新型颈椎后路椎管成形桥接融合器三维运动力学及稳定性测试
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摘要
[目的]探讨新型颈椎后路椎管成形桥接融合器在颈椎后路单开门椎管扩大成形术中的生物力学特性。[方法]以正常成年人4具尸体颈椎标本进行试验,制备后路椎管单开门模型,以右侧为轴,分别在左侧行新型桥接融合器(融合器组)、ARCH钛钢板(钛板组)和钛缆(钛缆组)固定,对三种固定以及原始标本进行6自由度的生物力学测试。[结果]四组间后伸、左侧弯、左旋转活动度间的差异有统计学意义(P<0.05),四组间在前屈、右侧弯和右旋转活动度的差异无统计学意义(P>0.05)。钛缆组的各方向活动度均大于融合器组、钛板组和原始对照组,差异有统计学意义(P<0.05)。融合器组各方向活动度均小于钛板组,在左侧弯及左旋状态下融合器组的活动范围与钛板组的差异有统计学意义(P<0.05),而在后伸、前屈及右侧弯状态下的活动范围融合器组与钛板组之间的差异无统计学意义(P>0.05)。[结论]生物力学试验中6自由度活动度测试显示在颈椎单开门椎管扩大成形术中应用新型桥接融合器内固定能维持较好的颈椎活动度,同时术后拥有良好的即刻稳定性,完全满足目前经后路椎管成形术的治疗要求。
[Objective]To investigate the biomechanical properties of a novel cervical posterior lumbar bridging fusion cage for posterior cervical single open-door laminoplasty.[Methods] Four fresh cadaver cervical spines form healthy adults were used in this study.After posterior cervical single open-door laminoplasty models created on the specimens with axis on the right sides,the novel cervical posterior lumbar bridging fusion cage,arch plate and titanium cable were used for fixation of the laminoplasty on left sides.The 3 treated samples and a sample in original state were tested biomechanically in 6 degrees of freedom.[Results] Among the 4 groups,there were significant differences regarding to range of motion(ROM) in extension,left bending and left rotation(P<0.05),although no significant differences were noted in flexion,right bending and right rotation(P>0.05).The titanium cable group had significantly greater ROM in all direction than the fusion cage group,arch plate group and the original control group(P<0.05).The fusion cage group had less ROM in all directions than the arch plate group,which was statistically significant in left bending and left rotation(P<0.05),whereas not statistically significant in extension,flexion and right bending(P>0.05).[Conclusion] The 6 degree of freedom biomechanicaltests show that the new type of bridging fusion cage forinternal fixation of single open-door laminoplasty does maintain a proper degree of cervical motion,and restore the immediate stability as well,which meet the need of posterior open-door laminoplasty in clinical setting.
[Objective]To investigate the biomechanical properties of a novel cervical posterior lumbar bridging fusion cage for posterior cervical single open-door laminoplasty.[Methods] Four fresh cadaver cervical spines form healthy adults were used in this study.After posterior cervical single open-door laminoplasty models created on the specimens with axis on the right sides,the novel cervical posterior lumbar bridging fusion cage,arch plate and titanium cable were used for fixation of the laminoplasty on left sides.The 3 treated samples and a sample in original state were tested biomechanically in 6 degrees of freedom.[Results] Among the 4 groups,there were significant differences regarding to range of motion(ROM) in extension,left bending and left rotation(P<0.05),although no significant differences were noted in flexion,right bending and right rotation(P>0.05).The titanium cable group had significantly greater ROM in all direction than the fusion cage group,arch plate group and the original control group(P<0.05).The fusion cage group had less ROM in all directions than the arch plate group,which was statistically significant in left bending and left rotation(P<0.05),whereas not statistically significant in extension,flexion and right bending(P>0.05).[Conclusion] The 6 degree of freedom biomechanicaltests show that the new type of bridging fusion cage forinternal fixation of single open-door laminoplasty does maintain a proper degree of cervical motion,and restore the immediate stability as well,which meet the need of posterior open-door laminoplasty in clinical setting.
引文
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[7]Ohnari H,Sasai K,Akagi S,et al.Investigation of axial symptoms after cervical laminoplasty,using questionnaire survey[J].Spine J,2006,6(3):221-227.
[8]Sakaura H,Hosono N,Mukai Y,et al.CS palsy after decompression surgery for cervical myelopathy:review of the literature[J].Spine,2003,28(21):2447-2451.
[9]Derenda M,Kowalina I.Cervical laminoplasty--review of surgical techniques,indications,methods of efficacy evaluation,and complications[J].Neurol Neurochir Pol,2006,40(5):422-432.
