Evans J H
Clin Orthop Relat Res. 1985 Mar(193):38-46.
If lumbar fusion is indicated to restore stability and prevent irritating intrasegmental motion, then there are a wide range of candidate constructs from which to make a choice. The criteria for choice must include the immediate postoperative stability of the construct, the stability and strength of the eventual fusion, and the potential for decompression or restoration of normal anatomic relations. Interbody fusions are particularly sound biomechanically. Two model constructs of the lumbar interbody fusion, the tripod concept and flagpole concept, are presented. The posterior lumbar interbody fusion (PLIF), in particular, encompasses the most desirable biomechanic features: posterolateral siting of load-bearing grafts is the optimal location in relation to the load-bearing capacity of the vertebral bodies; posterior distraction is enhanced by maintaining the anterior anulus and ligament--they act as a fulcrum or pivot; and when adequate soft-tissue connections are maintained between posterior processes, or when they are supplemented by wire-ties, the graft is stable and strong enough for early weight-bearing. Variations on the theme can accommodate a wide range of presenting cases, whether previously operated or not. PLIF is gratifying to both patient and surgeon, even if technically demanding.
如果需要进行腰椎融合术以恢复稳定性并防止节段内运动产生刺激，那么可供选择的候选植入物种类繁多。选择的标准必须包括植入物术后即刻的稳定性、最终融合的稳定性和强度，以及减压或恢复正常解剖关系的可能性。椎间融合术在生物力学方面尤其合理。本文介绍了腰椎椎间融合术的两种模型植入物，即三脚架概念和旗杆概念。特别是后路腰椎椎间融合术（PLIF），具备最理想的生物力学特征：承重移植物位于后外侧，相对于椎体的承重能力而言是最佳位置；通过维持前侧纤维环和韧带，后伸牵引得以增强——它们起到支点或枢轴的作用；并且当在后侧突起之间保持足够的软组织连接，或者通过钢丝结扎进行补充时，移植物足够稳定和坚固，可早期负重。该术式的变体能够适应各种呈现的病例，无论之前是否接受过手术。PLIF对患者和外科医生来说都令人满意，即使技术要求较高。
