两种水平前路腰椎间融合术后路内固定，经关节突螺钉和椎弓根螺钉哪一种更好？
Which posterior instrumentation is better for two-level anterior lumbar interbody fusion: translaminar facet screw or pedicle screw?
机构信息
Department of Spine Surgery, The People's Hospital of Xingtai, Xingtai 054001, China.
出版信息
Arch Orthop Trauma Surg. 2013 Jan;133(1):37-42. doi: 10.1007/s00402-012-1636-y. Epub 2012 Oct 30.
PURPOSE
To determine whether translaminar facet screws can provide stability equivalent to pedicle screws and whether the two posterior instrumentations have the same influence on the adjacent segments in two-level anterior lumbar interbody fusion.
METHODS
In a biomechanical study conducted, we used 12 fresh human lumbar spines and tested an intact spine with a stand-alone two-level anterior lumbar interbody fusion and anterior fusion augmented with pedicle screws or translaminar facet screws, under 400 N compressive preloads and 7.5 N m moments in flexion, extension, axial rotation and lateral bending, and measured the stiffness of the operated level, range of motion and intradiscal pressure at the adjacent levels.
RESULTS
We found a significant increase in the stiffness of the segments operated, range of motion and intradiscal pressure at the adjacent superior segment in the stand-alone two-level anterior lumbar interbody fusion during flexion, axial rotation and lateral bending, but a decrease in extension, when compared with the intact spine. The stiffness of operated segments, range of motion and intradiscal pressure in the adjacent segment are significantly higher in the two-level anterior lumbar interbody fusion augmented with posterior instrumentation than in the stand-alone two-level anterior lumbar interbody fusion. There was no significant difference between the two augmented constructs except that, at the adjacent superior segment, the intradiscal pressure was more in the construction augmented with a pedicle screw than with a translaminar facet screw in flexion.
CONCLUSIONS
Translaminar facet screws can provide stability equivalent to pedicle screws, but their influence on the adjacent segments is relatively lower; therefore, we suggest that translaminar facet screws be the choice in the optimal posterior instrumentation in a two-level anterior lumbar interbody fusion.
目的
确定经关节突螺钉能否提供与椎弓根螺钉相当的稳定性，以及两种后路内固定物在双节段前路腰椎间融合中对相邻节段的影响是否相同。
方法
在一项生物力学研究中，我们使用 12 具新鲜的人腰椎标本，分别对完整脊柱、单纯双节段前路腰椎间融合以及前路融合联合椎弓根螺钉或经关节突螺钉固定的脊柱进行测试，在 400N 压缩预加载和屈伸、轴向旋转和侧屈 7.5N·m 力矩下，测量手术节段的刚度、运动范围和相邻节段椎间盘内压力。
结果
我们发现，与完整脊柱相比，单纯双节段前路腰椎间融合在屈伸、轴向旋转和侧屈时，手术节段的刚度、运动范围和相邻上位节段椎间盘内压力显著增加，而在伸展时则显著降低。后路内固定物增强的双节段前路腰椎间融合的手术节段刚度、运动范围和相邻节段椎间盘内压力明显高于单纯双节段前路腰椎间融合。两种增强结构之间除了在屈伸时，后路内固定物增强的双节段前路腰椎间融合的上位相邻节段椎间盘内压力比经关节突螺钉固定更高外，没有显著差异。
结论
经关节突螺钉可以提供与椎弓根螺钉相当的稳定性，但对相邻节段的影响相对较低；因此，我们建议在双节段前路腰椎间融合中，经关节突螺钉是最佳后路内固定物的选择。
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