Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis.
Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis.
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保留后路复合体可以预防后路腰椎间融合手术后的邻近节段疾病：有限元分析
DOI：
10.1371/journal.pone.0166452
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Wang LZ
中科院分区：
文献类型：
--
作者：
Huang YP;Du CF;Cheng CK;Zhong ZC;Chen XW;Wu G;Li ZC;Ye JD;Lin JH;Wang LZ
探讨后路腰椎椎体间融合术（PLIF）后腰椎后路复合体对相邻节段的生物力学影响。修改L1-S1节段的有限元模型，以模拟全椎板切除术（PLIF-LAM）和半椎板切除术（PLIF-HEMI）的PLIF手术。模型承受400 N随动载荷，屈曲、伸展、扭转和侧弯力矩为7.5 N.m。比较两组的关节活动度（ROM）、椎间盘内压（IDP）和韧带力。在PLIF-LAM模型中，后纵韧带、横突间韧带和囊韧带的ROM、IDP和韧带力在近端相邻节段显著增加，而在PLIF-HEMI模型中略有增加。两种PLIF模型之间的ROM、IDP和L5-S1水平的韧带力几乎没有差异，尽管与完整腰椎（INT）模型相比，黄韧带的韧带力显著增加。在其他载荷条件下，两种模型的ROM、IDP和相邻椎间盘上的韧带力几乎没有差异。保留的后复合体在PLIF手术期间充当后张力带，并导致屈曲时近端相邻节段上的ROM、IDP和韧带力较小。在减压过程中保留后复合体可以有效防止PLIF手术后相邻节段退变（ASD）。
To investigate the biomechanical effects of the lumbar posterior complex on the adjacent segments after posterior lumbar interbody fusion (PLIF) surgeries. A finite element model of the L1–S1 segment was modified to simulate PLIF with total laminectomy (PLIF-LAM) and PLIF with hemilaminectomy (PLIF-HEMI) procedures. The models were subjected to a 400N follower load with a 7.5-N.m moment of flexion, extension, torsion, and lateral bending. The range of motion (ROM), intradiscal pressure (IDP), and ligament force were compared. In Flexion, the ROM, IDP and ligament force of posterior longitudinal ligament, intertransverse ligament, and capsular ligament remarkably increased at the proximal adjacent segment in the PLIF-LAM model, and slightly increased in the PLIF-HEMI model. There was almost no difference for the ROM, IDP and ligament force at L5-S1 level between the two PLIF models although the ligament forces of ligamenta flava remarkably increased compared with the intact lumbar spine (INT) model. For the other loading conditions, these two models almost showed no difference in ROM, IDP and ligament force on the adjacent discs. Preserved posterior complex acts as the posterior tension band during PLIF surgery and results in less ROM, IDP and ligament forces on the proximal adjacent segment in flexion. Preserving the posterior complex during decompression can be effective on preventing adjacent segment degeneration (ASD) following PLIF surgeries.
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