Li Xin-Ru, Yu Jia, Zhang Wen, Gao Gong-Ming, Han Long, Chen Liang, Nong Lu-Ming
Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, P.R. China.
Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, P.R. China; Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, P.R. China.
World Neurosurg. 2020 Jul;139:e255-e264. doi: 10.1016/j.wneu.2020.03.190. Epub 2020 Apr 12.
To investigate the effect of partial facetectomy on lumbar stability using percutaneous endoscopy.
Five male adult volunteers with no history of lumbar disease participated in the study. Based on computed tomography data, a three-dimensional model of the L3-S1 segment was created using the Mimics l5.0 and Ansys 13.0 software. The use of an 8.5-mm-diameter ring saw was simulated to cut through 5 different needle insertion points (IPs) commonly used in the clinic on the left-side facet joint (FJ) of L5 to perform facetectomy. The first to third IPs were on the apex of the superior FJ, the midpoint of the ventral side of the superior FJ, and the lowest point of the ventral side of the superior FJ. The fourth and fifth IPs represented the positions of the second and third IPs (8.5 mm/2) after the radius of the ring saw was translated to the dorsal side of the superior FJ. Physiologic load was applied to the human models. The pressure on the left and right FJ of the L5 vertebra, the pressure on the L4-5 intervertebral disc, and the range of motion of the lumbar spine were recorded when normal flexion and extension and lateral flexion and rotation of the lumbar spine model after facetectomy were simulated.
Compared with the intact group, the second IP, maximum pressure on the L4-5 intervertebral disc after facetectomy was not significantly different under any condition (P > 0.05). The maximum pressure on the left FJ of L5 showed significant differences during right rotation of the lumbar spine (P < 0.05). The pressure on the right FJ of L5 was significantly different during left rotation of the lumbar spine (P < 0.05). The range of motion of the lumbar spine was not significantly different under any condition (P > 0.05).
The second IP at the midpoint of the ventral side of the superior FJ showed minimal effect on lumbar spine biomechanics compared with all the other IPs during percutaneous transforaminal facetectomy. Thus, it can be considered as the most suitable IP for facetectomy.
探讨经皮内镜下部分关节突切除术对腰椎稳定性的影响。
5名无腰椎疾病史的成年男性志愿者参与本研究。基于计算机断层扫描数据，使用Mimics 15.0和Ansys 13.0软件创建L3-S1节段的三维模型。模拟使用直径8.5毫米的环锯，在L5左侧关节突关节（FJ）上临床常用的5个不同进针点（IP）进行关节突切除术。第一至第三个进针点分别位于上关节突的顶点、上关节突腹侧中点和上关节突腹侧最低点。第四和第五个进针点分别为环锯半径平移至上关节突背侧后第二和第三个进针点的位置（8.5毫米/2）。对人体模型施加生理负荷。模拟腰椎模型关节突切除术后正常屈伸及侧屈和旋转时，记录L5椎体左右关节突关节的压力、L4-5椎间盘的压力以及腰椎的活动范围。
与完整组相比，关节突切除术后第二个进针点在任何情况下L4-5椎间盘的最大压力均无显著差异（P>0.05）。L5左侧关节突关节在腰椎右旋转时最大压力有显著差异（P<0.05）。L5右侧关节突关节在腰椎左旋转时压力有显著差异（P<0.05）。腰椎的活动范围在任何情况下均无显著差异（P>0.05）。
在经皮椎间孔关节突切除术中，上关节突腹侧中点的第二个进针点与所有其他进针点相比，对腰椎生物力学的影响最小。因此，可将其视为关节突切除术最合适的进针点。
