“人工颈椎复合关节系统”的优化设计及其生物力学评价
|
摘要
颈椎前路手术是治疗颈椎病、颈椎骨折、肿瘤、结核的主要手段,其中一些病例大多需要行椎体次全切术治疗,之后需要对颈椎进行稳定性重建。目前主要存在两种手术方式:一是植骨融合内固定术,一是人工椎体植入术,但这类手术都存在两个共同的问题:一是重建节段活动度完全丧失,患者颈椎正常活动受限;二是由于重建节段活动度完全丧失,造成应力集中以及颈椎活动度重新分配,最终导致远期邻近节段椎间盘退变加速的问题,而一旦发生这类问题,处理起来相当困难,效果更是不能令人满意。因此,在重建颈椎椎体次全切除术后颈椎稳定性的同时,保留节段的正常活动度,避免相邻节段加速退变,具有重要意义。如何解决这个问题,是颈椎外科的一个重要课题,课题组在前期工作中研制开发了“人工颈椎复合关节系统”,并对其进行了初步生物力学评价,结果表明这一假体所具有的球窝关节等独特设计在一定程度上可以实现颈椎稳定性与三维活动度的共存,避免邻近节段的活动度变化。
研究目的:正常颈椎的运动模式是在运动过程中具有可变的运动中心,并且相邻椎体间存在相对位移,但该假体的球窝关节设计只是中心固定的旋转运动,尚不能实现该模式的重建,另外在假体与相邻椎体间的连接,以及与残余椎体间的固定与融合等方面需要进一步的改进,使其能够实现完全生理性的重建。本研究在前期设计的基础上,利用对国人颈椎进行精确测量获得的科学数据,并且从固定强度及仿生学方面对“人工颈椎复合关节系统”进行优化设计,并对假体植入后的人颈椎标本进行相关生物力学测试,评价其应用于颈椎稳定性重建及保留节段动度的价值,以期更好解决上述问题。
研究方法:1)利用本课题组对国人颈椎的解剖学参数及生理活动度测量获得的数据,结合查阅参考国内外相关文献,获得椎体、椎间盘的相应几何参数,使用Solid Works及Auto CAD制图软件对假体进行设计。采用医用钛合金作原料,分别通过模具铸造及数控机床进行加工成型,装配整合成假体,并在假体相应表面均匀喷涂钛多孔涂层。2)将冷冻保存的14具新鲜成人下颈椎标本,进行实验前处理,随机抽取7具进行稳定性实验,之后将14具标本随机分为钉板固定组和假体植入组2组,每组7例,对每组标本分别进行实验前处理:钉板固定组依次行前路C5椎体次全切、植骨融合内固定术;假体植入组依次行C5椎体次全切、假体植入术。采用MTS858 Mini Bionix II生物材料实验系统对处理后各组标本进行稳定性实验。3)将冷冻保存的14具新鲜成人下颈椎标本,进行实验前处理,随机抽取7具进行正常颈椎各节段活动度测定,之后将全部标本随机分为钉板固定组和假体植入组2组,每组7例,同2)进行实验前处理。采用MTS 858 Mini Bionix II生物材料实验系统及立体摄像系统测定各组标本手术邻近节段椎间活动度。
研究结果: 1)优化设计并制造出“人工颈椎复合关节系统”,改进后的“人工颈椎复合关节系统”由两端的关节头部件和中间的椎体部件构成,关节头的球窝结构与椎体部件的球面相关节,并以固定环固定,定位销锁定固定环,形成难以脱位的万向球窝滑槽关节,在各方向上允许0～14度的活动度,以及前屈、后伸允许0～2㎜的位移,左右侧屈中允许0～1㎜。该关节的特有球窝滑槽设计模拟了颈椎的正常运动模式,实现了椎体间的相对位移变化,在保证颈椎正常活动度的条件下,通过固定环的设计限制其位移的大小,防止颈椎失稳的发生。关节头上表面及椎体部件侧面的防退槽增加了假体固定的稳定性,结构简便,机械稳定性好。2)应用“人工颈椎复合关节系统”进行颈椎重建(假体植入组),与正常颈椎组相比,下颈椎的在三维六自由度的活动中ROM均无显著差异。而钉板固定组在前屈、后伸、左右扭转中的ROM均小于显著正常颈椎和假体植入组,左右侧弯活动中无显著差异。对于手术节段而言,钉板固定组在6个自由度上的ROM均显著小于正常颈椎组和假体植入组,而假体植入组仅在后伸运动中ROM显著大于正常颈椎组,其余活动中均与正常颈椎组无显著差异。3)对于C3/4椎间活动度,假体植入组与正常颈椎组无显著差异。钢板螺钉组前屈、后伸活动度均较其余两组显著增大,左右侧弯与其余两组均无显著差异。三组间C6/7椎间活动度无显著差异。
结论:应用“人工颈椎复合关节系统”行颈椎重建后,颈椎的活动度获得了一定的保留,同时稳定性也与正常状态相接近。与标准的融合器植骨钢板螺钉内固定相比,更符合生理性重建的要求,在技术上向颈椎生理性重建迈出了一大步,为将来临床行颈椎前柱重建提供了一种全新的选择。同时未引起邻近节段椎间隙活动度异常增大,这对避免远期邻近节段退变的发生和加剧可能具有重要意义。
Cervical spine syndrome is one of common and multiple diseases. Subtotal corpectomy is used for the treatment of many kinds of cervical spine syndrome clinically, and after that, cervical spine reconstruction of stability is need. Nowadays bone graft with internal fixation and artificial vertebral replacement are the most common methods used for reconstruction, but all of the two have two deficits as following: one is the loss of the motion of surgical region which leads to decrease of the motion of cervical spine. The other is long-term acceleration of adjacent segment degeneration caused by stress concentration and motion redistribution of cervical spine. In case it occurs, it’s very