| PART Ⅰ The study of The Initial Stability After modified unilateral posterior lumber interbody fusion with traditional posterior lumber interbody fusionObject : To compare the stability of the lumbar intervertebral segmental stiffness after After modified unilateral posterior lumber interbody fusion with traditional posterior lumber interbody fusion.Methods: Choose 10 fresh calf specimens, randomly into two groups:(1) complete specimen group(control group);(2) the modified unilateral PLIF additional unilateral pedicle screw fixation group(unilateral PLIF group).To spin out the specimen by the vertebral muscles, but retain the ligaments and intervertebral disc and fiber ring.Make models according to the clinical operation:modified unilateral PLIF additional unilateral pedicle screw fixation.The specimen model on bone cement platform, affix of electrodes.Then specimens placed in the spine biomechanics test machine, hierarchical load 0 ~ 500 n physiological load, per 100 n grading loading, loading speed should be controlled in the rate of 1.4 mm/min load on the symmetric axis of center of gravity in the lumbar spine mechanics.Lumbar load simulate working condition of human physiological movement and inpure compression,flexion, extension, and lateral bending.To test the average strain, axial stiffness and shear stiffness values, torsional strength, and comparing with complete specimen group research.Results:(1)Compared with the intact group, the mean strainness increased 6.5%(p<0.05)in the condition of axial compression. It increased 6.25% in flexion( P<0.05). It increased 12.2% in bending and increased 16.3% in rear protraction.( P<0.05).(2)the mean axis compression stiffess increased 20.8%,the mean anteroposterior shear stiffess increased 23.9%( P<0.05).(3)the axial rotational stiffess increased 12.3( P<0.05)Conclusion: Modified unilateral posterior lumber interbody fusion with traditional posterior lumber interbody fusion can support the lumbar sufficient initial stability.PART Ⅱ Comparative study of the modified unilateral posterior lumber interbody fusion with traditional posterior lumber interbody fusion for lumbar disc herniation with lumbar instabilityObjective: To investigate the clinical outcome of the modified unilateral posterior lumber interbody fusion with traditional posterior lumber interbody fusion for lumbar disc herniation with lumbar instability.Methods: 51 cases patients with herniation associated with lumbar spinal instability, were randomly divided into two groups:(1) Modified unilateral PLIF groups: 26 cases of male 12 cases, 14 cases female, age 41 ~ 57.1 ~ 24 years duration.14 cases of segmental in L4 ~ 5, 12 cases in L5 ~ S1.(2) the traditional PLIF groups: 25 cases of male 12 cases, 13 cases of female, age 46 ~ 67 years old.Duration of 2 ~ 21 years.12 cases of segmental in L4 ~ 5, 13 cases in L5 ~ S1.Two groups of patients with general data comparison difference has no statistical significance(P > 0. 05). An observational study of operational duration, amount of bleeding, the therapeutic effect, rate of bone graft fusion was conducted.Results: the mean operation time: traditional PLIF group was 120 min, modified unilateral PLIF group was84 min.(2) the mean intraoperative bleeding: traditional PLIF group was 320 ml, and unilateral PLIF group of about 120 ml, both has the significant difference(P < 0. 05).There are 7 patients postoperative blood transfusion in traditional PLIF group and unilateral PLIF group was no blood transfusion.(3) clinical efficacy: The Excellent rates of clinical efficacy is 86.5% in traditiona PLIF and 93.1% in modified PLIF, the difference between the two groups was statistically significant(P < 0. 05).(4) bone graft fusion rate: bone graft fusion rate of traditional PLIF group was 92.4%, the modified unilateral PLIF group was 94.1%, there there was no significant difference(P > 0. 05).(5) complications: in traditional PLIF group, 2 cases of incision delayed healing and incision infection did not happen;The wounds all were primary healing in Modified unilateral PLIF group. 2cases in traditional PLIF and 1 in modified PLIF increased nerve root pain after surgery.Intraoperative dural sac tear: 1 case in traditional PLIF group, no case in unilateral PLIF group.No horsetail nerve damaging in both groups. No case of screw loosing or Cage sinking and so on。Conclusion: The modifed unilateral PLIF are safe and efficient techniques to treat lumbar disc herniation with lumbar instability. There is no significant different in rate of graft fusion, but modified PLIF is superior to traditional PLIF in the aspects of clinical efficacy, operational time, trauma, complications and so on. |
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