本文關(guān)鍵詞： 椎間孔鏡下髓核摘除術(shù) 椎間盤修復(fù) 縫合 Maxon縫線　出處：《南京中醫(yī)藥大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：椎間孔鏡髓核摘除術(shù)治療腰椎間盤突出癥是脊柱十分常見(jiàn)有效的手術(shù),可是伴隨而來(lái)的髓核再突出和椎間盤退化加速這兩個(gè)并發(fā)癥又十分棘手,大多數(shù)學(xué)者認(rèn)為椎間盤完整性破壞是原位再突出的主要原因。Cauthen研究證明直接縫合重建纖維環(huán)結(jié)構(gòu)可以防止髓核突出,但是缺乏實(shí)驗(yàn)數(shù)據(jù)證明纖維環(huán)是否有力學(xué)特性改變或是改善椎間盤退變情況。本實(shí)驗(yàn)通過(guò)針刺蘇中豬腰椎間盤來(lái)建立纖維環(huán)破損的模型,通過(guò)負(fù)荷測(cè)試來(lái)比較復(fù)雜縫合組和其他分組對(duì)破損纖維環(huán)修復(fù)后的產(chǎn)生的力學(xué)變化。目的(1)模擬椎間孔鏡下髓核摘除術(shù)(PELD)術(shù)后椎間盤破損模型,離體及活體實(shí)驗(yàn)觀測(cè)縫合纖維環(huán)生物力學(xué)改變及纖維環(huán)愈合情況。(2)觀測(cè)一種新縫合方法是否可以促進(jìn)術(shù)后破損椎間盤愈合和生物力學(xué)改變,將簡(jiǎn)單縫合的方法與復(fù)雜情況進(jìn)行比較,觀察它們的差異。根據(jù)結(jié)果分析微創(chuàng)器械下一針簡(jiǎn)單縫合是否具有理論意義。方法選擇六頭九月齡雌性蘇中豬,對(duì)L2-6共嬰個(gè)椎間盤隨機(jī)分為四組：空白組(A組)、對(duì)照組(B組)、復(fù)雜縫合組(C組)、簡(jiǎn)單縫合組(D組)。B、C、D組在暴露椎管結(jié)構(gòu)后,根據(jù)出口神經(jīng)位置確定椎間盤位置,插入2.5mm克氏針,刺入深度控制12mm,停留時(shí)間3分鐘后拔出克氏針,A組暴露后不破壞纖維環(huán)結(jié)構(gòu),作為假手術(shù)組。B組造模后不處理破損的纖維環(huán)結(jié)構(gòu),C組使用自行設(shè)計(jì)的改良鉸合法縫合纖維環(huán),D組使用普通外科縫合方式一針縫合破損纖維環(huán)缺口。C、D組均使用電子萬(wàn)能實(shí)驗(yàn)機(jī)固定縫線兩端,在50N均勻拉力下完成四個(gè)外科結(jié),保證打結(jié)齊同性。將四組處理完的樣本固化后,使用電子萬(wàn)能機(jī)測(cè)量記錄負(fù)荷下的受力-位移數(shù)據(jù),使用分析軟件測(cè)量泄漏壓力情況,判斷四組情況下力學(xué)特點(diǎn)。結(jié)果(1)加載負(fù)荷后,B、C、D組均可見(jiàn)從造模形成的破損纖維環(huán)缺損處泄漏的髓核組織,A組可見(jiàn)椎間盤高度丟失,髓核從擠壓破裂的纖維環(huán)四周溢出。(2)加載負(fù)荷后,C、D組未見(jiàn)縫合線的斷裂或滑結(jié),縫線外觀良好。(3)力學(xué)檢測(cè)顯示空白組(A組)、對(duì)照組(B組)、復(fù)雜縫合組(C組)、簡(jiǎn)單縫合組(D組)均在髓核漏出時(shí)發(fā)生明顯的曲線陡峭,可以使用軟件確定泄漏時(shí)的負(fù)荷壓力值。(4)通過(guò)統(tǒng)計(jì)分析發(fā)現(xiàn),復(fù)雜縫合組(C組)、簡(jiǎn)單縫合組(D組)與對(duì)照組(B組)組間配對(duì)T檢驗(yàn)均有顯著性差異(P0.05),泄漏壓力明顯高于B組。(5)簡(jiǎn)單縫合組(D組)與空白組(A組)組間配對(duì)T檢驗(yàn)均有顯著性差異(P0.05),泄漏壓力明顯小于生理狀況下纖維環(huán)破損時(shí)壓力；復(fù)雜縫合組(C組)與空白組(A組)組間配對(duì)T檢驗(yàn)均無(wú)顯著性差異(P0.05),雖不能說(shuō)明改良式縫合方式與生理狀況纖維環(huán)泄漏壓力相當(dāng),當(dāng)數(shù)值上明顯優(yōu)于剩余兩組。(6)復(fù)雜縫合組(C組)和簡(jiǎn)單縫合組(D組)組間配對(duì)T檢驗(yàn)均有顯著性差異(P0.05),C組原位破損纖維環(huán)再破裂的負(fù)荷壓力值明顯高于D組。結(jié)論(1)纖維環(huán)損傷會(huì)導(dǎo)致輕微負(fù)荷情況下椎間盤內(nèi)髓核的突出。(2)改良式鉸合法可以為椎間盤提供更好的力學(xué)穩(wěn)定性,與簡(jiǎn)單縫合組相比能抵抗更高的軸向負(fù)荷而不破裂。(3)簡(jiǎn)單縫合方式也能明顯改善椎間盤的生物力學(xué)特性,且操作更加方便。(4)兩種縫合情況下均未出現(xiàn)縫線斷裂或滑結(jié),單股聚甘醇碳酸可吸收縫線可用于維持縫合纖維環(huán)上的遺留缺損。
[Abstract]:Percutaneous transforaminal endoscopic discectomy for treatment of lumbar disc herniation is very common and effective spinal surgery, but accompanied by the nucleus pulposus of intervertebral disc degeneration and protrusion and accelerate the two complications is very difficult, most scholars believe that the integrity of intervertebral disc damage is the main reason to highlight the.Cauthen study demonstrated that in situ direct suture reconstruction fiber ring structure can prevent the nucleus