Biomechanics of Transforaminal Endoscopic Approaches
經(jīng)椎間孔內(nèi)鏡入路的生物力學(xué)研究
Study Design.
Biomechanical cadaveric study. Objective. The aim of this study was to compare the effect of transforaminal endoscopic approaches with open decompression procedures.
Summary of Background Data.
Clinical studies have repeatedly highlighted the benefits of endoscopic decompression, however, the biomechanical effects of endoscopic approaches (with and without injury to the disk) have not been studied up to now.
Materials and Methods.
Twelve spinal segments originating from four fresh-frozen cadavers were biomechanically tested in a loadcontrolled endoscopic transforaminal approach study. Segmental range of motion (ROM) after endoscopic approach was compared with segmental ROM after (1) microsurgical decompression with unilateral laminotomy and (2) midline decompression with bilateral laminotomy. In the intact state and after decompression, the segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS), and axial rotation (AR).
Results.
Vertebral segment ROM was comparable between the two endoscopic transforaminal approaches. However, there was a —statistically nonsignificant—trend for a larger ROM after accessing via the inside-out technique. FE: +3% versus +7%, P=0.484; LS: +1% versus +12%, P= 0.18; LB: +0.6% versus +9%, P=0.18; AS: +2% versus +11%, P= 0.31; AR: ?4% versus +5%, P= 0.18. No significant difference in vertebral segment ROM was seen between the transforaminal endoscopic approaches and open unilateral decompression. Vertebral segment ROM was significantly smaller with the transforaminal endoscopic approaches compared with midline decompression for almost all loading scenarios: FE: +4% versus +17%, P=0.005; AS: +6% versus 21%, P=0.007; AR: 0% versus +24%, P= 0.002.
Conclusion.
The transforaminal endoscopic intracanal technique preserves the native ROM of lumbar vertebral segments and shows a trend toward relative biomechanical superiority over the insideout technique and open decompression procedures.
Key words:
endoscopy, endoscopic spine surgery, endoscopic approach, endoscopic decompression, transforaminal, intracanal technique, inside-out technique, biomechanics, lumbar disk herniation, lumbar spine
研究設(shè)計(jì)：
尸體生物力學(xué)研究。目標(biāo)。本研究的目的是比較經(jīng)椎間孔內(nèi)窺鏡入路與開放式減壓手術(shù)的效果。背景數(shù)據(jù)匯總。臨床研究一再?gòu)?qiáng)調(diào)內(nèi)鏡下減壓的好處，然而，迄今為止尚未對(duì)內(nèi)鏡入路(有無(wú)椎間盤損傷)的生物力學(xué)效應(yīng)進(jìn)行研究。
材料與方法：
在一項(xiàng)負(fù)荷控制內(nèi)窺鏡下經(jīng)椎間孔入路研究中，對(duì)來(lái)自4具新鮮冷凍尸體的12個(gè)脊柱節(jié)段進(jìn)行了生物力學(xué)測(cè)試。比較內(nèi)鏡下入路后的節(jié)段活動(dòng)度(range of motion, ROM)與(1)單側(cè)椎板切開顯微減壓術(shù)和(2)雙側(cè)椎板切開中線減壓術(shù)后的節(jié)段活動(dòng)范圍。在完整狀態(tài)和減壓后，對(duì)節(jié)段進(jìn)行屈伸(FE)、側(cè)向剪切(LS)、側(cè)向彎曲(LB)、前向剪切(AS)和軸向旋轉(zhuǎn)(AR)加載。
結(jié)果：
兩種內(nèi)鏡經(jīng)椎間孔入路的椎節(jié)段活動(dòng)范圍相當(dāng)。然而，采用由內(nèi)向外技術(shù)訪問(wèn)后，活動(dòng)范圍有統(tǒng)計(jì)學(xué)上不顯著的趨勢(shì)。FE: +3% vs +7%， P=0.484;LS: +1% vs +12%， P= 0.18;LB: +0.6% vs +9%， P=0.18;AS: +2% vs +11%， P= 0.31;AR:?4% vs . +5%， P= 0.18。經(jīng)椎間孔內(nèi)鏡入路與單側(cè)開放減壓術(shù)的椎體活動(dòng)范圍差異無(wú)統(tǒng)計(jì)學(xué)意義。在幾乎所有的負(fù)重情況下，經(jīng)椎間孔內(nèi)鏡入路與中線減壓術(shù)相比，椎體活動(dòng)范圍均顯著減小:FE: +4% vs . +17%， P=0.005;AS: +6%對(duì)21%，P=0.007;AR: 0% vs +24%， P= 0.002。
結(jié)論：
經(jīng)椎間孔鏡椎管內(nèi)技術(shù)保留了腰椎節(jié)段的原始活動(dòng)度，并顯示出相對(duì)于內(nèi)翻技術(shù)和開放減壓手術(shù)的生物力學(xué)優(yōu)勢(shì)的趨勢(shì)。
關(guān)鍵詞：內(nèi)窺鏡，脊柱內(nèi)窺鏡手術(shù)，內(nèi)窺鏡入路，內(nèi)窺鏡減壓，經(jīng)椎間孔，椎管內(nèi)技術(shù)，內(nèi)外技術(shù)，生物力學(xué)，腰椎間盤突出癥，腰椎
