腰椎间盘突出及脊椎滑脱与植入物置入后的力学关系

Biomechanics relationships of lumbar disc herniation and spondylolisthesis with transplanted implants

背景:腰椎间盘突出及脊椎滑脱手术治疗的目的不单是减压植骨固定,更重要的是保持瞬时旋转中心的正常应力点范围,以减少脊椎前滑力,维持脊椎近期和远期的力学稳定。目的:对腰椎间盘突出、脊椎滑脱植入物置入治疗及其植入物生物力学等问题进行阐述,并对2005-01/05本院收治的腰椎间盘突出症合并椎体滑脱行治疗的68例患者进行总结分析。方法:68例腰椎间盘突出症和脊椎滑脱患者均有腰痛或同时伴有坐骨神经痛,全部采用后路行半椎板或全椎板切除探查减压、椎间盘摘除、椎间植骨融合、后路短节段椎弓根钉置入复位内固定。结果与结论:68例患者均完成1.5年随访,按Stamffer疗效标准,良好63例,可5例,良好率达92.6%。由于脊椎瞬时旋转中心应力点的异常,腰椎间盘突出症和脊椎滑脱在病理上是互为因果的,植入物置入后保持了瞬时旋转中心的正常应力范围,减少了脊椎前滑力,维持了脊柱各方向近期和远期的力学稳定性。

BACKGROUND： The purpose of lumbar disc protrusion and spondylolysis operation is not only to anterior decompression and fusion, but also to maintain the mechanical stability of vertebrae by holding the normal stress spot range of instantaneous center of rotation （ICR）. OBJECTIVE： Using mechanical tenet to explain the pathological relationship between lumbar disc protrusion and spondylolysis, and to summarize the treatments for 68 cases with lumbar disc herniation and spondylolisthesis. METHODS： Totally 68 cases of lumbar disc protrusion and spondylolisthesis suffered lumbago or sciatica simultaneously. All patients were treated by the surgical method containing posterior whole or half laminectomy exploration decompression, discectomy, intervertebral fusion and the short segment posterior pedicle screw reduction and internal fixation. RESULTS AND CONCLUSION： All patients received 1.5 years follow-up. According to Stamffer criterion of therapeutic effectiveness, 63 patients were good, and 5 patients were average, with 92.6% good rate. Due to abnormal ICR, the pathological disc and spondylolysis were reciprocal causation. Following implantation, the stress of ICR was kept in a normal range, and the anterior sliding power of vertebrae was reduced, which can maintain the mechanical stability of vertebrae.