腰椎间盘突出症两种常规手术对椎间盘压应力影响的实验研究

THE EXPERIMENTAL STUDY OF INTRADISCAL PRESSURE AFTER DIFFERENT OPERATIONS OF PROLAPSEOF LUMBAR INTERVERTEBRAL DISC

目的 :分析不同腰椎间盘突出症手术对邻近椎间盘变性的影响 ,为手术方法的选择和改进提供依据。方法 :采用 3 0具新鲜小牛腰椎标本 ,制成两种腰椎间盘突出症的手术模型 (椎板间开窗、全椎板切除 ) ,模拟人体载荷前屈和侧屈运动 ,测量邻近椎间盘的压应力 ,并与正常对照组的椎间盘压应力进行比较。结果 :在前屈和侧屈运动中不同手术对邻近椎间盘压应力的影响有着不同程度的差异。结论 :后路椎板开窗术具有创伤小 ,对手术区域和邻近节段的干扰及稳定性影响较轻微 ,可作为多数腰椎间盘突出症治疗的选择 ;而全椎板切除对手术邻近节段的干扰和稳定性的影响较大 ,应严格掌握其手术适应症。

Objective: A biomechanical study was performed to identify the effects of different posterior operations of prolapse of lumbar intervertebral disc on the intradiscal pressure between adjacent segments. The results of this study can provide substantial foundation for improvements of future operations. Methods: Two surgical methods (fenestration, total-laminectomy) were operated on thirty fresh lumbar spine specimens of calf. After those operations, intradiscal pressure between adjacent segments of the spine specimens was measured during the ante flexion and lateral flexion. The effects are compared with those of intact spine specimens. Results: During the anteflexion and lateral flexion, the intradiscal pressure increases when the flexion degree increases in these surgical methods. However, significant differences were found among intact spine and the two different surgical spine. Conclusion: The fenestration lumbar laminectomy has the advantages like fewer traumas, better lumbar structural stability, and etc. It is a better solution for those who are adaptable to perform on. Because the other methods has some negative effects on the stability of operated segments and adjacent segments,this should only be adopted with more considerations on the clinical setting.