颈椎连续三节段Hybrid手术与融合术的生物力学研究  

Biomechanical Study on Contiguous Three-Level Cervical Hybrid Surgery and Anterior Cervical Discectomy and Fusion

作　　者：周维 张亚丽 戎鑫[2] 黄康康 张小刚 刘浩[2] 靳忠民 ZHOU Wei;ZHANG Yali;RONG Xin;HUANG Kangkang;ZHANG Xiaogang;LIU Hao;JIN Zhongmin(School of Mechanical Engineering,Southwest Jiaotong University,Chengdu 610031,China;Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]西南交通大学机械工程学院,成都610031 [2]四川大学华西医院骨科,成都610041

出　　处：《医用生物力学》2023年第1期45-51,共7页Journal of Medical Biomechanics

基　　金：国家自然科学基金项目(51905456,52035012)。

摘　　要：目的 比较颈椎连续三节段Hybrid手术[颈前路减压植骨融合(anterior cervical discectomy and fusion,ACDF)+人工颈椎间盘置换(cervical disc arthroplasty,CDA)]与三节段ACDF对颈椎生物力学的影响。方法 基于CT数据建立C1~T1颈胸椎有限元模型,通过植入Prestige LP和Zero-P假体模拟3种模型,包括两种Hybrid模型(AFA:C3~4、C5~6节段植入Prestige LP,C4~5节段植入Zero-P;FAF:C3~4、C5~6节段植入Zero-P,C4~5节段植入Prestige LP)和三节段ACDF模型(FFF)。比较各模型前屈、后伸、侧弯以及轴向旋转时相邻节段及整体活动范围(range of motion,ROM)以及相邻节段椎间盘内压力(intradiscal pressure,IDP)及小关节接触力(facet contact force,FCF)的变化。结果 AFA模型相邻节段及整体ROM都更接近完整模型,FAF、FFF模型相邻节段ROM最大增幅分别为15.0%和23.4%。AFA、FAF、FFF模型相邻节段最大IDP最大增幅分别为19.0%、66.7%、147.6%,FCF最大增幅分别为17.4%、55.7%、80.1%。结论 研究结果为三节段Hybrid手术治疗连续三节段颈椎病提供生物力学基础。Objective To compare the biomechanical effects of contiguous three-level cervical Hybrid surgery [anterior cervical discectomy and fusion(ACDF) + cervical disc arthroplasty(CDA)] and three-level ACDF.Methods The finite element model of C1-T1 cervical-thoracic spine was developed based on CT data.Three models were simulated by the implantation of Prestige LP and Zero-P prostheses,including two Hybrid models(AFA,Prestige LP implanted at C3-4 and C5-6 segments and Zero-P implanted at C4-5 segment;FAF,Zero-P implanted at C3-4 and C5-6 segments and Prestige LP implanted at C4-5 segment) and three-level ACDF model(FFF).The changes in range of motion(ROM) of adjacent levels during flexion,extension,lateral bending and axial rotation,the overall ROM,as well as the intradiscal pressure(IDP) and facet contact force(FCF) of adjacent levels were compared.Results The ROM in adjacent levels and the overall ROM of the AFA model were closer to the intact model,and the maximum increases in the ROM of the adjacent levels for the FAF and FFF models were 15.0% and 23.4%,respectively.For AFA,FAF and FFF models,the maximum increases in the maximum IDP of adjacent levels were 19.0%,66.7%,147.6%,and the maximum increases in FCF were 17.4%,55.7%,80.1%,respectively.Conclusions This study provides biomechanical basis for three-level cervical Hybrid surgery in treating patients with the contiguous three-level cervical degenerative disc disease.

关 键 词：Hybrid手术 颈前路减压植骨融合 颈椎间盘置换 三节段颈椎病 

分 类 号：R318.01[医药卫生—生物医学工程]