人工颈椎间盘假体高度对小关节影响的形态学研究  

Impact of artificial disc height on the morphology of cervical facet joint

作　　者：孟阳[1] 刘浩[1] 王晓斐 王贝宇[1] 戎鑫[1] 洪瑛[2] Meng Yang;Liu Hao;Wang Xiaofei;Wang Beiyu;Rong Xin;Hong Ying(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu610041,China;Department of Operation Room,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,成都610041 [2]四川大学华西医院手术室,成都610041

出　　处：《中华医学杂志》2019年第46期3622-3622,3623-3626,共5页National Medical Journal of China

摘　　要：目的探究不同高度的人工颈椎间盘假体对小关节形态学的影响。方法建立C2.7有限元模型,模拟5、6、7 mm的Prestige-LP间盘置入,观测术后小关节重合距离、小关节夹角、小关节重合面积等形态学指标的变化。结果合适高度的Prestige-LP假体能较好地模拟颈椎生理特性。与完整情况相比,高2 mm假体置入后颈椎整体活动度在前屈时减少19.2%,后伸时减少19.4%,侧偏时减少18.4%,旋转时减少19.0%;手术节段活动度在前屈时减少15.8%,后伸时减少15.4%,侧偏时减少15.4%,旋转时减少15.3%。相比C5,6节段,C4/5及k节段活动度受假体高度影响更大,前屈时分别下降26.8%、26.5%,后伸时均下降26.6%,侧偏时分别下降26.5%、26.4%,旋转时分别下降26.4%、26.3%;上位邻近节段小关节重合距离降低9.6%,小关节夹角增大30.7%,小关节重合面积降低17.9%;手术节段小关节重合距离减少22.3%,小关节夹角增大35.3%,重合面积减少28.2%;下位邻近节段小关节形态学受假体高度影响较小。结论人工颈椎间盘置换术术中选择假体高度应尽可能地与术前生理状况下高度一致,高2 mm假体将显著改变小关节形态,临床中应避免使用。Objective To investigate the impact of implant height on the morphology of cervicalfacet joints in artificial cervical disc replacement (ACDR). Methods A finite element model of the cervicalspine from C2 to C7 was constructed. The surgical processes of ACDR were simulated by insertion of 5 mm,6 mm or 7 mm Prestige-LP artificial cervical discs. The morphological changes of cervical facet joints wererecorded in terms of facet overlap distance, facet overlap area and facet angle. Results The normal heightPrestige-LP cervical disc could restore the natural status of the cervical spine. Compared with the intactcondition, the model with ^2 mm height implant would reduce the overall range of motion (ROM) by 19.2%in flexion, 19.4% in extension, 18.4% in lateral bending and 19.0% in axial rotation. Besides, the ROM atthe surgical level reduced by 15.8% in flexion, 15.4% in extension and lateral bending and 19.0% inrotation. The upper and lower adjacent levels (C4/5 and C5/6) showed more obvious changes in ROM, whichreduced by 26.8% and 26.5% in flexion, 26.6% in extension, 26.5% and 26.4% in lateral bending, and26.4% and 26.3% in rotation, respectively. The reduction of facet overlap distance, facet angle and facetoverlap area with the ^2 mm height artifact was 9.6%, 30.7%, and 17.9% respectively at the upper adjacentlevel, and 22.3%, 35.3% and 28.2% respectively at the surgical level, compared with the intact model.Themorphology of facet joints at the lower adjacent level were slightly changed.Conclusion The implant heightselection in ACDR should be in accordance with the physiological intervertebral disc height. Artifactwith ^2 mm in height would obviously change the morphology of facet joints, thus should not be used inclinical practice.

关 键 词：颈椎 人工颈椎间盘 小关节 有限元分析 

分 类 号：R68[医药卫生—骨科学]