基于腹腔镜辅助L5-S1轴向融合术工作通道构建和生物力学分析的解剖学研究

The L5-S1 intervertebral disc is prone to injury or degeneration in the unique biomechanical environment,resulting in severe low back pain...1.Chanllenges..Axial interbody fusion is an ideal minimally invasive operation,but there still are enormous challenges：.①Safe channel are difficultly established without direct vision.Once offset from the surgery plane,hardly controlled blooding may bother about..②Inaccurate starting points generate fixed axes which don't complies with the biomechanical requires.Actually,it lead to L5-S1 AxiaLIF procedure failure...③Preoperative simulation training can not be undertaken without L5-S1 AxiaLIF visual virtual reality（VVR） model...2.Content of the research subject：.①To simulate and construct channel assisted with laparoscopic in adult fresh cadaver and to confirm starting point..②To find out the best among controversial fixed axes which are analyzed by biomechanical test and finite element analysis..③To provide solidly-built foundations for preoperative simulated training through the L5-S1 AxiaLIF VVR model...3.Object.①To provide precise anatomy points of presacral space channal assisted with laparoscopic and the mark of point of screw..②To supply the best fixed axes by biomechanical test and finite element analysis..③To offer VVR model and to perform preoperative simulated training of VVR..The safety and effectiveness of AxiaLIF can be radically resolved through this study.

L5-S1椎间盘处于独特的生物力学环境中，易受伤、退化，继发严重腰痛。在腰骶椎融合术中，轴向融合术为较理想的微创术式，但其最大的挑战是：①非直视下操作，难以构建安全的工作通道，可能出现难以控制的出血或神经损伤；②不能准确的选择置钉靶点和角度，无法获得符合生物力学要求的固定轴线，致L5-S1不融合；③缺少L5-S1固定可视模拟手术模型，无法进行模拟训练。在前期研究基础上，我们计划：①采用新鲜人体标本腹腔镜辅助下构建工作通道，确认进钉靶点和角度；②对两种不同的L5-S1轴线固定术式进行生物力学测试和有限元分析，确认最佳固定轴线；③构建L5-S1固定可视模拟手术模型，为模拟训练打下基础。目标：①提供腹腔镜下骶前工作通道构建的解剖要点、确认置钉靶点和角度；②通过生物力学测试和有限元分析，提供最佳固定轴线；③提供可视化模拟手术模型，实现术前模拟训练。本研究可望从根本上解决该术式的安全性和有效性问题。

L5-S1椎间盘处于独特的生物力学环境中，易受伤、退化，继发严重腰痛。在腰骶椎融合术中，轴向融合术为较理想的微创术式，但其最大的挑战是：①非直视下操作，难以构建安全的工作通道，可能出现难以控制的出血或神经损伤；②不能准确的选择置钉靶点和角度，无法获得符合生物力学要求的固定轴线，致L5-S1不融合；③缺少L5-S1固定可视模拟手术模型，无法进行模拟训练。为此，我们在过去初步研究的基础上：①采用新鲜人体标本腹腔镜辅助下构建工作通道，基本阐明了进钉靶点和角度；②对两种不同的L5-S1轴线固定术式进行生物力学测试和有限元分析，对大部分个体可以确认最佳固定轴线；③构建L5-S1固定可视模拟手术模型，为模拟训练打下基础。基本达到了计划目标：①提供腹腔镜下骶前工作通道构建的解剖要点、确认置钉靶点和角度；②通过生物力学测试和有限元分析，可对大部分标本提供最佳固定轴线；③提供可视化模拟手术模型，实现术前模拟训练。