后部结构分级切除对下腰椎稳定性影响的实验研究

目的 探讨小尾寒羊L5,6后部结构分级切除对腰椎稳定性的影响.方法 选取14只小尾寒羊,截取L4～L7脊柱标本.实验前摄正、侧位X线片以排除脊柱疾患,CT定位关节突关节分级切除.对L5,6节段后部结构依次分级切除如下:Ⅰ正常→Ⅱ全椎板减压→Ⅲ左侧关节突切除1/2→Ⅳ左侧关节突全部切除→Ⅴ右侧关节突切除1/2→Ⅵ右侧关节突全部切除→结束.利用Instron 8874液压伺服动态生物力学测试系统依次测试标本六个自由度上椎间运动的变化,计算平均刚度.利用SPSS 11.5行单因素方差分析,检验水准α值取0.05.结果 全椎板减压和左侧关节突的全部切除对于前屈或后伸的稳定性影响不大;当再切除右侧关节突1/2时,前屈或后伸的平均刚度比正常时分别下降32.33%和30.83%.腰椎后路结构的切除对于腰椎侧弯的稳定性影响不大.全椎板减压即出现左和右扭转失稳,平均刚度分别比正常时下降26.13%和26.20%,关节突关节与扭转的稳定性亦具有重要意义,特别是对对侧扭转的稳定性.结论 行腰椎后路手术时,在保证手术视野的情况下,力求做到微创,尽量保留后部结构的完整性.     

退变性脊柱侧凸不同方式长节段固定融合术后邻近节段生物力学变化的有限元分析

目的:探讨退变性脊柱侧凸(degenerative scoliosis,DS)不同方式长节段固定融合术后脊柱活动度及固定邻近节段椎间盘和关节突软骨的应力变化。方法:基于DS患者T12～S1上段连续的CT扫描图像,导入E-feature Biomedical Modeler软件,从三维实体模型直接划分生成腰椎各节段的高质量体网格,根据DS的病理特点赋予模型特定的材料属性,将三维有限元模型导入ANSYS 12.0有限元分析软件,对其去除L4棘突、全椎板、部分关节突,行L4/5椎间融合后,分别采用L2~L4椎板融合+L2～L5 8枚椎弓根螺钉固定(方案一)、L1～L4椎板融合+L1～L5 10枚椎弓根螺钉固定(方案二)、L1～S1椎板融合+L1～S1 12枚椎弓根螺钉固定(方案三),在前屈、后伸、左侧弯、右侧弯、左旋转、右旋转六种工况下对术后模型进行加载,计算和分析三种手术方案术后脊柱的活动度及固定邻近节段椎间盘和关节突软骨的应力变化,并与术前DS模型进行比较。结果:三种手术方案固定融合后脊柱活动范围均减小,方案三<方案二<方案一;三种手术方案对固定邻近节段椎间盘应力均有影响,前屈、旋转时三种方案均可使固定上位节段椎间盘的应力减少,侧弯时三种方案均可使上位节段椎间盘的应力增加,后伸时对上位椎间盘的应力减少明显;前屈、侧弯及左旋转时方案一、二均可使下位节段椎间盘应力增加,后伸、右旋转时方案一、二均可使下位节段椎间盘应力减少,但三种方案对固定邻近上、下位节段椎间盘应力的影响差异不明显。方案三的固定相邻节段关节突软骨最大应力达到532.98MPa,方案二为494.08MPa,方案一为63.27MPa,即方案二、三固定相邻节段的关节突软骨容易出现较大的应力集中情况,方案一影响较小。结论:治疗DS固定融合的节段越多,对术后脊柱活动度及固定相邻节段椎间盘和关节突软骨的应力影响越大,对于长节段固定融合术治疗DS时,在能够解除症状、达到脊柱稳定的前提下应尽可能减少固定节段。     

单节段腰椎后部结构逐级切除对脊柱三维运动稳定性的影响

目的 观察单节段脊柱后部结构对腰椎三维运动稳定性的影响。方法 选用6具成人新鲜尸体脊柱标本腰1-骶1(L1～S1)，采用单节段逐步切除腰椎后部结构的方法，形成7种状态，通过脊柱三维运动试验机施加10N．m的载荷，使脊柱产生前屈／后仲，左／右侧屈和左／右轴向旋转运动。结果 切除脊柱的后部结构后，在脊柱的三维稳定性中，前屈及轴向旋转运动的稳定性最易受到破坏，前屈平均运动范围增加5．1度，旋转增加3．4度。结论 除小关节骨性结构及关节囊外，后部结构对维持腰椎的稳定性具有重要作用，特别是对前屈及轴向旋转运动。     