difficult to deal with it, and its clinical prognosis cannot give satisfaction to us. So, when do cervical spine reconstruction after subtotal corpectomy, it’s very important to restore segmental motion of surgical region in order to avoid long-term acceleration of adjacent segment degeneration. Now there is no technique which can either reconstruct the stability or restore segment motion used for reconstruction following cervical subtotal corpectomy. Our group designed and manufactured ACJC and did relative biomechanical tests on cervical spines into which ACJC were implanted earlier. Results showed that ACJC can restore segmental motion of surgical region fairly, in order to avoid long-term acceleration of adjacent segment degeneration.
Objective: The movement of normal cervical spine has a variable center of motion, with the shift of adjacent segment. The structure of“artificial cervical joint complex”(ACJC) can not realize the movement as normal cervical spine. To realize physiological reconstruction totally, we should improve the fixation between prosthesis and adjacent segment, the fusion between prosthesis and remnant of Centrum. Based on the geometric and movement parameters o f human’cervical spine, we optimized and manufactured“ACJC”with titanium alloy.
Methods: 1) Based on the geometric and movement parameters o f human’cervical spine, we optimized“artificial cervical joint complex”(ACJC) with Solid Works and Auto CAD software. Then manufactured the prosthesis with titanium alloy by numerical controlled machine tool, assembled them to the whole one and brushed it with Ti-porosity smear layer evenly. 2)Drawing out 7 samples of 14 fresh cervical spines as intact group randomly, carried on the experiments on stability under the biomaterial experimental system of MTS 858 Mini Bionix II. Divided 14 cervical spines into two groups including plate-screw fixation group and prosthesis-implanted group averagely and randomly, then tackled them before experiment respectively: conduct anterior C5 subtotal corpectomy, bone graft fusion and internal fixation by turns for the plate-screw fixation group; conduct C5 subtotal corpectomy and prosthesis implantation by turns for the prosthesis-implanted group, carried on the same experiments as the intact group. 3)Divided 14 cervical spines into two groups including plate-screw fixation group and prosthesis-implanted group averagely and randomly, Then tackled them with the same ways mentioned above in method Measured the motion of surgical adjacent segment with the biomaterial experimental system of MTS 858 Mini Bionix II and three-dimensional shot system.
