中国成人腰椎“V”形置钉固定的影像学研究

[目的]通过对中国成人腰椎“V”形置钉钉道的影像学测量与分析,研究“V”形置钉的可行性与安全性,为“V”形置钉技术提供影像学参考数据.[方法]应用多层螺旋CT,对60例中国成人进行腰椎三维重建,在椎板轴位断面中测量骨性直线通道长度、最小厚度,测量经椎板关节突螺钉钉道与矢状面和水平面的夹角,以及经椎板关节突螺钉钉道与椎弓根螺钉钉道在水平面和矢状面的夹角.[结果] L3/4、L4/5、L5/S1经椎板关节突螺钉钉道最大长度分别为(42.93±1.01) mm、(44.81±1.59) mm、(46.33 ±2.27) mm,L3/4和L5/S1男女间存在统计学差异,钉道最大直径分别为(5.44±0.23)mm、(6.27±0.41) mm、(5.18±0.34) mm,男女间不存在统计学差异.经椎板关节突螺钉钉道与矢状面夹角较为固定,与水平面夹角从L3/4～L5/S1逐渐加大.经椎板关节突螺钉钉道与椎弓根螺钉的位置关系较为固定,在水平面夹角为36.438°±2.41°,在矢状面夹角为52.884°±2.54°.[结论]在中国成人腰椎中沿椎板轴线存在一个贯穿关节突关节的骨性直线通道,该通道内可置入经椎板关节突螺钉.经椎板关节突螺钉与邻近椎弓根螺钉存在较固定的位置关系,此影像学测量可为术中置钉提供安全依据.     

L5S1前路椎间融合生物力学稳定性实验研究

[目的]对腰椎完整标本、单纯腰椎前路椎间融合术（ALIF）、ALIF分别行椎弓根钉固定及经椎板关节突螺钉固定4种状态进行测试，比较生物力学稳定性。[方法]采用新鲜腰椎标本8具，分别于完整状态、L5S1前路植以Cage、L5S1前路Cage分别行椎弓根钉固定及经椎板关节突螺钉固定下，测定前屈、后伸、侧弯及扭转运动下运动范围并进行比较。[结果]单纯ALIF标本同完整标本相比，其后伸运动范围增大（P〈0．01），而前屈、侧弯、扭转运动范围减小（P〈0．01）；而ALIF经椎弓根钉固定或经椎板关节突螺钉固定后各方向运动范围均小于完整标本及单纯ALIF标本（P〈0．01）。[结论]L5S1单纯行ALIF后伸稳定性差，为增加其稳定性，经椎板关节突螺钉应当是首选的内固定器械。     

以椎板边缘对腰椎椎弓根螺钉进钉点的个体化定位

[目的]探讨以椎板边缘对腰椎椎弓根螺钉进钉点个体化定位方法的有效性和可靠性。[方法]取4具脊柱骨骼标本，以L2为中心摄取X线正位片，测量椎弓根中心点与椎板上缘和外缘的垂直和水平距离，据此在椎弓根中心点涂钡剂，再摄片，测量钡点与椎弓根圈的关系；测量107例正常腰椎正位X线片上椎板边缘与椎弓根中心点的距离，对不同性别和不同投照中心的数据进行比较；对40例腰椎经椎弓根内固定病人应用了此进钉定位方法，复习了30例以横突、关节突为定位标志的经椎弓根内固定病人的住院资料。[结果]实验发现除L3椎板外缘显示欠清楚外，其余椎板边缘均显示清楚，标本上置钉选点的准确率达92．5％；在正常X线片上发现射线中心线对其附近3个节段内的椎板边缘与椎弓根的关系没有明显影响；临床应用发现一次性置钉准确率96％，平均手术时间96min，平均失血量212ml，与横突、关节突组比较有显著性差异。[结论]以椎板边缘对腰椎椎弓根螺钉进钉点个体化定位方法是可行和可靠的、创伤小、准确率高。     

