人工颈椎间盘假体高度对置换节段活动度影响的生物力学研究  

Effect of different heights of artificial cervical disc replacement on the range of motion of the treated segment

作　　者：娄纪刚 刘浩[1] 李元超[2] 武文杰[1] 孟阳[1] 杨运北 戎鑫[1] 

机构地区：[1]四川大学华西医院骨科,成都610000 [2]上海交通大学机械与动力工程学院,200240

出　　处：《中华骨科杂志》2016年第10期605-610,共6页Chinese Journal of Orthopaedics

摘　　要：目的 探讨采用不同高度的人工颈椎间盘假体进行间盘置换术后手术节段活动度的变化规律.方法 收集9具男性新鲜尸体颈椎标本,术前均行颈椎正位、侧位X线片,分别测量C5.6椎间隙高度,并筛选高度为5 mm左右的标本3具进行自身对照实验,先后依次进行完整颈椎组、C5.6节段合适高度（5 mm）人工椎间盘置换组、高度增加1 mm（6 mm）人工椎间盘置换组和增加2 mm（7 mm）人工椎间盘置换组颈椎标本模型的生物力学测试.将标本固定于脊柱三维运动试验机,予75 N跟随载荷,前屈、后伸、左/右侧弯、左/右轴向旋转均施加2 Nm纯力矩载荷,在0.2 Nm/S的变化条件下测量手术节段的活动范围.结果 完整组与5 mm组的前屈、后伸、侧弯及轴向旋转活动范围的差异均无统计学意义;6mm组前屈/后伸、侧弯及轴向旋转的活动范围均较5 mm组增加,且更加接近完整组活动范围,但差异无统计学意义;7 mm组屈伸活动范围（9.5°±1.0°）明显小于完整组（12.5°±0.9°）、5 mm组（11.3°±0.8°）和6 mm组（11.6°±0.9°）,但轴向旋转活动范围（10.4°±1.4°）明显大于5 mm组（8.6°±0.3°）,差异有统计学意义,而侧弯活动范围与其他3组相比差异均无统计学意义.结论 人工颈椎间盘置换术中试模时两个相邻高度间盘假体植入均合适时,选择高度增加1 mm的间盘可一定程度改善手术节段的活动范围;而高度增加2 mm的间盘置换则可导致手术节段屈伸活动范围减小,旋转活动范围则有增加的趋势.Objective To cxplore the variation of the range of motion （ROM） of operative level after different heights of artificial cervical disc replacement,and to provide guidance for clinical work in selecting appropriate height of artificial cervical disc prosthesis.Methods The preoperative cervical anteroposterior and lateral Ⅹ-rays of 9 fresh male cadaveric cervical spine specimens were obtained to measure the intervertebral height of C5-6,and 3 screened specimens with the height of about 5 mm were included in the experiment.The experiment was designed to test self-control,and other four groups of cervical specimens including intact group,appropriate height （5 mm） of C5.6 artificial cervical disc replacement group,1mm increased （6 mm） group and 2 mm increased （7 mm） group were made biomechanical test sequentially.The specimens were fixed to the cervical three-dimensional movement machine,with a 75 N follower load and pure moments of 2 Nm for flexion/extension 、left/right bending and left/right axial rotation,to measure the ROM of operative level under the condition of changes in 0.2 Nm/s.Results There were no significant differences in the ROM of flexion/extension,lateral bending and axial rotation between 5 mm group and intact group;the ROM of flexion/extension、lateral bending and axial rotation in 6 mm group increased compared with 5 mm group,but the difference was not statistically significant;the ROM of flexion/extension in 7 mm group was significantly less than that of intact,5mm and 6 mm group （9.5°± 1.0° vs 12.5°±0.9°、11.3°±0.8°、11.6°±0.9°）,but significantly greater in axial rotation than 6 mm group （10.4°±1.4°vs 8.6°±0.3°）,and there was no significant difference in lateral bending compared with other 3 groups.Conclusion 2 adjacent heights of cervical disc prostheses are implantedsuitably when testing the mold of disc prosthesis,the choice of cervical disc prosthesis with 1 mm increased can improve the ROM of operative level to some extent;while the height wit

关 键 词：全椎间盘置换 生物力学 活动范围 

分 类 号：R687[医药卫生—骨科学] R318.01[医药卫生—外科学]