脊柱内镜不同程度椎间孔一次成形对腰椎稳定性影响

目的应用有限元法分析脊柱内镜不同程度椎间孔一次成形对腰椎稳定性的影响。方法建立L3～5有限元模型,于L4～5节段模拟经皮椎间孔入路脊柱内镜手术,分别在环锯直径(d=7. 5 mm)的1/3、2/3及3/3位置处平行于冠状面及椎间盘水平切除L4～5左侧关节突腹侧进行椎间孔一次成形。记录不同程度椎间孔一次成形后模型L4～5节段的前屈、后伸、左右侧屈及左右旋转范围和椎间盘最大应力,并与正常模型比较。结果在1/3 d及2/3 d处进行椎间孔一次成形时,运动范围及椎间盘最大应力在各运动状态下较正常均无明显变化。在3/3 d处进行椎间孔成形时,运动范围在右侧屈及右旋转状态下较正常增大;椎间盘最大应力在右侧屈及左右旋转运动状态下较正常增大,但腰椎没有达到失稳状态。结论应用7. 5 mm环锯进行椎间孔一次成形不会破坏腰椎稳定性,但切除较大关节突时存在脊柱侧屈及旋转失稳的趋势,应注意对关节囊和关节面的保护。     

单侧小关节分级切除对腰椎稳定性影响的三维运动研究

采用８具新鲜尸体腰椎功能单位，通过脊柱三维运动实验机施加最大载荷为１０．０Ｎｍ的６种力偶，使脊柱产生前屈／后伸、左／右侧弯和左／右轴向旋转运动。经立体摄像计算机图像处理得到Ｌ_２～Ｌ_３节段的运动范围（ＲＯＭ）、中性区（ＮＺ）和弹性区（ＥＺ）等参数。将完整标本测量的结果为自身对照组，然后在Ｌ_２、Ｌ_３节段依次切除左侧小关节１／３、１／２、和３／３。作ｔ检验和方差分析来分析单侧小关节切除对腰椎三维运动的影响。结果表明：单侧小关节切除１／３后ＲＯＭ增加不显著（Ｐ＞０．０５），不影响脊柱的稳定；小关节全切除后后伸、左侧弯和右旋的ＲＯＭ增加显著（Ｐ＜０．０５）。小关节切除１／２后ＲＯＭ虽增加不显著，但经方差分析与小关节全切的结果无明显差异，说明小关节切除范围超过１／２将导致脊柱失稳。     

腰椎椎间孔成形幅度对关节突关节应力变化的有限元分析

目的建立L_(3~5)三维有限元模型,分析椎间盘摘除并不同幅度椎间孔成形前后对L_4/L_5关节突关节应力分布的影响。方法选取1名既往无腰椎疾病史的20岁男性志愿者,获取其腰椎CT数据构建有限元模型并验证其有效性。在L_4/L_5椎间盘中度退变模型(M1)的基础上,模拟经椎间孔入路经皮内窥镜技术,去除椎间盘左后侧约1/4纤维环中部及1/4髓核,模拟腰椎椎间盘摘除术,构建模型M2;以圆柱体代替环锯模拟切除L_5上关节突部分骨质行椎间孔扩大成形,构建一级椎间孔成形模型M3(环锯直径5.0 mm)、二级椎间孔成形模型M4(环锯直径6.5 mm)和三级椎间孔成形模型M5(环锯直径7.5 mm)。给予特定加载条件,比较模型在前屈、后伸、左右侧曲、左右旋转6种工况下L_4/L_5关节突关节应力变化。结果建立的L_(3~5)三维有限元模型有效。M1模型在各种工况下L_4/L_5关节突关节的应力左侧较右侧大。M2模型在前屈工况下左侧L_4/L_5关节突关节应力下降,右侧应力上升;在后伸工况下左侧应力上升,右侧应力下降;在右旋工况下,左侧应力变化不明显,右侧应力稍下降;在左侧屈及左旋工况下两侧应力均上升;在右侧屈工况下左侧应力稍下降,右侧应力变化不明显。除M5模型左旋工况下右侧应力增加明显外,其他各种工况下M3、M4、M5模型应力变化不明显。结论椎间盘摘除后引起病变节段关节突关节面所承载的负荷不对称;在精确穿刺的指引下,环锯直径5.0、6.5、7.5 mm行椎间孔成形对病变节段关节突关节应力变化无显著影响。     