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[11]Roy-Camille R,Saillant G,Mazel C.Internal fixation of the unstablecervical spine by a posterior osteosynthesis with plates and screws.The Cervical Spine[M]//Edited by the cervical spine research society.Philadelphia:JB Lippincott Co,1989:390-403.
[12]Houten JK,Cooper PR.Laminectomy and posterior cervical plating formultilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament:effects on cervical alignment,spinal cord compression,and neurological outcome[J].Neurosurgery,2003,52(5):1081-1087.
[13]Anderson PA,Matz PG,Groff MW,et al.Laminectomy and fusion for the treatment of cervical degenerative myelopathy[J].J Neurosurg Spine,2009,11(2):150-156.
[14]Dimar JR 2nd,Bratcher KR,Brock DC,et al.Instrumented opendoor laminoplasty as treatment for cervical myelopathy in 104 patients[J].Am J Orthop(Belle Mead NJ),2009,38(7):E123-128.
[15]昌耘冰,刘晖,尹庆水,等.微型钛板固定在改良单开门颈椎管成形术中的应用[J].中国骨与关节损伤杂志,2010,25(2):100-102.
[16]余进伟,陈长青,邵艳,等.颈椎后路固定钦板在颈椎管单开门扩大成形术的临床应用[J].颈腰痛杂志,2008,29(5):433-435.2018-05-17
[2]Freedman BA,Hoffler CE,Cameron BM,et al.A comparison of computed tomography measures for diagnosing cervical spinal stenosis associated with myelopathy:a case-control study[J].Asian Spine J,2015,9(1):22-29.
[3]Hirabayashi K,Watanabe K,Wakano K,et al.Expansive opendoor laminoplasty for cervical spinal stenotic myelopathy[J].Spine,1978,8(7):693-699.
[4]Ryken TC,HearyRF,MatzPG,et al.Cervical laminectomy for the treatment of cervical degenerative myelopathy[J].J Neurosurg Spine,2009,11(2):142-149.
[5]Steinmetz MP,Resnick DK.Cervical laminoplasty[J].Spine J,2006,6(6):2745-2815.
[6]Ryken TC,Heary RF,Matz PG,et al.Cervical laminectomy for the treatment of cervical degenerative myelopathy[J].J Neurosurg Spine,2009,11(2):142-149.
[7]Ohnari H,Sasai K,Akagi S,et al.Investigation of axial symptoms after cervical laminoplasty,using questionnaire survey[J].Spine J,2006,6(3):221-227.
[8]Sakaura H,Hosono N,Mukai Y,et al.CS palsy after decompression surgery for cervical myelopathy:review of the literature[J].Spine,2003,28(21):2447-2451.
[9]Derenda M,Kowalina I.Cervical laminoplasty--review of surgical techniques,indications,methods of efficacy evaluation,and complications[J].Neurol Neurochir Pol,2006,40(5):422-432.
[10]Hale JJ,Gruson KI,Spivak JM.Laminoplasty:a review of its role incompressive cervical myelopathy[J].SpineJ,2006,6(6 Supply):2895-2985.
[11]Roy-Camille R,Saillant G,Mazel C.Internal fixation of the unstablecervical spine by a posterior osteosynthesis with plates and screws.The Cervical Spine[M]//Edited by the cervical spine research society.Philadelphia:JB Lippincott Co,1989:390-403.
[12]Houten JK,Cooper PR.Laminectomy and posterior cervical plating formultilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament:effects on cervical alignment,spinal cord compression,and neurological outcome[J].Neurosurgery,2003,52(5):1081-1087.
[13]Anderson PA,Matz PG,Groff MW,et al.Laminectomy and fusion for the treatment of cervical degenerative myelopathy[J].J Neurosurg Spine,2009,11(2):150-156.
[14]Dimar JR 2nd,Bratcher KR,Brock DC,et al.Instrumented opendoor laminoplasty as treatment for cervical myelopathy in 104 patients[J].Am J Orthop(Belle Mead NJ),2009,38(7):E123-128.
[15]昌耘冰,刘晖,尹庆水,等.微型钛板固定在改良单开门颈椎管成形术中的应用[J].中国骨与关节损伤杂志,2010,25(2):100-102.
[16]余进伟,陈长青,邵艳,等.颈椎后路固定钦板在颈椎管单开门扩大成形术的临床应用[J].颈腰痛杂志,2008,29(5):433-435.2018-05-17