以关节突关节面及棘突为参照定位腰椎椎弓根的临床置钉研究

目的探讨以关节突关节面及棘突为参照定位腰椎椎弓根并应用于临床置钉的准确性和可行性。方法测量关节突关节面后缘距离椎弓根轴线的水平距离（D）;测量上位椎节下关节突下缘水平线与本位椎节椎弓根轴线的垂直距离（K）;测量L1-L5椎节棘突上缘中段切线与椎弓根轴线夹角即头倾角（α角）。统计分析比较D值L1-L5椎节间的差异性;统计分析比较K值L1-L5椎节间差异性。使用关节突关节面-棘突法进行临床置钉,术后行CT检查评价螺钉位置,分析关节突关节面-棘突法置钉准确率、风险率、绝对风险率。结果模型D值数据与CT影像D值数据相比较,L1-L4椎节差异性无统计学意义,L5椎节差异性有统计学意义。经统计学分析,L1-L5不同椎节间K值差异性无统计学意义。所有患者住院及随访期间均未出现神经血管损伤并发症以及断钉、断棒、螺钉松动等情况。结论使用关节突关节面-棘突法置钉,准确率高,风险率低,满足个体化置钉同时克服部分骨骼变异,为临床手法置入腰椎椎弓根螺钉提出了一种新方法。     

成人下腰椎神经根与椎板骨窗之间CT容积再现技术成像特点与意义

目的:观察正常成人下腰椎神经根与对应椎板骨窗之间CT容积再现技术(volume rendering technique,VRT)成像的影像学特点,为完全内窥镜下经椎板间隙入路技术的安全应用提供依据.方法:从2011年9月～11月在我院体检人群中选取60例正常成人的下腰椎CT片,男32例,女28例,年龄20～59岁,平均40岁.将64排螺旋CT平扫下腰椎的三维重建数据传至工作站,在多平面重建技术下获得矢状面、冠状面及横断面成像,确定神经根起始点位置,在前后位上以神经根起始点为参照,与对应椎板骨窗之间进行VRT成像,测量以下参数:椎板骨窗的上下径及左右径,神经根起始点与相应椎板骨窗的椎板上缘及上下关节突内侧缘(椎板骨窗的外侧缘)垂直距离,神经根起始点与相应椎弓根上缘垂直距离,神经根与硬膜囊夹角(根囊角),以及神经根起始点至相应椎弓根下缘的直线距离和垂直距离,并进行统计学分析.结果:60例均获得了下腰椎神经根起始点与椎板骨窗对应的清晰图像.根据神经根起始点与椎板骨窗位置对应关系分为四型:即上缘内型、上缘外型、下缘内型和下缘外型.各相邻节段神经根测量参数比较均有统计学意义(P＜0.05),即椎板窗的上下及左右径均逐渐增大,L4～S1的神经根起始点至椎板上缘的距离逐渐增大,与上下关节突内侧缘的距离逐渐增大,根囊角逐渐减小,神经根在椎管内的直线投影距离逐渐增长,神经根起始点至椎弓根上、下缘的距离逐渐增长.结论:VRT技术可快速、直观显示下腰椎神经根与对应椎板骨窗之间的空间关系,能为完全内窥镜下经椎板间隙入路技术应用提供指导.     

单侧切口微创经椎间孔腰椎椎间融合术混合内固定治疗双节段腰椎退行性疾病北大核心CSCD

目的探讨采用单侧切口微创经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbarinterbody fusion,MIS-TLIF)以椎弓根螺钉结合对侧经椎板关节突螺钉混合内固定治疗双节段腰椎退行性疾病的可行性及临床疗效。方法 2010年1月-2012年1月,收治19例双节段腰椎退行性疾病患者。男7例,女12例;年龄22～68岁,平均50.4岁。病程8个月～15年,中位病程37个月。手术节段:L3～56例,L4～S113例。在单侧切口工作通道下完成MIS-TLIF手术,采用椎弓根螺钉结合对侧经椎板关节突螺钉双侧混合内固定。结果患者均顺利完成手术,平均手术时间158 min、术中出血量156 mL、切口长度42 mm、术后下地时间35 h、住院时间4.1 d、经椎板关节突螺钉长度51 mm。术后切口均Ⅰ期愈合;除1例术中硬膜撕裂外,未出现其他并发症。19例均获随访,随访时间12～24个月,平均17.1个月。术后各时间点腰痛视觉模拟评分(VAS)、腿痛VAS评分及Oswestry功能障碍指数(ODI)评分均较术前显著改善(P<0.05);且随时间延长症状逐渐缓解。术后X线片示内固定物位置良好,经椎板关节突螺钉均穿过棘突根部、椎板和关节突关节,其中2枚(5.3%)经椎板关节突螺钉穿透椎板外侧皮质,1枚(1.8%)椎弓根螺钉略偏出椎弓根外,但均无神经损伤症状。术后12个月CT平扫及三维重建显示椎体间骨性融合良好;根据Bridwell椎间融合评价标准评价,Ⅰ级11例,Ⅱ级8例。结论采用单侧切口MIS-TLIF混合内固定治疗双节段腰椎退行性疾病安全可行,具有手术时间短、创伤小、出血少及恢复快等优点。     

