Ao Jun, Jin An-min, Zhao Wei-dong, Zhang Hui, Min Shao-xiong, Yu Bo, Chen Wei-yi
Department of Orthopedic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2009 May;29(5):959-61, 965.
To assess the biomechanical stability of asymmetrical posterior internal fixation for transforaminal lumbar interbody fusion (TLIF) with transfacetopedicular screws (TFPS).
Range of motion (ROM) testing was performed in 7 fresh-frozen human cadaveric lumbar spine motion segments in flexion/extension, lateral bending, and axial rotation using 10.0 Nm torques at the L3-4 motion segment. The sequential test configurations included intact motion segment, TLIF and ipsilateral pedicle screw (PS), TLIF and ipsilateral PS plus contralateral TFPS according to Boucher technique, and TLIF and bilateral PS. The ROM was determined to assess the construct stability.
In flexion/extension, lateral bending, and axial rotation, no measureable difference was found in the ROM between the standard bilateral pedicle screw and the novel asymmetric posterior internal fixation after TLIF. After TLIF, the ipsilateral PS construct provided less segment stability than the novel asymmetric construct with TFPS in flexion, left bending and left rotation. In rotation, the novel asymmetric construct allowed for significant off-axial rotation motions detrimental to the stability and fusion.
Ipsilateral PS placement plus contralateral TFPS provides stability comparable to that of TLIF with bilateral PS, and can be an alternative in minimal invasive surgery.
评估经椎间孔腰椎椎间融合术（TLIF）中使用经关节突椎弓根螺钉（TFPS）进行不对称后路内固定的生物力学稳定性。
在7个新鲜冷冻的人体腰椎运动节段上进行活动度（ROM）测试，在L3 - 4运动节段使用10.0 Nm的扭矩进行屈伸、侧屈和轴向旋转测试。连续的测试构型包括完整运动节段、TLIF和同侧椎弓根螺钉（PS）、根据布歇技术的TLIF和同侧PS加对侧TFPS，以及TLIF和双侧PS。通过测定ROM来评估内固定结构的稳定性。
在屈伸、侧屈和轴向旋转中，TLIF后标准双侧椎弓根螺钉与新型不对称后路内固定之间的ROM没有可测量的差异。TLIF后，同侧PS内固定结构在屈曲、左侧弯曲和左侧旋转时提供的节段稳定性低于带有TFPS的新型不对称结构。在旋转时，新型不对称结构允许显著的离轴旋转运动，这对稳定性和融合不利。
同侧PS置入加对侧TFPS提供的稳定性与TLIF双侧PS相当，可作为微创手术的一种替代方法。
