颈椎人工椎间盘置换或前路融合内固定术后关节突间压力的改变  

Pressure variation of facet joint following cervical total disc replacement anterior cervical discectomy and fixation

作　　者：徐波[1] 张忠民[1] 赵卫东[2] 朱青安[3] 周荣平[1] 金大地[1] 

机构地区：[1]南方医科大学第三附属医院骨科,广州市510630 [2]南方医科大学医用生物力学实验室,广州市510515 [3]南方医科大学南方医院骨科,广州市510515

出　　处：《中国脊柱脊髓杂志》2010年第5期406-410,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:通过测量颈椎前路融合内固定或人工椎间盘置换术后关节突间压力的变化,探讨两种手术对颈椎手术节段后部结构的力学影响。方法:6具成年男性新鲜尸体颈椎标本(C2～C7)作为测试对象,分为完整颈椎组、人工椎间盘置换组及前路融合内固定组。在完整颈椎测试后,所有标本先后行C4/5节段Prestige-LP人工椎间盘置换和前路C4/5节段植骨融合固定术后进行测试。将预制的压敏片置于C4/5左侧关节突关节内,标本先给予75N跟随载荷,再持续加载纯力偶进行三维运动测试。屈伸和侧屈最大运动载荷为2.0N·m、旋转最大运动载荷为4.0N·m,测量加载后的运动范围和零运动载荷、最大运动载荷时的关节突间压力。结果:与零运动载荷时相比,在运动加载后完整颈椎组和颈椎人工椎间盘置换组在后伸、左侧屈和右旋时均表现出左侧关节突间压力明显增大(P<0.05);但前屈、右侧屈和左旋时左侧关节突间压力变化没有差异;颈椎前路融合内固定组各运动加载后关节突间压力与零运动载荷下压力均无显著性差异(P>0.05)。在三个测试组间比较,完整颈椎组和人工椎间盘置换组在各运动载荷下的关节突间压力最为接近;颈椎前路融合内固定组虽然在后伸、左侧屈和右旋时关节突间压力都有减小,但与其他两组比较无显著性差异(P>0.05)。结论:颈椎人工椎间盘成形术后关节突间压力与正常颈椎相比没有明显改变,可以有效地维持关节突间正常生理压力。Objective：To measure the pressure variation of facet joint after cervical total disc replacement（TDR） anterior cervical discectomy and fixation（ACDF）,and explore mechanical effect for cervical facet joint following two operations.Method：A total of 6 adult human fresh cervical spinal specimens（C2-C7） were divided into intact cervical specimens group,TDR group and ACDF group.Following intact specimens analysis,all specimens were sequentially reconstructed at C4-C5 segment with TDR and ACDF.Pressure sensitive film was put into left-side facet joints of C4-C5 segment.Firstly a 75N follower load was applied,then a three-dimensional movement was performed with the continous load.Pressures of facet joint were measured in 0N·m and 2.0N·m（flexion/extension,left/right lateral bending）,4.0N·m moment（left/right axial rotation）.Result：To compare with the pressure of left-side facet joint in neutral position,pressure of facet joint of intact specimens and TDR increased significantly in extension,left lateral bending and right axial rotation（P〈0.05）,but not obviously changed in flexion,right lateral bending and left axial rotation.In contrast with intact specimens and TDR,the pressure of facet joint of ACDF were not significant between in neutral position and any motions（P〉0.05）.In the comparison among three tested groups,the pressure variation of facet joint was similar between intact specimens and TDR.The pressures of facet joint of ACDF were obviously decreased in extension,left lateral bending and right axial rotation,but there were not significance among three groups（P〉0.05）.Conclusion：Pressure variation of facet joint is not significant between TDR and intact specimens.It indicates that cervical total disc replacement can effectively restore normal physiological pressure of cervical facet joint.

关 键 词：颈椎 人工椎间盘 内固定 压敏片 生物力学 

分 类 号：R681.5[医药卫生—骨科学] R318.01[医药卫生—外科学]