腰椎椎板的解剖测量及临床意义

目的：通过对椎板的解剖学测量,有助于对临床和病理生理的进一步研究。方法：３０ 具尸体标本,依次测量椎板长度、厚度、椎板倾斜角及椎板上缘至同一椎间隙上缘的距离。结果：自Ｌ５ ～Ｌ１ 椎板长度及厚度均增加,椎板倾斜角改变不大,椎板上缘对椎间隙的遮盖依次变小。结论：腰椎形态与腰椎的功能及病理改变有关,椎板对椎间隙的遮盖,为椎间盘手术切除椎板的范围提供了依据。     

前路经寰枢关节螺钉内固定术置钉安全性的CT测量研究

[目的]探讨前路经寰枢关节螺钉内固定术螺钉置入的相对安全范围,为国人行此手术提供CT解剖学依据。[方法]采用多层螺旋CT(MSCT)对20套中国成人常规福尔马林浸泡的寰枢椎标本及30例健康中国成年自愿者的寰枢椎行2.0 mm层厚扫描,1.0 mm层厚重建,在容积重建(VR)及多平面重建(MPR)图像上全方位观察并利用GE RA600 PACS工作站AW三维测量软件进行相关解剖学数据测量,最后对所得结果进行统计学分析,评价置钉安全性。[结果]前路经寰枢关节螺钉内固定术以枢椎前弓下缘与枢椎椎体侧缘交界点上方4 mm处为进针点,在相对于矢状面上螺钉置入的外偏角的参考值范围为17.69°～21.13°,相对于冠状面上螺钉置入的后倾角的参考值范围为11.75°～19.50°,内侧钉道长度的参考值范围为11.19～27.51mm,外侧钉道长度的参考值范围为15.61～31.84mm。[结论]前路经寰枢关节螺钉内固定术是安全可行的,螺钉置入时的理想钉道角度为外偏18°～21°,后倾12°～20°,螺钉长度为16～28 mm。     

同种异体骨钉在椎管扩大成形术中的应用

目的研究同种异体骨钉在腰椎管扩大术中的应用，探讨棘突椎板复合体回植的方式部位。方法严重腰椎管狭窄症患者20例，行全椎板切除椎管减压术后，把棘突椎板复合体翻转90°横架于椎板峡部，上缘与上关节突及上位椎体下关节突下缘（腰椎小关节下缘处）紧密接触，用1根或2根同种异体骨钉固定，进行临床观察和CT测量。结果20例均获得随访1～5年，11例术后12～24个月做CT复查，有10例达到良好的骨性愈合，1例纤维连接，全部椎管直径较术前扩大50％以上，未见骨块移位及硬膜出现新的压迫，无腰椎不稳，临床效果满意。结论把棘突椎板复合体回植于椎板峡部，用同种异体骨钉固定的椎管扩大成形术，椎管接近术前解剖结构很好地重建脊柱稳定性，减少了硬脊膜黏连，避免了腰椎不稳，使骨块提早愈合。     

显微椎间盘镜手术的应用解剖学

目的　为MED手术操作提供解剖学依据。方法　 2 0具成人尸体标本 ,测量下 3个腰椎棘突下缘点与下位椎板上缘距离、椎板间隙外缘点与后正中线、椎间盘与椎板下缘的距离及其生理成角。结果　L3 、L4、L5的棘突下缘点与下位椎板上缘关系及其椎间盘与相应椎板下缘关系均有位于其上方、下方和持平 3种 ,椎板间隙外缘点距后正中线平均 1 1～ 1 5cm。矢状面上 ,L3、4、L4、5和L5S1椎间盘多呈 8 5°± 4°、 11°± 6 3°和 2 7 8°± 6 9°的头倾角 ;工作通道外展角 ,L3、4为 13°± 3°,L4、5为17°± 3 5°,L5S1为 2 8 8°± 6 3°。结论　棘突下缘点可作为MED手术切口中心点 ,工作通道放置角度应与椎间盘的生理倾角相符。     

