摘要
背景:经腹膜外侧前方入路腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)已被越来越多地应用到腰椎退行性疾病的治疗中。与传统后路椎间融合术相比,OLIF能否达到相同的稳定性仍值得商榷。目的:利用有限元技术探究不同OLIF手术术后融合器、固定装置和腰椎主要结构的应力变化及稳定性。方法:利用有限元技术建立正常成年男性腰椎模型(A组),OLIF术后单纯植入cage模型(B组),OLIF术后cage联合钉棒固定模型(C组)。分别对三个模型进行有限元分析,比较腰椎各部分行OLIF术后的稳定性及应力。结果:在施加载荷的前屈、后伸、左右侧屈、左右旋6种状态下,相比正常模型(A组),B组与C组模型L2-L3、L3-L4的活动度均减少,而B组与C组之间活动度相差不明显;与B组模型相比,C组模型的cage在6种状态下的等效应力减小;三组模型进行后伸时,B组手术节段以下腰椎小关节应力增加;与A组模型相比,B组及C组融合节段上下终板应力增大。结论:单纯cage融合及cage联合钉棒内固定的OLIF术后都可以达到良好的稳定性。单纯使用融合器时,融合节段以下小关节应力增加,提示可能会加速小关节的退化。联合使用钉棒内固定后,钉棒会分担部分融合器所受应力并减小融合器的载荷,将会减少融合器下沉移位等远期并发症的发生。
Background:Oblique lumbar interbody fusion(OLIF)has been increasingly used in the treatment of lumbar degenerative diseases.Whether OLIF can achieve the same stability as traditional posterior lumbar interbody fusion is still questionable.Objective:To investigate the stress changes and stability of cage,fixator and main structure of lumbar spine after different OLIF operations.Methods:The normal adult male lumbar models(group A),cage fixation after OLIF model(group B)and cage combined with screw rod fixation after OLIF group(group C)were established by finite element technique.The stability and stress of each part of lumbar spine after OLIF were analyzed and compared.Results:Under the six loading conditions(anteflexion,extension,left lateral bending,right lateral bending,axial rotations),the range of motion of L2-3 and L3-4 in group B and group C was lower than that in normal model,but there was no significant difference between group B and group C.Compared with group B,the equivalent stress of cage in group C was reduced under six working conditions.When the models of three groups were extended backward,the range of motion of L2-3 and L3-4 in group B and group C was decreased.Compared with group A,the stress of the upper and lower endplates of fusion segments in group B and group C increased.Conclusions:Two kinds of OLIF can achieve good stability after operation.The stress of the facet joint below the fused segment increases when the cage is used alone,which indicates that the degeneration of the facet joint may be accelerated.Combined use of screw rod internal fixation,the screw rod will share part of the cage stress and reduce the load of the cage,which will reduce the occurrence of long-term complications such as cage sinking and displacement.
作者
孙科
杨学军
SUN Ke;YANG Xuejun(Department of Thoracolumbar Surgery,The Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,China)
出处
《中华骨与关节外科杂志》
2021年第1期16-20,共5页
Chinese Journal of Bone and Joint Surgery
关键词
腰椎退行性疾病
有限元
OLIF
Lumbar Degenerative Disease
Finite Element
Oblique Lumbar Interbody Fusion
