胸腰椎二柱和三柱损伤短节段固定的稳定性比较
Biomechanic comparison of 2-column and 3-column thoracolumbar injury after short segmental fixation
目的 通过生物力学研究方法比较短节段固定对胸腰椎二柱(前中柱)损伤和三柱损伤的固定稳定性。 方法 选取8具新鲜家猪T13~L5节段的脊柱标本。实验标本需进行4种状态下的测试：正常状态(A)；二柱损伤状态(B)；二柱损伤短节段固定状态(C)；三柱损伤短节段固定状态(D)。标本先采用自由落锤方法制成L2椎体的二柱(前中柱)损伤不稳模型；再在二柱损伤基础上破坏棘间，棘上韧带，黄韧带和小关节制备成严重不稳的三柱损伤模型固定。测试每种状态下的L1~3的活动度(ROM)和压缩刚度(Compressive Stiffness)并进行统计分析。 结果 在后伸，侧屈及旋转方向上三柱损伤组的ROM值均显著高于二柱损伤固定组(P<0.05)。两柱损伤组在屈伸，侧屈，旋转方向的ROM均大于正常组(P<0.05)。两柱损伤固定组与两柱损伤组相比在各方向上ROM显著减少(P<0.05)。三柱损伤固定组和正常组相比前屈ROM(P=0.002)、侧屈ROM(P=0.001)显著增高。三柱损伤固定组压缩刚度显著低于两柱损伤固定组 (P<0.05)。三柱损伤固定组压缩刚度显著低于正常组(P<0.05)。 结论 胸腰椎两柱损伤采用短节段固定能获得足够的稳定性，而三柱损伤采用短节段固定术后即刻稳定性和垂直抗压强度均明显较差。
Objective To compare biomechanical stability of 2-column and 3-column thoracolumbar injury after short segmental fixation. Methods Eight fresh frozen porcine thoracolumbar spine specimens (T13-L5) were collected, and divided to four groups: intact group (A), injury group(B), 2-column injury fixation group(C), and 3-column injury fixation group(D). The stability of four groups at flexion, extension, lateral bending and axial rotation were measured respectively. Two-column injury model was created using dropping technique. For three-column injury model, The excision of supra-spinous ligament, inter-spinous ligament, ligamenta flava and zygapophysial joint was performed on the basis of two-column injury. Results The ROMs of group D at extension, lateral bending and rotation directions were signifcantly increased compared to that of group C (P<0.05), as well ROM of group D at axial rotation increased signifcantly compared to that of group A (P<0.05). The ROMs of group B at all directions increased significantly compared to group A (P<0.05), and ROM of group C decreased significantly compared to group B (P<0.05). The compression stiffness of group D decreased significantly compared to group C (P<0.05), and that of group C decreased significantly compared to group B (P<0.05). The compression stiffness of group D had no difference compared to group B (P>0.05). Conclusions Compare to the three-column injury, the short-segment fixation is more suitable for keeping mechanic stability of the 2-column injury of thoracolumbar level.
Two-column injury / Three-column injury / Biomechanics / Stability / Compressive Stiffness
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