Schultheiss Markus, Hartwig Erich, Sarkar Michael, Kinzl Lothar, Claes Lutz, Wilke Hans-Joachim
Department of Trauma, Hand and Reconstructive Surgery, University of Ulm, Steinhövelstrasse 9, 89075 Ulm, Germany.
Eur Spine J. 2006 Jan;15(1):82-9. doi: 10.1007/s00586-004-0837-7. Epub 2005 Feb 4.
Endoscopic minimally invasive techniques have become an established method of fracture stabilisation in the spine. In view of this fact, anterior stabilisation strategies must be reconsidered, as monosegmental A 3.1 compression fractures are increasingly being stabilised endoscopically from the anterior aspect using minimally invasive techniques. This study investigated the biomechanical necessity of anterior two-point or four-point stabilisation in the instrumentation of mono- and bisegmental fractures. In three biomechanical in vitro studies, burst fracture stabilisation was simulated, and anterior short fixation devices were tested under load with pure moments up to 3.75 Nm to evaluate the biomechanical stabilising characteristics of different kinds of instrumentations in flexion/extension, lateral bending, and axial rotation. Only anterior four-point stabilisation resulted in sufficient primary stability both in mono- and bisegmental instrumentation and therefore represents the standard procedure in open as well as in minimally invasive spinal surgery.
内镜微创技术已成为脊柱骨折稳定治疗的既定方法。鉴于这一事实,前路稳定策略必须重新考虑,因为单节段A 3.1压缩骨折越来越多地通过微创技术从前路进行内镜稳定治疗。本研究调查了单节段和双节段骨折内固定术中前路两点或四点稳定的生物力学必要性。在三项生物力学体外研究中,模拟爆裂骨折稳定,对前路短固定装置施加高达3.75 Nm的纯力矩负荷进行测试,以评估不同类型内固定在屈伸、侧屈和轴向旋转时的生物力学稳定特性。仅前路四点稳定在单节段和双节段内固定中均产生了足够的初始稳定性,因此代表了开放及微创脊柱手术的标准术式。