腰椎间盘突出症的骨结构差异及其对MED的指导意义

目的研究腰椎间盘突出症患者的腰椎后部骨结构解剖因素,分析其对显微内窥镜椎间盘切除术(microendoscopicdiscectomy,MED)的影响,及可能引起的危险和并发症。方法研究采用MED治疗的160例腰椎间盘突出症患者的CT扫描图像,对其突出节段的棘突成角、棘突偏向、椎板长、椎板厚、椎板成角、小关节纵轴长及小关节间距等解剖参数进行测量记录,分析各参数间相关性及其与MED术中情况的关系。结果椎板倾斜、棘突畸形偏向手术侧、椎小关节发育性或增生性内聚、椎板过厚、椎板相对椎间盘水平低或位置过低、椎板过短、椎管最小内径和椎管侧壁过深等是影响MED的解剖因素。同一MED病例L4,5节段比L5S1难度增加很多。研究表明椎板长度大于18mm、椎板角大于120°和椎管侧壁深度小于10mm的病例,行MED手术会非常容易。椎板长度小于12mm、椎板角小于100°和椎管侧壁深度大于14mm的患者行MED术会非常困难和危险,如有上述解剖变异和畸形情况,则不应采用MED治疗;介于两者之间的病例应根据具体情况慎重选择。结论因为器械因素,很多病例不适合MED手术。对切开手术影响不大的腰椎后部解剖结构变异,对MED非常重要,应该成为选择MED的一个手术指征。术前测量腰椎后部解剖数据,选择适合病例行MED,可预防并发症、提高手术的易行性和安全性。     

C7后路椎板螺钉固定解剖学可行性研究

目的:测量C7椎板的解剖学参数,探讨C7后路椎板螺钉固定的可行性。方法:用游标卡尺和量角器测量22具成人C7标本与椎板螺钉进钉技术相关的解剖学数据,指标包括椎板上、中、下部分的厚度(分别为T1、T2、T3),椎板高度(H),进钉点至椎弓根内侧壁及侧块外侧壁的距离(分别为L1、L2),椎板轴线与矢状面的夹角(α)。结果:椎板上部厚度(T1)平均为(4.30±0.27)mm;中部厚度(T2)平均为(5.32±0.27)mm,27%(6例)小于4.50mm;下部厚度(T3)平均为(4.78±0.26)mm;椎板中下部厚度均大于4.50mm;椎板高度(H)平均为(14.83±0.26)mm;进钉点至椎弓根内侧壁的距离(L1)平均为(26.99±0.48)mm;最长钉道长度(L2)平均(41.60±1.10)mm;椎板与矢状面夹角(α)平均(49.3±1.1)°。结论:C7后路椎板螺钉固定是可行的,适用于多数患者(73%)。与C7椎弓根螺钉技术相比,椎板螺钉技术更简单,神经血管损伤的可能性更低。     

腰椎经皮椎弓钉皮质轨迹置入的影像解剖测量

[目的]测量中老年人腰椎经皮椎弓根皮质骨螺钉的解剖学参数并分析其经皮置钉可行性.[方法]选取50例中老年人腰椎三维CT资料并导入Aquarius iNtuition Viewer V 4.4.6软件,测量各节段皮质骨螺钉置钉横断面与矢状面的进钉角度、安全范围、钉道直径及长度、螺钉轨迹皮肤进钉点至椎体上终板的距离和进钉点...     

Lumbar pedicle: surgical anatomic evaluation and relationships

Although several clinical applications of transpedicular screw fixation in the lumbar spine have been documented for many years, few anatomic studies concerning the lumbar pedicle and adjacent neural structures have been published. The lumbar pedicle and its relationships to adjacent neural structures were investigated through an anatomic study. Our objective is to highlight important considerations in performing transpedicular screw fixation in the lumbar spine. Twenty cadavers were used for observation of the lumbar pedicle and its relations. After removal of whole posterior bony elements including spinous processes, laminae, lateral masses, and inferior and superior facets, the isthmus of the pedicle was exposed. Pedicle width and height (PW and PH), interpedicular distance (IPD), pedicle-inferior nerve root distance (PIRD), pedicle-superior nerve root distance (PSRD), pedicle-dural sac distance (PDSD), root exit angle (REA), and nerve root diameter (NRD) were measured. The results indicated that the average distance from the lumbar pedicle to the adjacent nerve roots superiorly, inferiorly and to the dural sac medially at all levels ranged from 2.9 to 6.2 mm, 0.8 to 2.8 mm, and 0.9 to 2.1 mm, respectively. The mean PH and PW at L1-L5 ranged from 10.4 to 18.2 mm and 5.9 to 23.8 mm, respectively. The IPD gradually increased from L1 to L5. The mean REA increased consistently from 35 degrees to 39 degrees. The NRD was between 3.3 and 3.9 mm. Levels of significance were shown for the P < 0.05 and P < 0.01 levels. On the basis of this study, we can say that improper placement of the pedicle screw medially and inferiorly should be avoided.     

