背景:先前的研究已经证明了单纯减压治疗低级别腰椎滑脱的临床疗效。还观察到较高的手术翻修率和较低的背痛缓解率。然而,对于低级别腰椎滑脱,单纯减压后缺乏相关的生物力学证据.
目的:评估全椎板切除术的生物力学特征,半椎板切除术,和通过分析运动范围(ROM)来治疗低度脊椎滑脱症,椎间盘内压(IDP),纤维环应力(AFS),面关节接触力(FJCF),和地峡应力(IS)。
方法:首先,我们利用有限元工具建立了正常腰椎模型,并在此基础上构建了腰椎滑脱模型.然后我们做了全椎板切除术,半椎板切除术,在正常模型和脊椎滑脱模型中进行了三分之一的小关节切除术,分别。最后,我们分析了参数,如ROM,IDP,AFS,FJCF,而且是,对于所有模型在相同的集中力和力矩下。
结果:完整的脊椎滑脱模型显示出相对参数的显着增加,包括ROM,AFS,FJCF,而且是,与完整的正常腰椎模型相比。腰椎滑脱和正常腰椎模型的半椎板切除术和三分之一小关节切除术均未导致ROM的明显变化,IDP,AFS,FJCF,与术前状态相比。此外,接受相同手术后,腰椎滑脱模型和正常腰椎模型的参数变化程度无显著差异.然而,全椎板切除术显著增加ROM,AFS,和IS,并降低了正常腰椎模型和腰椎滑脱模型的FJCF。
结论:半椎板切除术和1/3小关节切除术对低级别腰椎滑脱的节段稳定性没有显著影响;然而,接受半椎板切除术和1/3小关节切除术的LDS患者在旋转过程中可能会在手术侧经历更高的峡部应力.此外,全椎板切除术改变了正常腰椎模型和腰椎滑脱模型的生物力学。
BACKGROUND: Previous studies have demonstrated the clinical efficacy of decompression alone in lower-grade spondylolisthesis. A higher rate of surgical revision and a lower rate of back pain relief was also observed. However, there is a lack of relevant biomechanical evidence after decompression alone for lower-grade spondylolisthesis.
OBJECTIVE: Evaluating the biomechanical characteristics of total laminectomy, hemilaminectomy, and facetectomy for lower-grade spondylolisthesis by analyzing the range of motion (ROM), intradiscal pressure (IDP), annulus fibrosus stress (AFS), facet joints contact force (FJCF), and isthmus stress (IS).
METHODS: Firstly, we utilized finite element tools to develop a normal lumbar model and subsequently constructed a spondylolisthesis model based on the normal model. We then performed total laminectomy, hemilaminectomy, and one-third facetectomy in the normal model and spondylolisthesis model, respectively. Finally, we analyzed parameters, such as ROM, IDP, AFS, FJCF, and IS, for all the models under the same concentrate force and moment.
RESULTS: The intact spondylolisthesis model showed a significant increase in the relative parameters, including ROM, AFS, FJCF, and IS, compared to the intact normal lumbar model. Hemilaminectomy and one-third facetectomy in both spondylolisthesis and normal lumbar models did not result in an obvious change in ROM, IDP, AFS, FJCF, and IS compared to the pre-operative state. Moreover, there was no significant difference in the degree of parameter changes between the spondylolisthesis and normal lumbar models after undergoing the same surgical procedures. However, total laminectomy significantly increased ROM, AFS, and IS and decreased the FJCF in both normal lumbar models and spondylolisthesis models.
CONCLUSIONS: Hemilaminectomy and one-third facetectomy did not have a significant impact on the segment stability of lower-grade spondylolisthesis; however, patients with LDS undergoing hemilaminectomy and one-third facetectomy may experience higher isthmus stress on the surgical side during rotation. In addition, total laminectomy changes the biomechanics in both normal lumbar models and spondylolisthesis models.