Results: 1) Optimized and manufactured“ACJC”, which was made up by articular head part on both sides and vertebrae part in the middle. The spherical surfaces of articular head part and vertebrae part structure the firm sphere-chute joint,with the fixation of fixed collar and locating pin. The activity of prosthesis changes from 0 to 14 degree in all directions. The shift in anteflexion and extension changes from 0 to 2㎜,and 0 to 1㎜ in Left and right axial rotation. The special structure of prosthesis not only imitates the movement of normal cervical spine, but also realize the shift of interbody. Devices on the articular head part and vertebrae part can avoid disarticulation. The prosthesis has simple structure and high mechanical stability.2) As for the lower cervical spine, there was no apparent difference between prosthesis-implanted group and intact group in the three-dimensions ROM. While in the plate-screw fixation group, ROM is smaller in the flexion, extension and tortion compared with the prosthesis implanted group and the intact group, with no difference in lateral bending. As for the surgical segment, ROM of the plate-screw fixation group is smaller in the three-dimensions ROM obviously compared with the prosthesis-implanted group and the intact group. ROM of the prosthesis-implanted group is the same in most of the activities as of the intact group while larger in the extension.3) As for the C3/4 intervertebral ROM, there is no obvious difference between the prosthesis-implanted group and the intact group. ROM of the plate-screw fixation group in flexion and extension is larger than the rest two groups without difference in lateral bending. They are the same in the C6/7 vertebra ROM.
Conclusion: Using ACJC to reconstructing cervical spine following subtotal corpectomy, can either restore segmental motion or regain almost the same stability as in intact condition. Compared with the standard bone graft and palte-screw internal fixation, it fits the requirements of physiological reconstruction more and steps towards physiological reconstruction of the cervical spine technically, which offers a new option for the reconstruction of cervical spine in the future. Meanwhile, it avoids abnormal increase of intervertebral ROM in the adjacent segment, which may make sense of prevention of long-term occurences and acceleration of degeneration of adjacent segments.
研究目的:正常颈椎的运动模式是在运动过程中具有可变的运动中心,并且相邻椎体间存在相对位移,但该假体的球窝关节设计只是中心固定的旋转运动,尚不能实现该模式的重建,另外在假体与相邻椎体间的连接,以及与残余椎体间的固定与融合等方面需要进一步的改进,使其能够实现完全生理性的重建。本研究在前期设计的基础上,利用对国人颈椎进行精确测量获得的科学数据,并且从固定强度及仿生学方面对“人工颈椎复合关节系统”进行优化设计,并对假体植入后的人颈椎标本进行相关生物力学测试,评价其应用于颈椎稳定性重建及保留节段动度的价值,以期更好解决上述问题。
研究方法:1)利用本课题组对国人颈椎的解剖学参数及生理活动度测量获得的数据,结合查阅参考国内外相关文献,获得椎体、椎间盘的相应几何参数,使用Solid Works及Auto CAD制图软件对假体进行设计。采用医用钛合金作原料,分别通过模具铸造及数控机床进行加工成型,装配整合成假体,并在假体相应表面均匀喷涂钛多孔涂层。2)将冷冻保存的14具新鲜成人下颈椎标本,进行实验前处理,随机抽取7具进行稳定性实验,之后将14具标本随机分为钉板固定组和假体植入组2组,每组7例,对每组标本分别进行实验前处理:钉板固定组依次行前路C5椎体次全切、植骨融合内固定术;假体植入组依次行C5椎体次全切、假体植入术。采用MTS858 Mini Bionix II生物材料实验系统对处理后各组标本进行稳定性实验。3)将冷冻保存的14具新鲜成人下颈椎标本,进行实验前处理,随机抽取7具进行正常颈椎各节段活动度测定,之后将全部标本随机分为钉板固定组和假体植入组2组,每组7例,同2)进行实验前处理。采用MTS 858 Mini Bionix II生物材料实验系统及立体摄像系统测定各组标本手术邻近节段椎间活动度。
研究结果: 1)优化设计并制造出“人工颈椎复合关节系统”,改进后的“人工颈椎复合关节系统”由两端的关节头部件和中间的椎体部件构成,关节头的球窝结构与椎体部件的球面相关节,并以固定环固定,定位销锁定固定环,形成难以脱位的万向球窝滑槽关节,在各方向上允许0～14度的活动度,以及前屈、后伸允许0～2㎜的位移,左右侧屈中允许0～1㎜。该关节的特有球窝滑槽设计模拟了颈椎的正常运动模式,实现了椎体间的相对位移变化,在保证颈椎正常活动度的条件下,通过固定环的设计限制其位移的大小,防止颈椎失稳的发生。关节头上表面及椎体部件侧面的防退槽增加了假体固定的稳定性,结构简便,机械稳定性好。2)应用“人工颈椎复合关节系统”进行颈椎重建(假体植入组),与正常颈椎组相比,下颈椎的在三维六自由度的活动中ROM均无显著差异。而钉板固定组在前屈、后伸、左右扭转中的ROM均小于显著正常颈椎和假体植入组,左右侧弯活动中无显著差异。对于手术节段而言,钉板固定组在6个自由度上的ROM均显著小于正常颈椎组和假体植入组,而假体植入组仅在后伸运动中ROM显著大于正常颈椎组,其余活动中均与正常颈椎组无显著差异。3)对于C3/4椎间活动度,假体植入组与正常颈椎组无显著差异。钢板螺钉组前屈、后伸活动度均较其余两组显著增大,左右侧弯与其余两组均无显著差异。三组间C6/7椎间活动度无显著差异。
