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http://hdl.handle.net/11455/35572| 標題: | 單側腰椎骨融合固定術之研究 Unilateral Cage-Instrumented Fixation for Lumbar Spine |
作者: | 張迪生 Chang, Ti-sheng |
關鍵字: | Bone fusion;骨融合;range of motion;degeneration;decompression;fixation;活動度;退化;減壓;固定 | 出版社: | 生物產業機電工程學系所 | 引用: | 1. B. K. Crpress,” Characteristics of physician visits for back symptoms: A National Prospective”, Am. J .Public. Health., vol 73, pp 389-395, 1983. 2. P. G. Shekelle, M. Markovich, and R. Louie,” An epidemiologic study of episodes of back pain care”, Spine., vol 20, pp 1668-1673, 1995. 3. J. W. Frymoya,” Back pain and sciatica”, N .Engl. J. Med., vol 3, pp 293-300, 1988. 4. A. C. Popageogion, G. F. Macfarlane, and E .Thomas,” Psychosocial factors in the workplace- do they predicting new episodes of low back pain?”, Spine., vol 22, pp 1137-1142, 1997. 5. D. Shier, J. L. Butler, R. Lewis, Hole's Human Anatomy and Physiology, 10th ed, McGraw-Hill, 2004. 6. J. L. Berry, J. M, Moran, W. S. Berg, and A. D. Steffee,”A morphometric study of human lumbar and selected thoracic vertebra”, Spine., vol 12, pp 362-366, 1987. 7. M. M. Panjabi, J. Duranceau, V. K. Goel, T. R. 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Rockville, MD: Aspen Publisher, 1989. | 摘要: | 本篇主旨乃探討對於腰椎退化性病變，以單側後位腰椎間骨融合手術與雙側後位腰椎間骨融合手術的生物力學特性比較與分析。 取十二隻羊屍之腰椎單一運動節段為樣本進行非破壞性橈度檢測,運動方向包含前曲、後仰、軸向旋轉及側彎曲，手術方式包括椎板切除、內側小面關節切除、椎間盤切除、椎間支架置入以及椎弓根釘置入，各個樣本在原始狀態下經不同運動方向檢測後，以此手術順序依次為之。十二隻樣本平均分為兩組，每組六隻。第一組接受單側腰椎間骨融合手術，第二組接受雙側腰椎間骨融合手術，兩組在各個手術後接受相同的純力距以及運動方向的檢測，接著進行兩組活動度以及中性區的分析比較。 在此羊腰椎模型下，兩組無論從活動度或中性區比較皆顯示有相似的穩定度，而在單側手術這一組，在接受破壞性手術（如椎板切除、內側小面關節切除以及椎間盤切除）和穩定性手術（椎間支架置入以及椎弓根釘置入）以後，無論側向彎曲或軸向旋轉，左右兩側皆無顯著差異：單側後位腰椎骨融合手術可減少手術暴露部位，伴隨椎弓根釘的使用，可增進椎體前柱的穩定效應，兩側不平均引致腰椎不愉悅的成對活動也沒有發生，同時單側手術方式的金額也較便宜，因此，單側後位腰椎骨融合手術，在臨床上，特別是一些以單側症狀表現的退化性腰椎病變患者，乃可提供替代傳統雙側後位腰椎骨融合手術的方式。 To investigate how unilateral cage-instrumented posterior lumbar interbody fusion (PLIF) affects degenerative disc disease by comparing the biomechanical characteristics of unilateral and bilateral cage-instrumented PLIF. Twelve motion segments in sheep lumbar spine specimens were tested for flexion, extension, axial rotation, and lateral bending by nondestructive flexibility test method using a nonconstrained testing apparatus. The specimens were divided into two equal groups. Group 1 received unilateral procedures while group 2 received bilateral procedures. Laminectomy, facetectomy, discectomy, cage insertion and transpedicle screw insertion were performed sequentially after testing the intact status. Changes in range of motion (ROM) and neutral zone (NZ) were compared between unilateral and bilateral cage-instrumented PLIF. Comparing ROM and NZ between, unilateral cage-instrumented PLIF and bilateral cage-instrumented PLIF revealed similar stability in the sheep spine model. In the unilateral cage-instrumented PLIF group, the destructive and stabilizing procedures did not demonstrate a significant difference between right and left side in the lateral bending and axial rotation direction. Based on the results of this study, unilateral cage-instrumented PLIF and bilateral cage-instrumented PLIF have similar stability in the sheep spine model. The unilateral approach can substantially reduce exposure requirements. It also offers the biomechanics advantage of construction using anterior column support combined with pedicle screws. The unpleasant effect of couple motion resulting from inherent asymmetry was absent in the unilateral group. |
URI: | http://hdl.handle.net/11455/35572 | 其他識別: | U0005-1611200921314300 |
| Appears in Collections: | 生物產業機電工程學系 |
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