Anatomic relationship of the cervical nerves to the lateral masses

Eight cervical specimens were transversely sectioned with slices approximately 2 mm to 3 mm in thickness to evaluate the anatomic relationship of the spinal nerves to the lateral masses. Results showed that the spinal nerve either does not appear or, when it does, is situated anteromedially to the superior facet on the cross sections through the upper portion of the superior facet. The anterolateral aspect of the superior facet is free from the spinal nerve. Cross sections through the lower pedicle of the vertebra showed that the spinal nerve rested on the transverse process anterolateral to the lateral mass. The mean distances between the posterior midline of the lateral mass and the posterior border of the spinal nerve measured 15 degrees in the lateral direction were 16.1+/-1.7 mm for C3, 16.5+/-1.8 mm for CA, 16.8+/-1.2 mm for C5, 16.3+/-2.0 mm for C6, and 8.5+/-0.9 mm for C7. This study suggests that the anterolateral corner of the superior facet and the anterior aspect of the lateral mass lateral to the origin of the transverse process would be safer zones for screw exit. Attention should therefore be paid to the screw orientation for the Magerl technique and to the screw length for the Roy-Camille technique. Care should be taken to insert the screw into the C7 lateral mass.     

Feasibility study on posterior laminar screw fixation techniques in the axis

Objective： To get morphologic parameters of Chinese adults through observation and measurement on axial laminas, to evaluate the feasibility of placing axial laminar screws and to introduce the technique. Methods： Relative parameters of 28 sets of fresh Chinese adults＇ axial specimens, including distance from the superior and inferior entry points of axial laminar screws to the superior margins of axial laminas, superior, middle, inferior thickness and height of the axial laminas, length and angle of the axial laminar screw trajectories, distance from the entry points of axial laminar screws to the transverse foramen and central points of the inferior articular process, were measured with a digital caliper and a goniometer. Data were statistically analyzed. Results： Averagely, distance from the superior and inferior entry points of axial laminar screws to the superior margins of axial laminas was 5 mm and 9 mm, superior, middle, inferior thickness and the height of the axial laminas were 3.2 mm, 6.7 mm, 5.5 mm and 12.8 mm respectively, and the length of the superior and inferior axial laminar screw trajectories was 26.2 mm and 25.5 ram, respectively. Conclusions： It is feasible and reliable to apply posterior laminar screw fixation techniques to the axes of Chinese adults. Also the C2 laminar screw fixation technique can be taken as a supplementary to conventional posterior screw fixations of C2.     

The projection of the cervical disc and uncinate process on the posterior aspect of the cervical spine

BACKGROUND: Surgical techniques of foraminotomy for decompression of the cervical nerve have been well described in the literature. Excessive resection of the facet joint and laminae may decrease segmental stability and increase scar formation. How much bony resection is adequate to remove a soft or hard disc herniation is not known. No studies regarding this subject are available. METHODS: Thirty-nine adult dry bone spines from C3 to C7 were used and four measurements on each vertebra were taken in this study. The first three measurements included the vertical distances between the superior borders of the lamina and the vertebral body measured at the midline of the laminae, the middle of the lamina, and the lamina-facet junction, respectively. The fourth was the horizontal distance between the medial most border of the superior facet and the tip of the uncinate process. RESULTS: No significant differences between male and female specimens were found in any measurements in this study. The mean vertical distances from the superior border of the lamina inferior to the superior border of the vertebral body measured at the three points for all levels were approximately 1-3 mm, although the standard deviations for those were relatively high. The tip of the uncinate process was located from 2 mm at C3 to 1 mm at C6 medial to the medial most border of the superior facet, and then changed to be located 1 mm lateral to the medial most border of the superior facet. CONCLUSIONS: This study suggests that a semicircular laminotomy placed on the inferior aspect of the lamina above may be adequate for a lateral soft disc herniation because the inferior border of the disc is higher than the superior border of the inferior lamina, whereas a traditional foraminotomy is needed for a hard disc pathology.     