结论:应用“人工颈椎复合关节系统”行颈椎重建后,颈椎的活动度获得了一定的保留,同时稳定性也与正常状态相接近。与标准的融合器植骨钢板螺钉内固定相比,更符合生理性重建的要求,在技术上向颈椎生理性重建迈出了一大步,为将来临床行颈椎前柱重建提供了一种全新的选择。同时未引起邻近节段椎间隙活动度异常增大,这对避免远期邻近节段退变的发生和加剧可能具有重要意义。
Cervical spine syndrome is one of common and multiple diseases. Subtotal corpectomy is used for the treatment of many kinds of cervical spine syndrome clinically, and after that, cervical spine reconstruction of stability is need. Nowadays bone graft with internal fixation and artificial vertebral replacement are the most common methods used for reconstruction, but all of the two have two deficits as following: one is the loss of the motion of surgical region which leads to decrease of the motion of cervical spine. The other is long-term acceleration of adjacent segment degeneration caused by stress concentration and motion redistribution of cervical spine. In case it occurs, it’s very difficult to deal with it, and its clinical prognosis cannot give satisfaction to us. So, when do cervical spine reconstruction after subtotal corpectomy, it’s very important to restore segmental motion of surgical region in order to avoid long-term acceleration of adjacent segment degeneration. Now there is no technique which can either reconstruct the stability or restore segment motion used for reconstruction following cervical subtotal corpectomy. Our group designed and manufactured ACJC and did relative biomechanical tests on cervical spines into which ACJC were implanted earlier. Results showed that ACJC can restore segmental motion of surgical region fairly, in order to avoid long-term acceleration of adjacent segment degeneration.
Objective: The movement of normal cervical spine has a variable center of motion, with the shift of adjacent segment. The structure of“artificial cervical joint complex”(ACJC) can not realize the movement as normal cervical spine. To realize physiological reconstruction totally, we should improve the fixation between prosthesis and adjacent segment, the fusion between prosthesis and remnant of Centrum. Based on the geometric and movement parameters o f human’cervical spine, we optimized and manufactured“ACJC”with titanium alloy.
Methods: 1) Based on the geometric and movement parameters o f human’cervical spine, we optimized“artificial cervical joint complex”(ACJC) with Solid Works and Auto CAD software. Then manufactured the prosthesis with titanium alloy by numerical controlled machine tool, assembled them to the whole one and brushed it with Ti-porosity smear layer evenly. 2)Drawing out 7 samples of 14 fresh cervical spines as intact group randomly, carried on the experiments on stability under the biomaterial experimental system of MTS 858 Mini Bionix II. Divided 14 cervical spines into two groups including plate-screw fixation group and prosthesis-implanted group averagely and randomly, then tackled them before experiment respectively: conduct anterior C5 subtotal corpectomy, bone graft fusion and internal fixation by turns for the plate-screw fixation group; conduct C5 subtotal corpectomy and prosthesis implantation by turns for the prosthesis-implanted group, carried on the same experiments as the intact group. 3)Divided 14 cervical spines into two groups including plate-screw fixation group and prosthesis-implanted group averagely and randomly, Then tackled them with the same ways mentioned above in method Measured the motion of surgical adjacent segment with the biomaterial experimental system of MTS 858 Mini Bionix II and three-dimensional shot system.
