腰椎后路手术对其稳定性的影响

The influence of posterior approaches on stability of the lumbar spine following surgery with the posterior approach

目的 从生物力学角度探讨不同的腰椎后路手术对其稳定性的影响。方法 采用新鲜人体脊椎骨制作成双侧开窗、小关节内侧半切除、小关节全切、全椎板减压及全椎板减压合并小关节全切共 5种手术模型 ,利用脊柱三维运动实验系统进行稳定性的测试和分析 ,并与正常组进行比较。结果 脊椎全椎板切除及双侧开窗对腰椎稳定性影响不显著 ,小关节部分或者全部切除则显著影响腰椎的侧弯、前屈和旋转活动度。结论 腰椎手术应尽量避免损伤小关节 ,以维护腰椎稳定性 。

Objective To investigate the influence of posterior approaches on the stability of lumbar spine from the view points of biomechanics Methods Fresh human cadaver specimens of spine were used to form five different types of models,with test system of three dimension movement to measure the staility of lumbar spine,and then the results were compared with that of the intact type.Results There is no significant influence on lumbar stability following total laminectomy TL and bilateral fenestration,however,there was significant influence on lumbar stability after partial or total resection of facets;there was impairment of lateral bending,anterior flexion and rotational movement of the lumbar spine.Conclusion One should avoid injury of facet joints in lumbar operations through posterior approaches so as to maintain lumbar stability and reduce postoperative syndromes.