人工腰椎间盘置换术与融合术后相邻节段活动度测试

The Activities Measurement of Adjacent Segments After TDR and Lumbar Interbody Fusion

目的:分析椎弓根钉棒系统内固定加后路腰椎体间融合术(posterior lumbar interbody fusion,PLIF)与腰椎间盘置换术(total disc replacement,TDR)后腰椎活动度代偿性,为相邻节段退变与运动代偿性关系分析提供基础。方法:采用12具人体腰椎标本(L3～S1),通过三维非接触式光电测量系统,测试原始态(intact)、TDR及PLIF术后各节段在6种独立工况的运动分布。结果:TDR术后腰椎整体运动趋势接近术前状态。除LR、RR工况外,其他工况中手术节段(L4/L5)关节活动度(rang of motion,ROM)均有所减小,但不存在显著性差异。上下相邻节段(L3/L4、L5/S1)在TDR术后接近原始状态,无明显变化趋势。PLIF术后,L4/L5节段ROM明显减少,有显著性差异。上下相邻节段运动存在显著增加。结论:TDR术能使腰椎恢复更接近正常的生理运动。

Objective To provide a basic relationship between adjacent segment degeneration and motion compensated, we analyzed the activities＇ measurement of adjacent segments of lumbar spine after Posterior Lumbar Interbody Fusion （PLIF） and Total Disc Replacement （TDR）. Methods 12 healthy cadaveric lurrbar spines（L3--S1） were chosen to measure the activities of adjacent segments after TDR and Lumbar Interbody Fusion by using a 3D motion measurement system and MTS Universal Material Tester （CMT6103） in intact, PLIF （L4/L5）and TDR （L4/LS）. All tests were carried out with displacement control in Flexion （Flex）, Extension （Ext）, Left Bending （LB）, Right Bending （RB）, Left Rotation （LR） and Right Rotation （RR）. Results The lumbar motion was closer to the preoperative state after TDR. Besides LR, RR condition, ROM of other conditions in operation section （L4/L5） reduced slightly without significant difference, qhe lumbar motion of the adjacent segments （L3/L4, L5/S1） was closer to the preoperative state after TDR, and no obvious trend was found. After PLIF, ROM of L4/L5 segment decreased obviously, while ROM of the adjacent segment significantly increased. Conclusion more efficient to improve the lumbar motion recovery toward normal physiological motions than TDR can be PLIE