Results: 1) Optimized and manufactured“ACJC”, which was made up by articular head part on both sides and vertebrae part in the middle. The spherical surfaces of articular head part and vertebrae part structure the firm sphere-chute joint,with the fixation of fixed collar and locating pin. The activity of prosthesis changes from 0 to 14 degree in all directions. The shift in anteflexion and extension changes from 0 to 2㎜,and 0 to 1㎜ in Left and right axial rotation. The special structure of prosthesis not only imitates the movement of normal cervical spine, but also realize the shift of interbody. Devices on the articular head part and vertebrae part can avoid disarticulation. The prosthesis has simple structure and high mechanical stability.2) As for the lower cervical spine, there was no apparent difference between prosthesis-implanted group and intact group in the three-dimensions ROM. While in the plate-screw fixation group, ROM is smaller in the flexion, extension and tortion compared with the prosthesis implanted group and the intact group, with no difference in lateral bending. As for the surgical segment, ROM of the plate-screw fixation group is smaller in the three-dimensions ROM obviously compared with the prosthesis-implanted group and the intact group. ROM of the prosthesis-implanted group is the same in most of the activities as of the intact group while larger in the extension.3) As for the C3/4 intervertebral ROM, there is no obvious difference between the prosthesis-implanted group and the intact group. ROM of the plate-screw fixation group in flexion and extension is larger than the rest two groups without difference in lateral bending. They are the same in the C6/7 vertebra ROM.
Conclusion: Using ACJC to reconstructing cervical spine following subtotal corpectomy, can either restore segmental motion or regain almost the same stability as in intact condition. Compared with the standard bone graft and palte-screw internal fixation, it fits the requirements of physiological reconstruction more and steps towards physiological reconstruction of the cervical spine technically, which offers a new option for the reconstruction of cervical spine in the future. Meanwhile, it avoids abnormal increase of intervertebral ROM in the adjacent segment, which may make sense of prevention of long-term occurences and acceleration of degeneration of adjacent segments.
引文
[1] Zdeblick TA, Ducker TB. The use of freeze-dried allograft bone for anterior cervical fusions. Spine 1991 Jul;16(7):726-729.
[2] Young WF, Rosenwasser RH. An early comparative analysis of the use of fibular allograft versus autologous iliac crest graft for interbody fusion after anterior cervical discectomy. Spine.1993 Jul; 18(9):1123-4.
[3] Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958;40:607-24.
[4] Ricciardi JE, Whitecloud TS, Flores AJ. The fate of fibular strut allografts in multiple level anterior cervical fusion: a radiographic analysis. Presentation at the 13th annual meeting of North American Spine Society, San Francisco, CA, October 28–31, 1997.
[5] Emery SE, Bolesta MJ, Banks MA, Jones PK. Robinson anterior cervical fusion comparison of the standard and modified techniques. Spine 1994;19:660-663.
[6] Chi-Chien Niu MD, Yong Hai MD. Anterior cervical corpectomy and strut graft fusion using a different method The Spine JournalVolume 2, Issue 3, May-June 2002, Pages 179-187.
[7] Bernard TN Jr, Whitecloud TS. Cervical spondylotic myelopathy and myeloradiculopathy. Anterior decompression and stabilization with autogenous fibula strut graft. Clin Orthop Relat Res. 1987; Aug; (221):149-60.
[8] Hanai K, Fujiyoshi F, Kamei K. Subtotal vertebrectomy and spinal fusionfor cervical spondylotic myelopathy. Spine.1986 May;11(4):310–5.
[9] Robinson RA, Walker AE, Ferlic DC, Wiecking DK. The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg. Am. 1962;44:1569-86.
[10] Lbere Riberio Jair Ortiz.Anterir cervical fusion by the Smith-Robinson Artrodesis cervical anterior por la tecnica de Smith-Robinson. COLUNA/COLUMNA. 2008;7(1):40-44.
