生理载荷下腰椎单/双边固定的三维运动学研究

Lumbar fusion has been become the standard surgical treatment for lumbar degenerative disease. At the mini-invasive background, transforaminal lumbar interbody fusion (TLIF) combined with unilateral pedicle screws instrumentation has become a focused issue in treating with single segment of lumbar spine degenerative disease recently. However there are only in vitro biomechanical studies toward this procedure, furthermore the conclusions of have big divergence. How to achieve the accurate in vivo biomechanical data of lumbar spine has become a challenging international medical and bioengineering problem. Combination of the Dual fluorescence imaging system (DFIS) and 2 dimensions to 3 dimensions (2D-3D) matching techniques will be used to study the in vivo kinematics of unilateral\bilateral instrumentation and normal lumbar groups. According to the previous studies, the precision of this technique is 0.3 mm/ 0.7 . We use CT scans to construct very vertebra 3D anatomic model in Rhinoceros? software. DFIS system captures dual X-ray images under seven functional positions. 2D-3D matching technique to accurately reproduce the physiological 6 Degree of Freedom (6-DOF) kinematics at operated and adjacent segments. This current research has been following the development frontiers of international orthopedic biomechanics science, which can provide a scientific basis for orthopedic doctors and researchers. The potential achievements can be directly beneficial to the patient's short and long -term clinical efficiency, medical expenditure and rational use of medical resources. Our completed works laid a solid foundation for current study.

腰椎融合是治疗腰椎退行性疾病的标准术式。微创背景下，采用单或双边椎弓根螺钉固定融合单节段腰椎疾病成为了关注的热点。两者的生物力学研究，目前国内外均采用体外实验方法，其结论具有明显争议。采用无创方法，真实复制、准确测量生理负重条件下脊椎的活动情况，是国际医学工程的难题。我们采用双C臂正交成像系统（DFIS） 和2维-3维（2D-3D）配准技术，对照研究单边固定、双边固定和正常腰椎组之间各腰椎体3D活动。精度可以达到0.3mm/0.7 。Rhinoceros?软件获取每一椎体的3D解剖模型，DFIS获取7个功能性体位下腰椎的正交双平面X线图像，2D-3D图像配准获得生理载荷下手术节段、手术邻近节段椎间的6DOF运动数据。紧接国际生物力学前沿，解决临床常用手术方式的科学依据。该成果关系到众多腰椎手术病人的近、远期临床疗效、医疗费用支出和医疗资源的合理使用。已完成的前期工作为该研究奠定了基础。

腰椎间盘退行性疾病通常被认为是引起腰痛的最常见原因，占文献报道中的41.8%。TLIF结合椎弓根螺钉固定术已被认为是治疗单节段DDD的经典术式，但单侧螺钉固定仍有争议。我们采用双平面正交成像系统结合2D-3D图像配准技术研究了28例单或双边固定术后邻近节段腰椎的短期在体三维运动特点。分析63例单双边固定的围手术期数据和2年以上的随访临床及影像学数据。结论发现单边固定组与双边固定组术后（6.3周VS 5.8周）相比：手术节段左右旋转度（2.1°VS 0.7° P＜0.001），上邻近节段左右旋转度（2.2°VS 3.2° P=0.003），左右侧屈度（2.3° VS 3.1°P=0.041）。手术节段左右侧屈和前屈后伸和上邻近节段的前屈、后伸以及下邻近节段的三维运动两组均无明显差异。临床数据发现单边组在出血量、手术时间、住院及费用方面有显著优势，短期腰痛评分双边固定组优于单边固定组（1月时VAS评分1.8 VS 2.4），但远期临床疗效和融合率无明显差异，单边固定组对上邻近椎影响要小于双边固定组。结论：单双边固定对单节段的DDD均有良好的临床疗效，但单边边固定组对上邻近椎的生物力学影响要小于双边固定组。

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