Sun Zhaozhong, Cheng Yan, Li Rui, Ren Jiabin, Fang Qingmin, Zheng Zhenyang, Liu Xin
Department of Spine Surgery, Affiliated Hospital of Binzhou Medical College, Binzhou Shandong, 256610, P.R.China.
Department of Neurology, Binzhou People's Hospital, Binzhou Shandong, 256610,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Feb 15;31(2):210-214. doi: 10.7507/1002-1892.201610092.
To investigate the feasibility of anterolateral approach for L vertebral resection, bone grafting, and screw rod fixation by imaging and biomechanics researches.
Twenty formalized adult cadavers (12 males and 8 females) were randomly divided into 2 groups; L vertebral resection, bone graft, and screw rod fixation was performed on 10 specimens by using anterolateral approach (experimental group), and on the other 10 specimens by combined anterior and posterior approach. CT scanning and three-dimensional reconstruction were performed in the experimental group; preoperative maximal safe entry angle and depth of screws and intraoperative actual entry angle and depth of screws were measured; the sacral screw position was observed after operation. The biomechanical test was done in 2 groups.
Twenty specimens smoothly underwent L excision and reconstruction. CT scan showed that there was no significant difference in maximal safe entry angle and depth of screws between males and females in experimental group before operation ( >0.05); the maximal safe entry angle and depth were 51.93° and 47.88 mm for anterior screw, and were 37.04° and 46.28 mm for posterior screw. After operation, depth of the sacral anterior and posterior screws were appropriate, which did not pierce into the spinal canal. The biomechanical test results indicated that the flexion, extension, and lateral flexion displacements, and vertical compression stiffness showed no significant difference between 2 groups ( >0.05).
For L lesions not invading posterior column, to use L vertebral resection, bone graft, and screw rod fixation by anterolateral approach is a safe and feasible method to reconstruct lumbosacral stability, with the advantages of no changing posture, less operation time and incision, and prevention of bone graft shift, but effectiveness need further be identified.
通过影像学和生物力学研究，探讨经前外侧入路行L椎体切除、植骨及螺钉棒固定的可行性。
将20具成年规范化尸体（男12具，女8具）随机分为2组；对10个标本采用前外侧入路行L椎体切除、植骨及螺钉棒固定（实验组），对另外10个标本采用前后联合入路。对实验组进行CT扫描及三维重建；测量术前螺钉的最大安全进针角度和深度以及术中螺钉实际进针角度和深度；术后观察骶骨螺钉位置。对两组进行生物力学测试。
20个标本均顺利完成L切除及重建。CT扫描显示，实验组术前男女之间螺钉的最大安全进针角度和深度差异无统计学意义（>0.05）；前路螺钉最大安全进针角度和深度分别为51.93°和47.88 mm，后路螺钉分别为37.04°和46.28 mm。术后，骶骨前后路螺钉深度合适，未穿入椎管。生物力学测试结果表明，两组间的前屈、后伸、侧屈位移及垂直压缩刚度差异无统计学意义（>0.05）。
对于未侵犯后柱的L病变，采用前外侧入路行L椎体切除、植骨及螺钉棒固定是重建腰骶稳定性的一种安全可行的方法，具有无需改变体位、手术时间及切口较小、防止植骨移位等优点，但有效性尚需进一步验证。
