TLIF后路不同的内固定方式生物力学特性的比较分析

doi:10.13418/j.issn.1001-165x.2016.05.015

中国临床解剖学杂志 ›› 2016, Vol. 34 ›› Issue (5): 551-556.doi: 10.13418/j.issn.1001-165x.2016.05.015

TLIF后路不同的内固定方式生物力学特性的比较分析

余伟波^1,2，　梁德²，　叶林强^1,2，　黄学成^1,2，　姚珍松²，　江晓兵²

1.广州中医药大学第一临床医学院；　2.广州中医药大学第一附属医院脊柱骨科, 广州 510405

收稿日期:2015-12-21 出版日期:2016-09-25 发布日期:2016-10-14
通讯作者: 江晓兵，副教授，E-mail:spinedrjxb@sina.com
作者简介:余伟波（1985-），男，在读博士，研究方向：中老年脊柱伤病及颈椎病，E-mail:yuweibo0530@163.com
基金资助:
广东省卫生厅医学科研基金（2014B2014175）；卫生部医药卫生科技发展研究中心资助课题（W2014ZT256）；卫生部医药卫生科技发展研究中心资助课题（W2012ZT0）

The biomechanical effect of transforaminal lumbar interbody fusion with different types of posterior instruments for stabilization

YU Wei-bo^1,2, LIANG De ¹, YE Lin-qiang ^1,2, HUANG Xue-cheng ^1,2, YAO Zhen-song², JIANG Xiao-bing²

1. The First School of Clinic Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510405, China; 2. Department of Spinal Surgery, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510405, China.

Received:2015-12-21 Online:2016-09-25 Published:2016-10-14

摘要/Abstract

摘要：

目的　比较3种不同后路经腰椎间孔椎间融合（transforaminal lumbar interbody fusion，TLIF）内固定方式的生物力学特性。方法　建立正常L3~5有限元模型，在验证其有效性基础上模拟3种不同TLIF后路内固定方式即：单侧或双侧椎弓根螺钉内固定组（Model A和Model B）、单侧+对侧关节突螺钉固定组Model C。分别比较其在生理活动范围（Range of the motion, ROM）下模型的稳定性以及内植物的应力差异。结果　对所有重构模型，在融合节段（L4~5）的ROM均显著下降，其中以Model B下降最多，屈伸活动减少达18.2%；内植物最大应力出现在Model C，左侧弯时达234.9 MPa；Model B的cage最大应力最小。结论　后路双侧椎弓根螺钉固定能获得最佳稳定性，且能降低cage下沉及移位的风险；单侧+对侧关节突螺钉亦能提供较好良好的稳定。

关键词: 经腰椎间孔椎体间融合（TLIF）, 椎弓根螺钉, 关节突螺钉, 有限元

Abstract:

Objective　To investigate the biomechanical effect of transforaminal lumbar interbody fusion (TLIF) with three different types of posterior instruments.　Methods　A validated L3~5 FE model was modified to simulate three different TLIF finite element modelsat L4~5: unilateral pediclescrew fixation;bilateral pedicle screw fixation; a unilateral pedicle screw fixation supplemented with contralateral facet screw construct. Various biomechanical parameters were evaluated for intact and implanted models in all loading planes.　Results　When compared with the intact model, all reconstructive models displayed decreased motion at L4~5, and Model B conferred greater stability in flexion-extension (18.2% of intact model). The maximum stress of instruments was found in Model C with 234.9 MPa under left lateral bending. In addition, Model B generated the lowest cage stress.　Conclusion　The reconstruction with bilateral pedicle screw fixation can gain the optimal stability and decrease posterior instrumentation stress. A unilateral pedicle screw fixation supplemented with contralateral facet screw construct could also gain a relatively good stability.

Key words: Transforaminal lumbar interbody fusion, Pedicle screw fixation, Contralateral facet screw construct, Finite element analysis

余伟波,梁德,叶林强,黄学成,姚珍松,江晓兵. TLIF后路不同的内固定方式生物力学特性的比较分析[J]. 中国临床解剖学杂志, 2016, 34(5): 551-556.

YU Wei-bo,LIANG De, YE Lin-qiang,HUANG Xue-cheng,YAO Zhen-song, JIANG Xiao-bing. The biomechanical effect of transforaminal lumbar interbody fusion with different types of posterior instruments for stabilization[J]. Chinese Journal Of Clinical Anatomy, 2016, 34(5): 551-556.

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TLIF后路不同的内固定方式生物力学特性的比较分析

The biomechanical effect of transforaminal lumbar interbody fusion with different types of posterior instruments for stabilization

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