[11] Emery SE, Bohlman HH, Bolesta MJ, Jones PK. Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. J Bone Joint Surg (Am) 1998;80:941-51.
[12] Herkowitz HN. The surgical management of cervical spondylotic radiculopathy and myelopathy. Clin Orthop Relat Res .1989 Feb; (239):94-108.
[13] Kojima T, Waga S, Kubo Y, Kanamaru K, Shimosaka S, Shimizu T. Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament. Neurosurgery 24:864-72.1989.
[14] Saunders RL, Bernini PM, Shirreffs TG, Reeves AG. Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 1991Feb;74(2):163-70.
[15] Seifert V. Anterior decompressive microsurgery and osteosynthesis for the treatment of multi-segmental cervical spondylosis, Pathophysiological Considerations, Surgical indications, Results and Complications: a survey. Acta Neurochir 1995;135:105-121.
[16] Zdeblick TA, Bohlman HH. Cervical kyphosis and myelopathy, treatment by anterior corpectomy and strut-grafting. J Bone. Joint Surg (Am)71:170-182,1989.
[17] Connolly PJ, Esses SI, Kostuik JP. Anterior cervical fusion: outcome analysis of patients fused with and without anterior cervical plates.[J].Spinal Disord,1996,9:202-206.
[18] Emery SE ,Bolesta MJ . Robinson anterior cervical fusion Comparison of standard and modified techingues. Spine 1994;19:660-663.
[19] Yoo Yu ,Bayley J ,Zou D , et al . Effect of cervical spine motion on beuro foramina digmengions. Spine , 1996 ,17 (21) :1131.
[20] Caspar W, Barbier DD, Klara PM, et al. Anterior cervical fusion and Caspar plate stabilization for cervical trauma Neurosurgery 25:491-502,1989.
[21] Leize EM,Hemmerle J . Voegel JC. Characterization analyses of a corlcollagen compostre used for bone replacement graft material. J Mater Med ,1999,10(12):47-51.
[22]王以进,王介鳞.骨科生物力学[M].北京:人民军医出版社,1989,239.
[23]王以进.骨科生物力学实验统计和实施[J].中国矫形外科杂志,2005,13:69-71.
[24]俞杭平,唐天驷,王以进等.颈前路单椎间减压植骨融合与加用钛板内固定的比较研究[J].中华骨科杂志,2003,23:549-553.
[25]郭翔,倪斌.颈椎生物力学模型的应力及进展,[J].中国矫形外科杂志,2006,14:1225-1227.
[26]王小红.骨修复材料的研究进展,生物医学工程学杂志2001 ,18(4):647-652.
[27]陈峰,陈兴,康发军,等.无机骨粒与羟基磷灰石复合材料在颈椎前路手术中的应用.中国矫形外科杂志,2001,8(4):408.
[28] Connolly PJ, Esses SI, Kostuik JP.Anterior cervical fusion analysis of patients fused with and without anterior cervical plates[J].Orthop Trans,1994,18:7.
[29]胡蕴玉,陆裕朴,刘伟,等.重组合异种骨的实验研究与临床应用.中华外科杂志,1993 ,31(12):709-712.
[30]张旭.前路减压固定带血管蒂肋骨瓣植骨治疗胸腰椎骨折.中国修复重建外科杂志.2001,15,1.
[31]赵筑川,曹永飞,彭智,等.颈椎前路钛网钢板内固定及自体髂骨植骨在不同颈椎节段中的生物力学研究.中国修复重建外科杂志2006,20(11): 1076-1079.
[32] Traynelis VC,Donaher PA,Roach RM,et al.Biomechanical comparison of anterior Caspar plate and three-level posterior fixation techniques in a human cadaveric model.J Neurosurg,1993;79:96-103.
[33] Bose B. Anterior cervical fusion using Caspar plating: analysis of results and review of the literature[J].Surg Neurol, 1998,49:25-31.
[34]袁文,贾连顺,戴力扬,等.AO纯钛带锁钢板在颈椎前路固定的初步报告[J].中国脊柱脊髓杂志,1996,6(4):161-163.
