腰椎间盘置换术后对邻近节段腰椎终板的应力影响与影响因素分析

目的探讨腰椎间盘置换术后对邻近节段腰椎终板的生物影响。方法选用4具新鲜成人腰椎(L2～S1)节段标本,采用SMH-1型人工腰椎间盘实验假体进行人工腰椎间盘置换操作。所有邻近节段终板模型标本选择正常腰椎间盘、髓核摘除术和人工腰椎间盘置换术,然后进行轴向压缩运动测验。结果轴向压缩下邻近节段终板平均最大应力均显示有所增大,与腰椎间盘正常状态组别比较差异有统计学意义(P<0.05),但是明显少于腰椎间盘摘除术(P<0.05)。邻近节段应力测试定点,终板类型以及手术方法对邻近节段腰椎终板都有明显的生物影响。结论腰椎间盘置换术对上邻近节段终板应力负荷明显小于腰椎间盘摘除术,可有效地预防上方邻近节段加速退变,值得推广应用。

Stress effects and influencing factors of lumbar disc replacement surgery for adjacent segment vertebral endplate

Objective To investigate the stress effects and influencing factors of lumbar disc replacement surgery for adja- cent segment vertebral endplate. Methods Four fresh adult lumbar spine （L2-S1） segments of specimens were selected, SMH-1 artificial disc experimental prosthesis for artificial disc replacement operation was used. All adjacent segment end- plate model specimens were choose from normal lumbar intervertebral disc, discectomy and artificial disc replacement surgery, and then proceed to axial compression movement test. Results Adjacent segment endplate average maximum stress showed increased in axial compression, compared with normal lumbar intervertebral disc status group, it had significant dif- ference （P 〈 0.05）, but significantly less than lumbar discectomy （P 〈 0.05）. Adjacent segment stress test fixed-point, end plate type and operation on the lumbar spine endplate of the adjacent segments had significant biological effects. Conclu- sion The stress load of lumbar intervertebral disc replacement on the adjacent segment endplate is significantly less than the lumbar discectomy, it can be effective in preventing the top of the adjacent segments and accelerate degeneration, should be widely applied.