【摘要】：目的:1.評估腰椎微創(chuàng)棘突間撐開系統(tǒng)對于置入節(jié)段及臨近節(jié)段的活動度等生物力學(xué)性能的影響2.評價腰椎微創(chuàng)棘突間撐開系統(tǒng)應(yīng)用于動物模型的可行性、安全性及有效性。方法:1.利用一名成年健康志愿者的CT數(shù)據(jù),建立正常腰椎有限元模型及L4,5置入微創(chuàng)棘突間撐開系統(tǒng)的有限元模型,施加400N的軸向載荷以及前屈/后伸/側(cè)彎/扭轉(zhuǎn)等4個方向上1ON·m的扭矩載荷,對比L4,5和鄰近節(jié)段的活動度及椎間盤最大應(yīng)力變化,觀察L4,5棘突和撐開器應(yīng)力分布情況。2.應(yīng)用腰椎微創(chuàng)棘突間撐開系統(tǒng)于4具新鮮腰椎尸體標(biāo)本(L2-S1),固定在MotionAnalysis光學(xué)動作捕獲系統(tǒng)中,施加前屈/后伸/側(cè)彎/旋轉(zhuǎn)等4個方向的純扭矩8N·m,對比L4,5節(jié)段及鄰近節(jié)段活動度的變化。3.應(yīng)用腰椎微創(chuàng)棘突間撐開系統(tǒng)于8頭巴馬小型豬(25-30kg) L4,5棘突間隙,對比置入前后L4,5椎間孔直徑、椎間孔橫徑、椎間盤前高度和椎間盤后高度等參數(shù),觀察撐開系統(tǒng)的置入過程、術(shù)后血液化驗結(jié)果及小型豬有無神經(jīng)功能異常。結(jié)果:1.腰椎微創(chuàng)棘突間撐開系統(tǒng)有限元模型中,后伸運(yùn)動時L4,5節(jié)段活動度和椎間盤最大應(yīng)力分別減少71.4%和83.4%,前屈/側(cè)彎/旋轉(zhuǎn)運(yùn)動的活動度和椎間盤最大應(yīng)力均無顯著變化,鄰近節(jié)段4個方向上各參數(shù)均無顯著變化;后伸運(yùn)動時L4棘突達(dá)最大應(yīng)力56.8 Mpa,L5棘突達(dá)最大應(yīng)力36.5 Mpa,撐開系統(tǒng)達(dá)最大應(yīng)力36.0Mpa。2.新鮮尸體腰椎標(biāo)本植入微創(chuàng)棘突間撐開系統(tǒng),后伸運(yùn)動時L4,5節(jié)段活動度顯著減小(t=-3.444, P=0.009),前屈/側(cè)彎/扭轉(zhuǎn)運(yùn)動時兩組間的活動度差異均無統(tǒng)計學(xué)意義(P0.05);鄰近節(jié)段4個方向上活動度差異均無統(tǒng)計學(xué)意義(P0.05) 。3. 8例巴馬小型豬模型均成功置入腰椎微創(chuàng)棘突間撐開系統(tǒng);術(shù)后L4,5椎間孔直徑顯著增大(t=-2.214,P=0.044),椎間孔橫徑顯著增大(t=-1.824, P=0.012),椎間盤后高度顯著增大(t=-2.441,P=0.029),椎間盤前高度差異無統(tǒng)計學(xué)意義(t=-0.691,P=0.501);血液化驗正常,活動良好并無神經(jīng)異常癥狀。結(jié)論:腰椎微創(chuàng)棘突間撐開系統(tǒng)的應(yīng)用是安全可行的,有效地限制置入節(jié)段后伸運(yùn)動,增加該節(jié)段椎間孔直徑、橫徑和椎間盤后高度等解剖學(xué)參數(shù),具有減輕腰椎退變性疾病臨床癥狀的療效。
[Abstract]:Objective: 1. To evaluate the effect of lumbar minimally invasive interspinous process distraction system on biomechanical properties of implanted and adjacent segments. To evaluate the feasibility, safety and effectiveness of lumbar minimally invasive interspinous process distraction system in animal models. Methods: 1. Using CT data of a healthy adult volunteer, a finite element model of normal lumbar vertebrae and a minimally invasive interspinous protruding system were established. The axial load of 400N and the torque load of 1ON m in four directions of forward flexion / extension / lateral bending / torsion were applied to compare the range of motion and maximum stress of intervertebral disc between L4C5 and adjacent segments, and observe the stress distribution of spinous process and distractor of L4C5. 2. Four fresh lumbar vertebrae cadavers (L2-S1) were immobilized in the MotionAnalysis optical motion capture system with a minimally invasive spinous process protruding system. The pure torque of 8N m was applied in the four directions of flexion / extension / lateral bending / rotation. The changes of the activity of L4 ~ (5) segment and adjacent segment were compared with that of L4 ~ (5) segment and adjacent segment. 3. The intervertebral foramen diameter, transverse diameter of intervertebral foramen, anterior height of intervertebral disc and posterior height of intervertebral disc were compared in 8 25-30kg miniature pigs (25-30kg) by lumbar minimally invasive interspinous process protruding system in the intervertebral foramen diameter, transverse diameter of intervertebral foramen, anterior height of intervertebral disc and posterior height of intervertebral disc. To observe the procedure of placement of distraction system, the results of blood test after operation and the neurological abnormality in miniature pigs. Results: 1. In the finite element model of lumbar minimally invasive interspinous process distraction system, the range of motion and the maximum stress of intervertebral disc decreased by 71.4% and 83.4%, respectively. There was no significant change in the range of motion and the maximum stress of intervertebral disc in the flexion / lateral bending / rotation motion, and no significant change in the parameters in the four directions of adjacent segments. The maximum stress of L _ 4 spinous process is 56.8 Mpa,L5 and the maximum stress is 36.5 Mpa, during extension. The maximum stress is 36.0Mpa.2. Fresh cadaveric lumbar vertebrae specimens were implanted with a minimally invasive interspinous process distraction system, and the activity of L4L 5 segments decreased significantly during extension (t = -3.444, P = 0.009). There was no significant difference in activity between the two groups during flexion / lateral bending / torsion (P0.05). There was no significant difference in the activity of adjacent segments in four directions (P0.05). Eight Bama miniature pig models were successfully implanted into the lumbar spine minimally invasive interspinous process distraction system. After operation, the diameter of intervertebral foramen in L4 / 5 was significantly increased (t = 2.214), the transverse diameter of intervertebral foramen was significantly increased (t = 1.824, P = 0.012), and the height of intervertebral disc was significantly increased (t = 2.441U, P = 0.029). There was no significant difference in anterior intervertebral disc height (t = 0.691P = 0.501). Normal blood test, good activity and no neurological symptoms. Conclusion: the application of lumbar minimally invasive interspinous process distraction system is safe and feasible. It can effectively limit the extension motion of the inserted segment and increase the anatomical parameters such as the diameter of intervertebral foramen, transverse diameter and the height of the intervertebral disc. It can reduce the clinical symptoms of lumbar degenerative disease.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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