颈椎前路融合术中植骨块的高度对邻近节段关节突压力及椎间位移的影响
罗春山,欧阳北平,梁栋柱,陆廷盛,姚书耽,赵国权
中国临床解剖学杂志 ›› 2016, Vol. 34 ›› Issue (3) : 338-342.
颈椎前路融合术中植骨块的高度对邻近节段关节突压力及椎间位移的影响
Impact of graft height on zygapophyseal joint pressure and range of motion adjacent to segment following cervical anterior fusion
目的 探讨颈椎前路融合术中植骨块的高度对邻近节段关节突压力及活动度的影响,为临床上选择适宜的植骨高度提供依据。 方法 采用8例新鲜成人尸体颈椎标本，对完整状态，C5/6节段椎间隙减压术后（100%M、120%M、140%M、160%M)5组，于BOSE机加载下行三维运动，并测量颈C4/5，C6/7关节突压力值及C4/5，C6/7三维运动范围；最后将结果行多重比较分析。 结果 中立位状态下，关节突压力值各组无显著差异，P>0.05；后伸状态下，关节突压力值增加最大，各组有显著差异，P<0.05，但植骨高度中以120%M时关节突压力值增加最小，左右侧屈及左右旋转时，各组植骨高度之间差异均有显著意义，P<0.05，但植高度为120%M时，关节突压力值增加最小。在前屈后伸、左右侧屈下：120%M与完整状态相比，上下临近节段活动度差异无显著差异，P>0.05；与其他各组差异均有显著差异，P<0.05；2）在左右旋转时各组差异无显著差异，P>0.05。 结论 下颈椎单间隙减压植骨，撑开植骨理想高度为平均高度的120%。
Objective To discuss impact of graft height on zygapophyseal joint pressure and range of motion of adjacent segments following the cervical anterior fusion and to guide the choice of optimal graft height in clinic. Methods Eight fresh-frozen human cadaveric cervical spines were used in this series, specimens were tested in five conditions, normal(specimens with intact discs)and different graft height(120％,140％,160％of mean height) after Smith-Robinson discectomy between the fifth and sixth cervical vertebrae.Each specimens were subjected to flexion-extension. Lateral bending and axial rotation in material test system(BOSE ELECTROFORCE) were adopted to measure zygapophyseal joint pressure and rotation of the fourth to fifth segments and the sixth to seventh segments. Finally, The data for each state was used to determine the statistical significance of differences. Results The height of bone graft had little effect on the zygapophysial joints pressure values in neutral position with no statistical significance noted among each groups(P>0.05); The zygapophysial joints pressure value was the highest increase in extension position,but 120%M increased minimum of zygapophysial joints pressure value, and statistical significance were noted among each groups（P<0.05); the zygapophysial joints pressure value increased in various degrees under flexion and rotation positions, and statistical significance were noted among each groups（P<0.05）; but 120%M increased minimum of zygapophysial joints pressure value.The range of motion at the upper and lower adjacent segments were not significantly changed between 120%M and complete condition (P>0.05), and statistical significance were noted in others groups（P<0.05）;The range of motion at the upper and lower adjacent segment were not significantly changed among each groups (P>0.05). Conclusion The appropriate graft height after single discectomy may be 120％mean height.
[1] Oglesby M, Fineberg SJ,Palel AA,et a1.Epidemiological trends in cervical spine surgery for degenerative diseases between 2002 and 2009[J].Spine(Phila Pa 1976),2013,38(14):1226-1232．
[2] Lee CK.Accelerated degeneration of the segment adjacent to a lumbar fusion[J].Spine(Phila Pa 1976),1988,13(3):375-377.
[3] Schlegel JD, Smith JA, Schleusener RL. Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions[J]. Spine(Phila Pa 1976),1996,21(8):970-81.
[4] Eck JC, Humphreys SC, Hodges SD. Adjacent-segment degeneration after lumbar fusion: a review of clinical, biomechanical, and radiologic studies[J]. Am J Orthop,1999,28(6):336-40.
[5] Jiaquan Luo, Ming Gong,Sheng Huang,etal Incidence of adjacent segment degeneration in cervical disc arthroplasty versus anterior cervical decompression and fusion meta-analysis of prospective studies [J].Arch Orthop Trauma Surg,2015,135(2): 155–160.
[6] Liang-Zheng Xia,Yan-Ping Zheng,Hong-Guang Xu,etal.Effect of anterior cervical discectomy and fusion on adjacent segments in rabbits [J].Int J Clin Exp Med, 2014,7(11): 4291–4299.
[7] Tsunezuka H, Kato D, Okada S,et al.Three-dimensional kinematic analysis of active cervical spine motion by using a multifaceted marker device[J].Conf Proc IEEE Eng Med Biol Soc,2013:4879-82
[8] 贾连顺，袁文，倪斌，等．脊髓型颈椎病手术治疗的远期疗效[J]．中华骨科杂志，1999，19(5)：261-264．
[9] Brower RS,Herkowitz HN，Kurz L,et al.Effect of distraction on union rates of Smith-Robinson type anterior discectomy and fusion[C]．Presented at the twentieth annual meeting of the Cervical Spine Research Society．Palm Desert．California，1992．
[10]Luk KD,Chow HK,Evans JH,et al.Lumbar spinal mobility after short anterior interbody fusion[J]. Spine(Phila Pa 1976),1995,20(7):813-818
[11]Tye GW,Graham RS,Broaddus WC,et al.Graft subsidence after instrument-assisted anterior cervical fusion[J].J Neurosurg,2002,97(2):186-192.
[12]Baba G，Furusawa N，Imura S，et a1．Late radiographic findings at anterior cervical fusion for spondylotic myeloradiculopathy[J]. Spine(Phila Pa 1976),1993,18(21)：2167-2173．
[13]Hussain M, Natarajan RN, An HS, et al. Progressive disc degeneration at C5-C6 segment affects the mechanics between disc heights and posterior facets above and below the degenerated segment: A flexion-extension investigation using a poroelastic C3-T1 finite element model [J]. Med Eng Phys, 2012, 34(5): 552-558.
[14]Hussain M, Nassr A, Natarajan RN, et al. Biomechanics of adjacent segments after a multilevel cervical corpectomy using anterior, posterior, and combined anterior-posterior instrumentation techniques: a finite element model study [J]. Spine J, 2013, 13(6): 689-696.
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