羊颈椎半椎板切除、全椎板切除及椎板回植成形的实验研究  

Experimental Study of Hemilaminectomy,Total Laminectomy and Recapping Laminoplasty of Cervical Spine in Sheep

作　　者：黄菊英[1,2] 黄勇 张璨[4] 菅凤增[4] HUANG Juying;HUANG Yong;ZHANG Can;JIAN Fengzeng(School of Biomedical Engineering,Capital Medical University,Beijing 100069,China;Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application,Capital Medical University,Beijing 100069,China;Department of Neurosurgery,Civil Aviation General Hospital,Beijing 100123,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学生物医学工程学院,北京100069 [2]首都医科大学临床生物力学应用基础研究北京市重点实验室,北京100069 [3]民航总医院神经外科,北京100123 [4]首都医科大学宣武医院神经外科,北京100053

出　　处：《医用生物力学》2021年第6期929-934,共6页Journal of Medical Biomechanics

基　　金：国家自然科学基金项目(81271519);北京市自然科学基金项目-北京市教育委员会科技计划重点项目(KZ202010025043);北京市教委科技计划面上项目(KM201510025010);首都医科大学基础-临床合作项目(14JL17)。

摘　　要：目的研究半椎板切除、全椎板切除及椎板回植成形对颈椎稳定性的影响。方法将14例新鲜成年绵羊颈椎标本(C2~7)分为两组,每组7例。每例标本均被施加前屈后伸、左右侧弯和左右轴向旋转6个方向3.0 N·m载荷,测量C3~6运动节段在不同载荷下的运动范围(range of motion,ROM)及中性区(neutral zone,NZ)。对第1组进行完整状态、C5半椎板切除和C4~6半椎板切除3种状态下标本ROM和NZ的测量。对第2组进行完整状态、C4~6全椎板切除和C4~6椎板回植成形3种状态下标本ROM和NZ的测量。结果与完整状态比较,C5半椎板切除和C4~6半椎板切除状态下标本ROM和NZ没有明显差异,且C5半椎板切除和C4~6半椎板切除两种状态之间标本ROM和NZ也没有显著性差异。与完整状态比较,C4~6全椎板切除与C4~6椎板回植成形状态下在前屈后伸载荷下ROM有显著增大(P<0.05)。C4~6椎板回植成形与C4~6全椎板切除状态比较,标本在后伸载荷下ROM明显减小(P<0.05);而其余载荷下,椎板回植成形和全椎板切除ROM之间没有显著性差异。结论半椎板切除后,颈椎标本ROM和NZ无明显增加,并不影响颈椎的稳定性。全椎板切除后,颈椎标本在前屈后伸载荷下的ROM和NZ明显增加,颈椎稳定性受影响。椎板回植成形术并没有明显改善椎板切除术后颈椎的稳定性。Objective To study the effect of hemilaminectomy,total laminectomyand recapping laminoplasty on stability of the cervical spine.Methods Fourteen fresh adult sheep cervical spine specimens were divided into two groups,with 7 cases in each group.Each specimen was applied with a pure moment load of 3.0 N·m under flexion/extension,left/right lateral bending,and left/right axial rotation.The range of motion(ROM)and neutral zone(NZ)of specimens were measured.In the first group,the ROMs and NZs of the specimens were measured and compared under the intact state,C5 hemilaminectomy state and C4-6 hemilaminectomy state respectively.In the second group,the ROMs and NZs of specimens under the intact state,C4-6 total laminectomy state and C4-6 recapping laminoplasty state were measured and compared.Results There were no significant differences in ROMs and NZs between C5 hemilaminectomy state and C4-6 hemilaminectomy state compared with the intact state(P<0.05).Compared with the intact state,ROMs of the specimens were significantly increased during flexion and extension under C4-6 laminectomy state and C4-6 recapping laminoplasty state(P<0.05).In addition,compared with the C4-6 laminectomy state,ROMs of the specimen were significantly decreased only during extension unde C4-6 recapping laminoplasty state(P<0.05),while no significant differences were found in ROMs between total laminectomy and laminoplasty under other loads.Conclusions With hemilaminectomy,ROMs and NZs of the cervical spine did not increase significantly,and stability of the cervical spine was not affected.With C4-6 total laminectomy,ROMs and NZs during flexion and extension increased significantly,and stability of the cervical spine was affected.Recapping laminoplasty did not significantly improve stability of the cervical spine with total laminectomy.

关 键 词：半椎板切除 椎板回植成形 颈椎稳定性 

分 类 号：R318.01[医药卫生—生物医学工程]