内镜下单侧小关节分级切除对颈椎节段稳定性影响  

Effects of Unilateral Graded Facetectomy of Facet Joints under Endoscope on Stability of Cervical Spine

作　　者：杨广南 刘江 蒋强 张晗硕 李土胜 马靖博 丁宇 YANG Guangnan;LIU Jiang;JIANG Qiang;ZHANG Hanshuo;LI Tusheng;MA Jingbo;DING Yu(School of Medicine,South China University of Technology,Guangzhou 510006,China;Orthopedics of TCM Senior Department,the Sixth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]华南理工大学医学院,广州510006 [2]中国人民解放军总医院第六医学中心中医学部骨伤科,北京100048

出　　处：《医用生物力学》2024年第3期400-406,共7页Journal of Medical Biomechanics

基　　金：国家自然科学基金项目(82274637)。

摘　　要：目的 探究颈椎内镜下不同范围小关节切除对颈椎节段稳定性的影响,为临床手术提供生物力学理论基础。方法 基于CT数据建立颈椎C5~6正常有限元模型,并模拟颈椎内镜手术操作获得不同范围(0、25%、50%、75%、100%)单侧小关节切除椎板开窗模型(模型1~5),分析比较各组模型节段活动度(range of motion, ROM)及椎间盘von Mises应力情况。结果 除前屈工况外,模型1、2较正常模型各方向下ROM及椎间盘von Mises应力改变不明显,模型3较正常模型各方向下ROM及椎间盘von Mises应力出现较为明显增加,前屈、后伸、左侧弯、右侧弯、左旋转及右旋转时ROM分别增加27%、4%、3%、13%、5%、16%,von Mises应力分别增加32%、4%、2%、5%、9%、5%。模型4、5较正常模型各方向下ROM及椎间盘von Mises应力增加显著,模型4的ROM分别增加27%、14%、6%、24%、7%、167%,von Mises应力分别增加33%、13%、3%、32%、10%、130%;模型5的ROM分别增加27%、17%、6%、25%、7%、167%,von Mises应力分别增加33%、29%、8%、33%、12%、138%。结论 随着单侧小关节切除范围的增加,颈椎节段ROM和椎间盘von Mises应力极值逐渐增加。当单侧小关节切除超过1/2时,颈椎出现较大的ROM增加及应力改变。临床手术中应尽量保留1/2以上颈椎小关节,避免医源性失稳。Objective To investigate the effect of facet joint resection at different ranges under endoscopy on the stability of the cervical spine and provide a biomechanical theoretical basis for clinical surgery.Methods A normal finite element model of the cervical spine C5-6 was established based on CT data,and unilateral facetectomy models with different ranges(0,25%,50%,75%,and 100%)of laminectomy were obtained(Models 1-5)by simulating cervical endoscopic surgery.The ranges of motion(ROMs)of C5-6 and the von Mises stresses of the discs for the models in each group were compared and analyzed.Results Except for flexion,Models 1 and 2 showed insignificant changes in ROMs and disc von Mises stresses in each direction compared with those of the normal model.Model 3 showed a noticeable increase in ROMs and disc von Mises stresses in each direction compared with those of the normal model:ROMs under flexion,extension,left lateral bending,right lateral bending,left rotation,and right rotation increased by 27%,4%,3%,13%,5%,and 16%,respectively,and von Mises stresses increased by 32%,4%,2%,5%,9%,and 5%,respectively.Models 4 and 5 exhibited a significant increase in the ROMs and disc von Mises stresses in each direction compared to the normal model.For Model 4,ROMs were increased by 27%,14%,6%,24%,7%,167%,and von Mises stresses were increased by 33%,13%,3%,32%,10%,130%.For Model 5,ROMs were increased by 27%,17%,6%,25%,7%,167%,and von Mises stresses were increased by 33%,29%,8%,33%,12%,138%.Conclusions As the range of unilateral facetectomy increased,cervical ROM and disc von Mises stress extremum gradually increased.The cervical spine shows a significant ROM increase and stress changes when facet joint resection on one side exceeds 1/2.More than 1/2 of the facet joint should be preserved during surgery to avoid medical instability.

关 键 词：颈椎内镜手术 颈椎管狭窄症 小关节 分级切除 

分 类 号：R318.01[医药卫生—生物医学工程]