發(fā)布時間：2018-02-02 14:54

  本文關鍵詞： 單側椎弓根螺釘固定 關節(jié)突 椎間融合 開窗減壓 生物力學　出處：《吉林大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的：建立單邊內固定椎間融合與否及單純開窗減壓的離體實驗模型。探討不同腰椎術式對對側關節(jié)突生物力學的影響及其臨床意義，為臨床腰椎退行性疾病手術適應癥的把握、合理的術式及內固定器械的選擇提供生物力學基礎。 方法：取6具T12-L5小牛新鮮脊柱標本，模擬腰4、5退變先后制作單純開窗減壓（同側內1/3關節(jié)突切除）、單純單側椎弓根內固定（間盤及同側關節(jié)突切除）和單側椎弓根固定椎間融合模型。分別測量各標本在不同方式處理前后前屈、后伸載荷應力情況下對側關節(jié)突周圍不同測點（L3下關節(jié)突、L4上關節(jié)突、L4下關節(jié)突、L5上關節(jié)突）的應變值，以單向虎克定律計算各測點的應力值。結果采用統(tǒng)計學分析，通過使用SPSS16.0軟件包（SPSS,Chicago，IL,USA）進行數據分析，計算其標準差、平均差，各組間數據差異的比較采用Sceffe法進行比較。（P＜0.05為差異有顯著性意義）。 結果：單側內固定組在前屈后伸負荷下手術節(jié)段對側關節(jié)突周圍應力均大于單純開窗組及對照組，差異顯著。單側固定椎間融合組在前屈后伸負荷下手術節(jié)段對側關節(jié)突周圍應力明顯小于開窗組及對照組，差異顯著。各組前屈后伸負荷下上位鄰近節(jié)段關節(jié)突周圍應力均無統(tǒng)計學差異。 結論：小關節(jié)突穩(wěn)定性對完整脊柱及術后脊柱穩(wěn)定性具有重要意義，，小關節(jié)突破壞后單純單側內固定難以有效重建脊柱穩(wěn)定性，單側內固定椎間融合在前屈后伸狀態(tài)下能夠提供足夠的生物力學穩(wěn)定性。
[Abstract]:Objective: to establish an experimental model of unilateral intervertebral fusion and decompression with fenestration, and to explore the effect of different lumbar vertebrae on the biomechanics of contralateral articular process and its clinical significance. To provide biomechanical basis for clinical lumbar degenerative disease operation indication, reasonable operation method and choice of internal fixation instrument. Methods: 6 fresh spinal specimens of T12-L5 calves were taken and decompressed by fenestration (ipsilateral 1/3 articular process resection). Simple unilateral pedicle internal fixation (disc and ipsilateral arthrodesis) and unilateral pedicle fixation intervertebral fusion model were used to measure the anterior flexion of each specimen before and after treatment in different ways. Strain value of L3 inferior articular process L4 upper articular process L4 inferior articular process L5 upper articular process under extension stress. The stress values of each measuring point were calculated by using one-way Hook's law. Results the data were analyzed by using SPSS16.0 software package SPSS Chicagosil USA. The standard deviation and average deviation were calculated and the difference of data among groups was compared by Sceffe method (P < 0. 05). Results: the stress around the contralateral articular process in unilateral internal fixation group was higher than that in single fenestration group and control group. The stress around the contralateral articular process in the unilateral fixation fusion group was significantly lower than that in the windowed group and the control group under the load of anterior flexion and extension. There was no significant difference in periarticular stress between the upper and adjacent segments under the load of flexion and extension. Conclusion: the stability of facet process is of great significance to the stability of the whole spine and the postoperative spine. It is difficult to reconstruct the stability of the spinal column by unilateral internal fixation after the destruction of the facet process. Unilateral intervertebral fusion can provide enough biomechanical stability under flexion and extension.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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