一种新型脊柱动态内固定系统的理论验证

Theoretical verification of a new spinal dynamic stabilization system

背景:传统的腰椎融合固定后存在许多不可避免的缺陷,可造成邻近节段的退行性变或加剧已存在的脊柱退行性变。目前动态内固定系统的初步临床效果令人鼓舞,但进一步的临床应用却呈现出现有棘突间内固定器设计上的诸多不足,出现一些与器械直接相关的并发症。目的:研发一种新型脊柱动态内固定系统。方法:自行设计一种新型脊柱动态内固定系统,既能适应脊柱的万向活动,又能保留棘上韧带。从设计理念而言,更能满足人体脊柱的正常活动。结果与结论:腰椎棘突间动态固定在不牺牲脊柱即刻稳定性的前提下将其动态固定,置入后可分散坚固内固定的负荷传导,避免应力遮挡,还可增大椎管容积,增加椎间孔的大小,恢复椎间隙高度,卸载后方纤维环的负荷,减少相应节段小关节载荷。但由于现有腰椎棘突间动态稳定器的设计缺陷和昂贵价格,使临床应用受限。自主研发的一种棘间万向动态稳定器,可安于棘突根部,实现棘间、棘-板间弹性承载并能万向活动,从而有望克服现有技术的诸多不足并降低其价格。

BACKGROUND： There are many unavoidable defects after the traditional lumbar vertebral fusion operation, which can cause and aggravate the adjacent segment degeneration. Presently, primary clinical effects of dynamic internal fixation system are encouraging, but further clinical application exhibited some shortcomings in the design of internal fixation in the spinous process. Some complications related to instrument appeared. OBJECTIVE： To research and develop a new type of spinal internal fixation with dynamic stabilization system. METHODS： A new spinal dynamic stabilization system was designed. It can not only adapt spinal multidirectional activity, but also reserve supraspinal ligament to satisfy the normal range of spinal movement in the aspect of design principle. RESULTS AND CONCLUSION： The implantation of the spinal dynamic stabilization system can stabilize spine dynamical without sacrificing immediate stability of spine, can disperse load transmission and avoid stress shielding with strong internal fixation, also increase capacity of spinal canal and size of intervertebral foramina, restore height of intervertebral space, reduce the load of anulus fibrosus and facet joint＇s load. Nevertheless, because of high price and design defects, the use of this system was limited. The multidirectional active interspinous dynamic stabilization system designed by ourselves could be implanted in root of spinous process, implemented flexible fixation in spinous process, between spinous process and lamina of vertebral, and adapted spinal multidirectional activity, and expected to overcome the deficiencies of technology and reduced the price.