本文關(guān)鍵詞： 單側(cè)椎弓根螺釘固定 關(guān)節(jié)突 椎間融合 開窗減壓 生物力學(xué)　出處：《吉林大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：建立單邊內(nèi)固定椎間融合與否及單純開窗減壓的離體實(shí)驗(yàn)?zāi)Ｐ�。探討不同腰椎術(shù)式對對側(cè)關(guān)節(jié)突生物力學(xué)的影響及其臨床意義，為臨床腰椎退行性疾病手術(shù)適應(yīng)癥的把握、合理的術(shù)式及內(nèi)固定器械的選擇提供生物力學(xué)基礎(chǔ)。 方法：取6具T12-L5小牛新鮮脊柱標(biāo)本，模擬腰4、5退變先后制作單純開窗減壓（同側(cè)內(nèi)1/3關(guān)節(jié)突切除）、單純單側(cè)椎弓根內(nèi)固定（間盤及同側(cè)關(guān)節(jié)突切除）和單側(cè)椎弓根固定椎間融合模型。分別測量各標(biāo)本在不同方式處理前后前屈、后伸載荷應(yīng)力情況下對側(cè)關(guān)節(jié)突周圍不同測點(diǎn)（L3下關(guān)節(jié)突、L4上關(guān)節(jié)突、L4下關(guān)節(jié)突、L5上關(guān)節(jié)突）的應(yīng)變值，以單向虎克定律計(jì)算各測點(diǎn)的應(yīng)力值。結(jié)果采用統(tǒng)計(jì)學(xué)分析，通過使用SPSS16.0軟件包（SPSS,Chicago，IL,USA）進(jìn)行數(shù)據(jù)分析，計(jì)算其標(biāo)準(zhǔn)差、平均差，各組間數(shù)據(jù)差異的比較采用Sceffe法進(jìn)行比較。（P＜0.05為差異有顯著性意義）。 結(jié)果：單側(cè)內(nèi)固定組在前屈后伸負(fù)荷下手術(shù)節(jié)段對側(cè)關(guān)節(jié)突周圍應(yīng)力均大于單純開窗組及對照組，差異顯著。單側(cè)固定椎間融合組在前屈后伸負(fù)荷下手術(shù)節(jié)段對側(cè)關(guān)節(jié)突周圍應(yīng)力明顯小于開窗組及對照組，差異顯著。各組前屈后伸負(fù)荷下上位鄰近節(jié)段關(guān)節(jié)突周圍應(yīng)力均無統(tǒng)計(jì)學(xué)差異。 結(jié)論：小關(guān)節(jié)突穩(wěn)定性對完整脊柱及術(shù)后脊柱穩(wěn)定性具有重要意義，，小關(guān)節(jié)突破壞后單純單側(cè)內(nèi)固定難以有效重建脊柱穩(wěn)定性，單側(cè)內(nèi)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(xué)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(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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本文編號：1484796