后部结构对腰椎前屈／后伸稳定性的影响

目的：探讨小尾寒羊L5／6后部结构分级切除对腰椎前屈／后伸稳定性的影响。方法：利用改良的定位移生物力学测试方法,对L5／L6后部结构依次分级切除：Ⅰ正常→Ⅱ全椎板减压→Ⅲ左侧关节突切除1／2→Ⅳ左侧关节突全部切除→Ⅴ右侧关节突切除1／2→Ⅵ右侧关节突全部切除,Instron8874试验机依次测试标本前屈／后伸椎间运动的变化。结果：全椎板减压和左侧关节突的全部切除对于前屈／后伸的稳定性影响不大（P〉0．05）;当再切除右侧关节突1／2时,稳定性影响明显（P〈0.05）。结论：在保证手术视野的情况下,腰椎后路手术力求做到微创,尽量保留后部结构的完整性。     

腰椎间盘摘除前后椎间关节腔内应力变化的实验研究

目的 了解椎间盘摘除前后小关节突关节内应力变化。方法 使用自身对照法，观察椎间盘摘除前后小关节突关节腔内应力变化趋势。结果 单纯椎间盘摘除后小关节突关节内应力在屈曲、后伸时明显提高；但侧弯时有所下降。结论 椎间盘摘除后小关节突关节腔内应力增加是关节突增生的原因之一。     

不同入路经皮内窥镜下关节成形术对椎间盘生物力学影响的三维有限元分析

目的:通过三维有限元法分析经皮内窥镜下L4下关节突成形术与L5上关节突成形术对椎间盘生物力学的影响。方法:选取1例健康青年男性志愿者,对其进行薄层螺旋CT扫描,建立正常的L3～L5三维有限元模型,将上述有限元模型与经典文献数据进行验证。验证后,模拟腰椎经皮内窥镜技术分别于侧后方入路对L5上关节突与后方入路对L4下关节突做直径7.5mm的圆柱状骨切除以模拟椎间孔成形,从而获得正常模型、L5上关节突成形模型(A模型)和L4下关节突成形模型(B模型)3种模型。在L3椎体上表面向终板施加负荷为400N的垂直于水平面压力模拟正常人腰椎承载重力,在前屈、后伸、左右侧弯、左右旋转的方向上分别施加7.5N·m的纯扭矩,比较3种模型在前屈、后伸、左右侧曲、左右旋转状况下L3/4、L4/5椎间盘应力变化情况。结果:A模型前屈、后伸、左侧屈、右侧屈、左旋、右旋状态下L4/5椎间盘的最大应力分别为0.390MPa、0.520MPa、0.450MPa、0.430MPa、0.510MPa和0.498 MPa;B模型前屈、后伸、左侧屈、右侧屈、左旋、右旋状态下L4/5椎间盘的最大应力分别为0.375MPa、0.490MPa、0.440MPa、0.420MPa、0.482MPa和0.478MPa。A模型前屈、后伸、左侧屈、右侧屈、左旋、右旋状态下L3/4椎间盘的最大应力分别为0.369MPa、0.480MPa、0.442MPa、0.432MPa、0.468MPa和0.452MPa;B模型前屈、后伸、左侧屈、右侧屈、左旋、右旋状态下L3/4椎间盘的最大应力分别为0.368MPa、0.478MPa、0.436MPa、0.430MPa、0.465MPa和0.444MPa。结论:腰椎经皮内窥镜技术下,侧后入路L5上关节突成形较后方入路L4下关节突成形对L4/5椎间盘在后伸、旋转状态下的生物力学影响较大。两者对邻近节段L3/4椎间盘的应力变化的影响较小。     

颈椎分离损伤内固定的抗旋转和前屈强度测试

目的：比较四种颈椎内固定方法的旋转和前屈强度。方法：成年新鲜猪第２７颈椎标本５具，每具切取３个脊柱功能单位试件，切断椎间连接造成三柱分离性损伤，采用椎弓根钉、关节突钉、棘突钢丝、椎体钢板将椎骨两两固定，测试它们的旋转和前屈强度及位移大小。结果：椎弓根固定试件的旋转和前屈破坏力最大，加载过程的旋转位移大于正常，前屈位移小于正常，固定最牢。椎体钢板固定的旋转破坏力大于关节突和棘突钢丝试件，前屈破坏力小，位移大。关节突固定的旋转破坏力大于棘突钢丝，角位移小。结论：颈椎严重损伤在选用内固定后，由于抗旋转和前屈强度及位移差异，可适当辅以外固定     

