Ogon M, Haid C, Krismer M, Jesenko R, Wimmer C
Department of Orthopaedic Surgery, University of Innsbruck, Austria.
Spine (Phila Pa 1976). 1996 Nov 1;21(21):2458-62. doi: 10.1097/00007632-199611010-00009.
The feasibility of correcting scoliosis and creating lordosis simultaneously in the thoracolumbar and lumbar spine by anterior instrumentation was investigated by in vitro testing.
To evaluate the vertebral zones in which a compressive load applied in a motion segment creates side bending and lordosis in intact motion segments and after partial disc removal.
Most investigators have observed a kyphogenic effect of anterior scoliosis instrumentation and recommended dorsal placement of screws and the use of wedge grafts, although wedge grafts were not used routinely by all surgeons.
Zones of lordosization and side bending were determined by evaluation of balance lines between extension-flexion and side bending, respectively, by axial loading on ligamentous human motion segments with intact discs and after partial disc removal.
In lumbar motion segments with intact discs, it is possible to achieve ipsilateral side bending and lordosization by anterior instrumentation. After partial disc removal, the balance line between extension and flexion runs through the ipsilateral pedicle, and, therefore, a compressive load between the vertebral bodies always creates kyphosis.
After partial disc removal, it is not possible to create lordosis and correction of scoliosis simultaneously by ipsilateral anterior instrumentation without the use of intervertebral wedge grafts.
通过体外测试研究了前路器械在胸腰段和腰椎同时矫正脊柱侧弯并形成前凸的可行性。
评估在完整运动节段以及部分椎间盘切除后，在运动节段施加压缩负荷时产生侧弯和前凸的椎体区域。
大多数研究者观察到前路脊柱侧弯器械有导致后凸的作用，并建议螺钉置于后方以及使用楔形植骨，尽管并非所有外科医生都常规使用楔形植骨。
通过分别评估屈伸和侧弯之间的平衡线来确定前凸和侧弯区域，对完整椎间盘的人体韧带运动节段以及部分椎间盘切除后的节段进行轴向加载。
在椎间盘完整的腰椎运动节段，前路器械有可能实现同侧侧弯和前凸。部分椎间盘切除后，屈伸平衡线穿过同侧椎弓根，因此椎体间的压缩负荷总会导致后凸。
部分椎间盘切除后，不使用椎间楔形植骨，同侧前路器械不可能同时形成前凸并矫正脊柱侧弯。
