椎体骨水泥固定术作为腰椎融合术的半刚性韧带替代方法。
Vertebropexy as a semi-rigid ligamentous alternative to lumbar spinal fusion.
机构信息
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
出版信息
Eur Spine J. 2023 May;32(5):1695-1703. doi: 10.1007/s00586-023-07647-y. Epub 2023 Mar 17.
PURPOSE
To develop ligamentous vertebral stabilization techniques ("vertebropexy") that can be used after microsurgical decompression (intact posterior structures) and midline decompression (removed posterior structures) and to elaborate their biomechanical characteristics.
METHODS
Fifteen spinal segments were biomechanically tested in a stepwise surgical decompression and ligamentous stabilization study. Stabilization was achieved with a gracilis or semitendinosus tendon allograft, which was attached to the spinous process (interspinous vertebropexy) or the laminae (interlaminar vertebropexy) in form of a loop. The specimens were tested (1) in the native state, after (2) microsurgical decompression, (3) interspinous vertebropexy, (4) midline decompression, and (5) interlaminar vertebropexy. In the intact state and after every surgical step, the segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS) and axial rotation (AR).
RESULTS
Interspinous vertebropexy significantly reduced the range of motion (ROM) in all loading scenarios compared to microsurgical decompression: in FE by 70% (p < 0.001), in LS by 22% (p < 0.001), in LB by 8% (p < 0.001) in AS by 12% (p < 0.01) and in AR by 9% (p < 0.001). Interlaminar vertebropexy decreased ROM compared to midline decompression by 70% (p < 0.001) in FE, 18% (p < 0.001) in LS, 11% (p < 0.01) in LB, 7% (p < 0.01) in AS, and 4% (p < 0.01) in AR. Vertebral segment ROM was significantly smaller with the interspinous vertebropexy compared to the interlaminar vertebropexy for all loading scenarios except FE. Both techniques were able to reduce vertebral body segment ROM in FE, LS and LB beyond the native state.
CONCLUSION
Vertebropexy is a new concept of semi-rigid spinal stabilization based on ligamentous reinforcement of the spinal segment. It is able to reduce motion, especially in flexion-extension. Studies are needed to evaluate its clinical application.
目的
开发韧带性脊柱稳定技术（“椎体融合术”），使其可用于微创手术减压（完整的后结构）和中线减压（去除后结构），并详细阐述其生物力学特性。
方法
在逐步的手术减压和韧带稳定研究中，对 15 个脊柱节段进行了生物力学测试。通过使用同种异体肌腱（大收肌腱或半腱肌腱），将其固定在棘突（棘突间椎体融合术）或椎板（椎板间椎体融合术）上形成环，从而实现稳定。标本分别在（1）原始状态、（2）微创手术减压、（3）棘突间椎体融合术、（4）中线减压、（5）椎板间椎体融合术后进行测试。在完整状态和每个手术步骤后，将节段在屈伸（FE）、侧方剪切（LS）、侧方弯曲（LB）、前侧剪切（AS）和轴向旋转（AR）中加载。
结果
与微创手术减压相比，棘突间椎体融合术显著降低了所有加载情况下的运动范围（ROM）：FE 中降低了 70%（p<0.001），LS 中降低了 22%（p<0.001），LB 中降低了 8%（p<0.001），AS 中降低了 12%（p<0.01），AR 中降低了 9%（p<0.001）。与中线减压相比，椎板间椎体融合术降低了 ROM，FE 中降低了 70%（p<0.001），LS 中降低了 18%（p<0.001），LB 中降低了 11%（p<0.01），AS 中降低了 7%（p<0.01），AR 中降低了 4%（p<0.01）。除 FE 外，在所有加载情况下，棘突间椎体融合术的节段 ROM 均显著小于椎板间椎体融合术。这两种技术都能够在 FE、LS 和 LB 中使椎体节段 ROM 降低到超出原始状态。
结论
椎体融合术是一种基于脊柱节段韧带增强的新型半刚性脊柱稳定概念。它能够减少运动，特别是在屈伸运动中。需要进行研究来评估其临床应用。
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