The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine

Degenerative processes in the disc and facet joints affect the stability of the motion segment. The exact relations among disc degeneration, facet joint osteoarthritis, and the kinematics of the motion segment are not well defined in the literature. Magnetic resonance imaging and functional radiography of the lumbar spine were analyzed to examine the relations among segmental instability, facet joint osteoarthritis, and disc degeneration in patients with degenerative disorders of the lumbar spine. Seventy consecutive patients (mean age, 46 years) had both magnetic resonance imaging and flexion and extension radiographs of the lumbar spine. The lumbar instability was classified into abnormal tilting on flexion, rotatory instability in the sagittal plane, and translatory instability. Translatory instability was subdivided into anterior, posterior, and anteroposterior translatory instability. Disc degeneration as seen on T2-weighted sagittal images was classified into five grades. Facet joint osteoarthritis as seen on axial T1-weighted images was divided into four grades. This study revealed that the kinematics of the lumbar motion segment are affected by disc degeneration and facet joint osteoarthritis. Abnormal tilting movement on flexion and anteroposterior translatory instability both had negative associations with facet joint osteoarthritis. However, anterior translatory instability was positively associated with disc degeneration and facet joint osteoarthritis. Rotatory instability in the sagittal plane and posterior translatory instability were not associated with disc degeneration and facet joint osteoarthritis.     

腰椎关节突关节骨性关节炎对腰椎稳定性的影响

目的探讨腰椎退变过程中,腰椎间盘退变、关节突关节骨性关节炎与腰椎稳定性之间的关系.方法对78名腰椎退变患者进行腰椎MRI和动力位X线摄影.腰椎不稳分为椎间角度运动不稳、旋转不稳和椎间位移不稳,其中椎间位移不稳细分为前向不稳、后向不稳和前后向不稳.腰椎间盘退变依据矢状位T2加权像分为5级;关节突关节骨性关节炎依据水平位T1加权像分为4级.对资料进行统计分析.结果腰椎椎间角度运动不稳和前后向椎间位移不稳与关节突关节骨性关节炎存在显著负相关,前向椎间位移不稳与腰椎关节突关节骨性关节炎和椎间盘退变呈显著正相关,腰椎矢状面旋转不稳与腰椎关节突关节骨性关节炎无显著相关.结论腰椎间盘退变和腰椎关节突关节骨性关节炎可影响腰椎运动节段的稳定性.     

椎间盘退变和关节突关节骨性关节炎对腰椎稳定性的影响

目的 探讨腰椎退变过程中，腰椎间盘退变、关节突关节骨性关节炎与腰椎稳定性之间的关系。方法 对78名腰椎退变患者进行腰椎MRI和动力位X线摄影。腰椎不稳分为椎间角度运动不稳、旋转不稳和椎间位移不稳，其中椎间位移不稳细分为：前向不稳、后向不稳和前后向不稳。腰椎间盘退变依据矢状位T2加权像分为5级；关节突关节骨性关节炎依据水平位T1加权像分为4级。对资料进行统计分析。结果 腰椎椎间角度运动不稳和前后向椎间位移不稳与关节突关节骨性关节炎存在显著负相关，前向椎间位移不稳与腰椎关节突关节骨性关节炎和椎间盘退变呈显著正相关，腰椎矢状面旋转不稳与腰椎关节突关节骨性关节炎无显著相关。结论 腰椎间盘退变和腰椎关节突关节骨性关节炎可影响腰椎运动节段的稳定性。     

腰后关节紊乱症的病机和手法治疗生物力学研究

用微型传感器埋入法，测定腰椎后关节在不同姿势下的位移和受力情况，结果表明：其位移程度和方向受关节突形态的影响，脊柱活动时关节内压力集中在小关节的上端和下端，当某段关节失稳时，较邻近的小关节内压力增大８倍左右。对模拟旋转手法测定表明：后关节内压力呈波浪状变化，其下关节突出现向上→前→下→后的全方位移动。作者从生物力学的角度对腰后关节紊乱症的病机和手法治疗原理进行了探讨。     

Reduction in segmental flexibility because of disc degeneration is accompanied by higher changes in facet loads than changes in disc pressure: a poroelastic C5–C6 finite element investigation