下腰椎小关节的方向性与椎间盘突出和侧隐窝狭窄的关系

目的探讨下腰椎小关节的方向性在椎间盘突出的发生和侧隐窝狭窄的形成中的作用和影响。方法通过腰椎ＣＴ片对下腰椎小关节角度进行测量,并分析、研究小关节的对称性、方向性与椎间盘突出和侧隐窝狭窄的关系。共观察１３６例患者３８６个下腰椎间隙的ＣＴ影像,采用横切关节面角度（ＴＩＦＡ）测量法,测量了７７２个下腰椎小关节角度。结果（１）下腰椎椎间盘突出与小关节对称性无关;（２）在Ｌ４～Ｓ１小关节不对称的间隙中,椎间盘易突向矢状小关节侧;（３）小关节角度小于２０度易发生退行性侧隐窝狭窄症;（４）该组测量的国人下腰椎小关节角度明显小于西方学者测量的欧洲人的角度。结论（１）下腰椎高发椎间盘突出症为特殊体位导致的应力集中所致,与椎间小关节方向性无关;（２）在Ｌ４～Ｓ１椎间隙中,如果椎小关节角度不对称将影响椎间盘突出的方向;（３）下腰椎小关节角度太小易导致退行性侧隐窝狭窄的发生。     

枢椎后路椎板螺钉固定技术的可行性研究

目的:观察和测量国人枢椎椎板以获取形态学参数,探讨枢椎后路椎板螺钉固定的可行性及进针技术.方法:用电子游标卡尺、量角器测量28套正常成年人枢椎新鲜标本的相关参数,包括上位和下位椎板螺钉进针点距椎板上缘距离、枢椎椎板上、中、下部的厚度.枢椎椎板高度、上位和下位椎板螺钉的长度和进针角度、进针点至椎动脉孔及下关节突中心点距离等14项指标.并对测得的数据进行统计学分析.结果:上位和下位椎板螺钉进针点距椎板上缘距离分别为4mm和8 mm,枢椎椎板上、中、下部的厚度分别为3.2、6.7、5.5 mm,椎板高度为12.8mm,上位和下位椎板螺钉的长度分别为26.2mm和25.5mm.结论:枢椎后路椎板螺钉固定技术在国人解剖学上具有可行性,枢椎椎板螺钉固定可作为枢椎后路固定技术的补充.     

脊柱三维运动对腰髓核摘除术后小关节的作用机制

目的观测髓核摘除术后腰椎小关节的应力分布变化。方法取新鲜青壮年尸体下腰椎标本6具,在L4下关节突、L5上下关节突、S1上关节突分别贴横形和竖形微细应变片进行力学测试。首先在髓核摘除前测量各应变片在轴向加压、前屈、后伸、侧屈、旋转工况下的应变值;然后在所有标本上行单侧L5/S1开窗髓核摘除术,在同样加载条件下测量应变值;最后在所有标本对侧行L5/S1开窗髓核摘除术形成双侧髓核摘除,重复加载测量应变值。结果轴向加压工况时3种实验力学状态应变量均无差异;前屈工况时L5下关节突竖形应变量髓核摘除前与双侧髓核摘除状态差异有统计学意义;后伸工况时L5上、下关节突竖形应变量双侧髓核摘除状态与其它2种实验力学状态相比差异均有统计学意义;侧屈工况时3种实验力学状态应变量均无差异;旋转工况时L4下关节突竖形片应变量髓核摘除前与单侧髓核摘除相比、单侧髓核摘除与双侧髓核摘除状态比较差异均有统计学意义,L5下关节突横行片应变量双侧髓核摘除状态与其它2种实验力学状态比较差异有统计学意义,S1上关节突竖形片应变量髓核摘除前与双侧髓核摘除状态比较差异有统计学意义。结论单侧开窗髓核摘除术后邻近关节突稳定性保存良好,但是双侧开窗髓核摘除术后下腰椎邻近节段关节突在前屈、后伸、旋转运动时与髓核摘除前比较应变量显著增高,稳定性下降,需要给予适当的稳定措施。