pulposus, but the lack of experimental data to prove whether there is change in mechanical properties of fiber ring or improvement of intervertebral disc degeneration. The experiments of acupuncture in porcine lumbar disc Jiangsu to establish fiber ring damage model, through the load test to more complex suture group and other group produces damage mechanics change of fiber ring after repair. (1) simulated transforaminal endoscopic discectomy (PELD) postoperative intervertebral disc damage model in vitro and in vivo experimental observation of fiber ring suture Biomechanical changes and fiber ring healing. (2) to observe whether a new suture method can promote the postoperative healing of damaged intervertebral disc and biomechanical changes, the method is simple and complex suture were compared, observe their differences. According to the results of analysis of minimally invasive devices whether has the theoretical significance. Methods six simple suture needle head 9 month old female in pigs, for L2-6 common infant intervertebral disc were randomly divided into four groups: control group (A group) and control group (B group), complex suture group (C group), simple suture group (D group).B, C, D in the group exposed spinal structure, according to the determined disc the position of outlet nerve position, insert the 2.5mm Kirschner wire penetration depth control 12mm, residence time of 3 minutes after the Kirschner wire was removed after exposure, without destroying the fibrous ring structure of A group, sham operation group.B group after the model does not handle the breakage of the fiber ring structure, designed by modified C group Good hinge suture fiber ring, general surgery, D group using suture stitch broken fiber ring gap.C, D group were using the electronic universal testing machine and the fixed suture ends, the completion of the four surgical knot in the 50N uniform tension, to ensure homogeneity. Four groups of knotted processed samples fixed after using electronicuniversal measuring and recording machine load force displacement data, using the analysis software to measure leakage pressure, determine the mechanical characteristics of four groups of cases. Results (1) after loading, B, C, D groups were seen from the model of formation damage and the leakage of fiber ring defect of the nucleus pulposus of intervertebral, A group disc height loss, nucleus pulposus extruding from the rupture of the fibrous ring around the overflow. (2) loading, C, fracture group D no suture or suture knot, good appearance. (3) the mechanical test showed that the blank group (A group) and control group (B group), group C (complex suture simple suture group (group D). 緇，

本文編號(hào)：1514920