Background contextNerve fiber growth inside the degenerative intervertebral discs and facets is thought to be a source of pain, although there may be several other pathological and clinical reasons for the neck pain. It, however, remains difficult to decipher how much disc and facet joints contribute to overall degenerative segmental responses. Although the biomechanical effects of disc degeneration (DD) on segmental flexibility and posterior facets have been reported in the lumbar spine, a clear understanding of the pathways of degenerative progression is still lacking in the cervical spine.PurposeTo test the hypothesis that after an occurrence of degenerative disease in a cervical disc, changes in the facet loads will be higher than changes in the disc pressure.Study designTo understand the biomechanical relationships between segmental flexibility, disc pressure, and facet loads when the C5–C6 disc degenerates.MethodsA poroelastic, three-dimensional finite element (FE) model of a normal C5–C6 segment was developed and validated. Two degenerated disc models (moderate and severe) were built from the normal disc model. Biomechanical responses of the three FE models (normal, moderate, and severe) were further studied under diurnal compression (at the end of the daytime activity period) and moment loads (at the end of 5 seconds) in terms of disc height loss, angular motions, disc pressure, and facet loads (average of right and left facets).ResultsDisc deformation under compression and segmental rotational motions under moment loads for the normal disc model agreed well with the corresponding in vivo studies. A decrease in segmental flexibility because of DD is accompanied by a decrease in disc pressure and an increase in facet loads. Biomechanical effects of degenerative disc changes are least in flexion. Segmental flexibility changes are higher in extension, whereas changes in disc pressure and facet loads are higher in lateral bending and axial rotation, respectively.ConclusionsThe results of the present study confirmed the hypothesis of higher changes in facet loads than in disc pressure, suggesting posterior facets are more affected than discs because of a decrease in degenerative segmental flexibility. Therefore, a degenerated disc may increase the risk of overloading the posterior facet joints. It should be clearly noted that only after degeneration simulation in the disc, we recorded the biomechanical responses of the facets and disc. Therefore, our hypothesis does not suggest that facet joint osteoarthritis may occur before degeneration in the disc. Future cervical spine–based experiments are warranted to verify the conclusions presented in this study.     

经腰椎椎间孔开窗入路的解剖学研究与临床应用

 目的 设计经腰椎椎间孔开窗入路,探讨其可行性及临床应用效果。方法 选取30具成人腰椎尸体标本,模拟L₁～S₁各节段经椎间孔开窗入路操作,充分显露出口神经根及椎间盘后外侧,实体测量完全显露椎间孔时椎板和关节突的切除和剩余范围;在开窗前、开窗后行CT扫描三维重建,测量切除和剩余范围。选取31例成人腰椎三维CT图像,测量L₁～S₁各节段经椎间孔开窗入路切除的骨结构范围。采用可动式脊柱内镜下经椎间孔开窗入路治疗腰椎极外侧椎间盘突出症10例,男4例,女6例。L_3-4 2例,L_4-5 4例,L₅S₁ 4例。结果 自L₁至S₁椎板峡部和关节突关节逐渐增宽,横突逐渐下移,峡部外缘和上关节突外缘到硬膜囊外缘的距离逐渐增大;在L_1,2、L_2,3和L_3,4节段经椎间孔开窗入路切除较少的椎板峡部和关节突即可显露硬膜囊外缘和椎间盘后外侧;在L_4,5尤其L₅S₁节段椎间孔开窗操作空间小,需切除较多的椎板峡部和关节突关节外缘才能显露椎间盘后外侧,硬膜囊显露较困难,下内侧月牙形开窗可保留较多的椎板和下关节突连接。临床应用10例手术均顺利完成,显露充分,彻底摘除了突出和游离的椎间盘髓核。随访6～24个月,末次随访时Macnab评分优8例、良2例,均无腰椎失稳表现。结论 经腰椎椎间孔开窗入路可在保留椎板和下关节突连续性的基础上充分显露椎间孔,内镜下操作、下内侧月牙形开窗可以保留更多的骨性结构,治疗腰椎极外侧椎间盘突出症具有较好的可行性。     

Effectiveness of posterior tension band fixation in the thoracolumbar seat-belt type injuries of the young population

