单侧和双侧后路腰椎间融合构建物的生物力学特征。
Biomechanical Characterization of Unilateral and Bilateral Posterior Lumbar Interbody Fusion Constructs.
机构信息
Department of Orthopedic Surgery, Xingtai General Hospital of North China Medical Health Group, Xingtai 054000, China.
Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.
出版信息
Biomed Res Int. 2022 Aug 13;2022:7081238. doi: 10.1155/2022/7081238. eCollection 2022.
OBJECTIVES
To compare the biomechanical stability of two-level PLIF constructs with unilateral and bilateral pedicle screw fixations.
METHODS
Six cadaveric lumbar segments were evaluated to assess biomechanical stability in response to pure moment loads applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Each specimen was tested in six sequential configurations: (1) intact baseline; (2) facetectomy; (3) unilateral pedicle screws (UPS); (4) bilateral pedicle screws (BPS); (5) unilateral pedicle screws and cage (UPSC); and (6) bilateral pedicle screws and cage (BPSC).
RESULTS
Significant reductions in motion were observed when comparing all instrumented conditions to the intact and facetectomy stages of testing. No significant differences in motion between UPS, BPS, UPSC, or BPSC were observed in response to FE range of motion (ROM) or neutral zone (NZ). ROM was significantly higher in the UPS stage compared to BPS in response to LB and AT loading. ROM was significantly higher in UPSC compared to BPSC in response to LB loading only. Similarly, NZ was significantly higher in UPSC compared to BPSC in response to only LB loading. In response to AT loading, ROM was significantly higher during UPS than BPS or BPSC; however, no significant differences were noted between UPSC and BPSC with respect to AT ROM or NZ.
CONCLUSION
BPS fixation is biomechanically superior to UPS fixation in multilevel PLIF constructs. This was most pronounced during both LB loading. Interbody support did contribute significantly to immediate stability.
目的
比较双侧和单侧椎弓根螺钉固定的两节段经皮椎间融合术（PLIF）的生物力学稳定性。
方法
评估 6 个腰椎节段以评估在屈伸（FE）、侧屈（LB）和轴向旋转（AR）的纯力矩载荷下的生物力学稳定性。每个标本在 6 个连续的配置中进行测试：（1）完整的基线；（2）关节突切除术；（3）单侧椎弓根螺钉（UPS）；（4）双侧椎弓根螺钉（BPS）；（5）单侧椎弓根螺钉和笼（UPSC）；和（6）双侧椎弓根螺钉和笼（BPSC）。
结果
与完整和关节突切除阶段的测试相比，所有仪器化条件下的运动幅度均显著降低。在 FE 活动范围（ROM）或中立区（NZ）方面，UPS、BPS、UPSC 或 BPSC 之间的运动无显著差异。与 BPS 相比，UPS 在 LB 和 AT 加载时的 ROM 更高。仅在 LB 加载时，UPSC 的 ROM 明显高于 BPSC。同样，仅在 LB 加载时，UPSC 的 NZ 明显高于 BPSC。在 AT 加载时，UPS 的 ROM 明显高于 BPS 或 BPSC；然而，UPSC 和 BPSC 之间在 AT ROM 或 NZ 方面没有显著差异。
结论
在多节段 PLIF 构建中，BPS 固定比 UPS 固定具有更好的生物力学性能。在 LB 加载时最为明显。椎间支撑确实对即刻稳定性有显著贡献。
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