference preoperative and 1 month postoperative (P<0.05), while no significant difference in both groups(P>0.05). The clinical outcomes were determined using a Macnab criteria, which revealed that the excellent and good rate 90.0% in experimental group and 93.3% in control group(P>0.05). Both neuroforamen height and lumbar space height are ameliorated and maintained efficiently, there were significant difference preoperative and 1 month postoperative (P<0.05), while no significant difference postperative and 1 month postoperative in both index (P>0.05).The bony fusion rate was 90.0% in experimental group, 93.3% in control group(P>0.05). ConclusionAutogenous morselized bone graft impaction with pedicle screw fixation in posterior lumbar interbody fusion is a safe ,effective treatment for degenerated lumbar instability, because of its complete decompress,instant stability, reliable bony fusion, low complication rate, and worthy of popularization.更多还原