DIAM植入对腰椎屈伸状态下椎管和椎间孔形态变化影响的应用解剖研究

目的:探讨棘突间植入物DIAM对腰椎屈伸状态下椎管、椎间孔形态变化的影响.方法:对9具新鲜成人L1～5脊柱标本在屈曲和后伸15°位进行CT扫描,所得图像用多平面重建法行三维重建,在ADW4.2工作站上对重建图像进行处理后获得椎管水平面和旁矢状面图像,在该图像上分别测量L2～3、L3～4和L4～5椎管前后径及椎间孔宽度、高度和面积(对照组);在L3～4棘突间安装DIAM棘突间植入物后再次进行CT扫描、重建和测量(DIAM组).对两组测量结果行单样本正态性检验和双侧自身配对t检验.结果:腰椎椎管和椎间孔在屈曲时增大,后伸时变狭窄.椎管前后径、椎间孔宽度及面积等指标变化组间比较差异有统计学意义(P＜0.05);DIAM植入对椎间孔高度变化的影响无统计学意义(P＞0.05).结论:DIAM能够降低脊柱后伸时安装节段椎管和椎间孔变狭窄的程度,对相邻节段椎管和椎间孔形态无影响.

Effect of an Interspinous Implant on Anatomic Changes of the Spinal Canal and Intervertebral Foramen

Objective：To investigate the effect of an interspinous implant on anatomic changes of the spinal canal and intervertebral foramen at the implanted and adjacent levels. Methods： Nine fresh cadaveric L1-5 specimens were positioned to 15° of flexion and 15° of extension. Each specimen was scanned by Multi - slice Spiral CT （MSCT） with and without the interspinous implant placed between the L3 -4 spinous processes. All images were performed with Multi - plane reconstruction （MPR）. Dimension of posterior ligament to flaval ligaments, foraminal width, foraminal height and foramina area were compared between the intact and implanted specimens using T test with a level of significance of 0.05. Results ： The results of this study showed that lumbar spinal canal and intervertebral foramina narrow from flexion to extension. There was a significant difference in dimension of posterior ligament to flaval ligaments, foraminal width, foraminal height and foramina area between the intact and implanted specimens at all measured levels from flexion to extension （ P 〈 0.05 ）. There was no significant difference of the implant at the adjacent levels （ P 〉 0.05 ）. Conclusions ： The interspinous implant DIAM prevents narrowing of the spinal canal and foramina in extension. There are no significant effects of the implant at the adjacent levels.