The effects of different parameters on the mechanical behaviour of the lumbar spine were in most cases determined deterministically with only one uncertain parameter varied at a time while the others were kept fixed. Thus most parameter combinations were disregarded. The aim of the study was to determine in a probabilistic finite element study how intervertebral rotation, intradiscal pressure, and contact force in the facet joints are affected by the input parameters implant position, implant ball radius, presence of scar tissue, and gap size in the facet joints. An osseoligamentous finite element model of the lumbar spine ranging from L3 vertebra to L5/S1 intervertebral disc was used. An artificial disc with a fixed center of rotation was inserted at level L4/L5. The model was loaded with pure moments of 7.5 Nm to simulate flexion, extension, lateral bending, and axial torsion. In a probabilistic study the implant position in anterior–posterior (ap) and in lateral direction, the radius of the implant ball, and the gap size of the facet joint were varied. After implanting an artificial disc, scar tissue may develop, replacing the anterior longitudinal ligament. Thus presence and absence of scar tissue were also simulated. For each loading case studied, intervertebral rotations, intradiscal pressures and contact forces in the facet joints were calculated for 1,000 randomized input parameter combinations in order to determine the probable range of these output parameters. Intervertebral rotation at implant level varies strongly for different combinations of the input parameters. It is mainly affected by gap size, ap-position and implant ball radius for flexion, by scar tissue and implant ball radius for extension and lateral bending, and by gap size and implant ball radius for axial torsion. For extension, intervertebral rotation at implant level varied between 1.4° and 7.5°. Intradiscal pressure in the adjacent discs is only slightly affected by all input parameters. Contact forces in the facet joints at implant level vary strongly for the different combinations of the input parameters. For flexion, forces are 0 in 63% of the cases, but for small gap sizes and large implant ball radii they reach values of up to 533 N. Similar results are found for extension with a maximum predicted force of 560 N. Here the forces are mainly influenced by gap size, implant ball radius and scar tissue. The forces vary between 0 and 300 N for lateral bending and between 0 and 200 N for axial torsion. The parameters that have the greatest effect in both loading cases are the same as those for extension. Intervertebral rotation and contact force in the facet joints depend strongly on the input parameters studied. The probabilistic study shows a large variation of the results and likelihood of certain values. Clinical studies will be required to show whether or not there is a strong correlation of parameter combinations that cause high facet joint forces and low back pain after total disc replacement.     

脊柱三维运动对腰髓核摘除术后小关节的作用机制

目的观测髓核摘除术后腰椎小关节的应力分布变化。方法取新鲜青壮年尸体下腰椎标本6具,在L4下关节突、L5上下关节突、S1上关节突分别贴横形和竖形微细应变片进行力学测试。首先在髓核摘除前测量各应变片在轴向加压、前屈、后伸、侧屈、旋转工况下的应变值;然后在所有标本上行单侧L5/S1开窗髓核摘除术,在同样加载条件下测量应变值;最后在所有标本对侧行L5/S1开窗髓核摘除术形成双侧髓核摘除,重复加载测量应变值。结果轴向加压工况时3种实验力学状态应变量均无差异;前屈工况时L5下关节突竖形应变量髓核摘除前与双侧髓核摘除状态差异有统计学意义;后伸工况时L5上、下关节突竖形应变量双侧髓核摘除状态与其它2种实验力学状态相比差异均有统计学意义;侧屈工况时3种实验力学状态应变量均无差异;旋转工况时L4下关节突竖形片应变量髓核摘除前与单侧髓核摘除相比、单侧髓核摘除与双侧髓核摘除状态比较差异均有统计学意义,L5下关节突横行片应变量双侧髓核摘除状态与其它2种实验力学状态比较差异有统计学意义,S1上关节突竖形片应变量髓核摘除前与双侧髓核摘除状态比较差异有统计学意义。结论单侧开窗髓核摘除术后邻近关节突稳定性保存良好,但是双侧开窗髓核摘除术后下腰椎邻近节段关节突在前屈、后伸、旋转运动时与髓核摘除前比较应变量显著增高,稳定性下降,需要给予适当的稳定措施。     

手法治疗脊柱滑脱症的临床与实验研究

应用位移传感器测量新鲜尸体标本模拟运动及旋转复位时位移情况，可见腰椎下关节突产生向上及侧方位移，使椎间孔扩大，椎体产生相应向后回位趋势；肉眼观察峡部裂脊柱标本在手法作用下出现峡部裂间距加大。对３５例腰椎滑脱症病人手法治疗，效果较为满意，尤对退变型滑脱为佳；仰卧屈膝，屈髋腰起坐锻炼和等张肌力锻炼是治疗该病的重要措施。