[35] Aebi M,Zuber K,Marchesi D. Treatment of cervical spine injuries with anterior plating:indications, techniques, and results. Spine,1991,16 suppl3: 38-45.
[36]罗家明,郭春生,颈椎前路钢板在颈椎病中的应用[J].淮海医药,2009,3(2):185-186
[37] Hartington KD.Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine.J. Neurosurg.1984;61:107-117.
[38] Smith MD, Bolesta MJ. Esophageal perforation after anterior cervical plate fixation: a report of two cases [J]. J Spinal Disorders5:357-362,1992.
[39]瞿东滨,朱青安,钟世镇.脊柱融合术后邻近节段退变及其机制[J].中国脊柱脊髓杂志,1998,8(6):344-346.
[40] Randle MJ, Wolf A, Levi L, et al. The use of anterior Caspar plate fixation in acute cervical injury .Surg Neurol. 1991;36:181-189.
[41] Heidecke V, Rainov NG, Burket W. Anterior cervical fusion with the Orion locking plate system. [J]. Spine,1998,23:1796-1803.
[42] Fidler MW.Pathological fractures of the cervical spine palliative surgical treatment.J Bone Joint Surg(Br),1985,67:352-357.
[43] Hartington KD .The use of methylmethacrylate for vertebral-body replacement and anterior stabilization of pathological fracture-dislocations of the spine due to metastatic malignant disease.J Bone Joint Surg Am. 1981 Jan;63(1):36-46.
[44] Hamdi. FA. Prosthesis for an excised lumbar vertebra .A preliminary report.[J]. Can Med Assoc J,1969,100:576.
[45]卢公标,权正学,蒋电明,人工椎体的发展及在脊柱外科中的应用[J]中国修复重建外科杂志,2006,20(4):419-422.
[46]吴志宏,叶启彬,邱贵兴等.“自锁式”人工椎体在脊柱肿瘤综合治疗中的应用.中国医学科学院学报,1997,19(4):288-292
[47] A rbit E, Galicich JH. Vertebral body reconstruction with a modified Harrington rod distraction system fo r stabilization of the spine affected with metastatic disease. J Neurosurg, 83(4):617-620,1995.
[48] Lowery GL , Harm s J. T itanium surgicalmesh for vertebral defect replacement and intervertebral spacers. In: Thalgott JS, AebI M, eds. Manual of Internal Fixation of the Spine. Philadelphia: Lippincott-Raven Publishers,1996:127–46.
[49]原林,戴景兴.人工椎体的结构和界面之生物力学设计.生物医学工程学杂志,1999,16(增刊):29-30.
[50]原林,郝松林,钟世镇.弹性活动式人工椎体构形及其力学性能.医用生物力学.1995,10(4):245-247.
[51] John S. Thalgott, MD,Chen Xiongsheng, MD,James M. Giuffre, BA Single stage anterior cervical reconstruction with titanium mesh cages, local bone graft, and anterior plating, Spine Journal 3(2003):294-300.
[52]赵定麟,陈德玉,赵杰等.可调式中空人工椎体的研制与临床应用[J].中华骨科杂志,2001,21(4):222-224.
[53]王新伟,赵定麟,陈德玉等.可调式中空钛合金人工椎体动物实验研究.第二军医大学学报.2003,24(9):1013-1015.
[54]王新伟,赵定麟,陈德玉等.可调式中空钛合金人工椎体的生物力学评价.中华实验外科杂志.2003,20(6):550-552.
[55]王新伟,赵定麟,陈德玉等.牛胸腰椎椎体切除后不同内植物的极限力学性能测试.中国矫形外科杂志.2002,10(13):1322-1323.
[56]杨瑞甫,王臻,李涤尘等.自固定式人工椎体的设计及生物力学分析.中国矫形外科杂志.2003,ll(12):817-820
[57] ItohS, KikuchiM , Koyama Y, et al. Development of an artificial vertebral body using a novel biomaterial, hydroxyl apatite collagen composite. Biomaterials, 2002, 23 (19):3919-3926.
[58]林明侠,陈剑飞,马业淘,等.生物椎体的研制与临床应用.中国矫形外科杂志, 2002, 9 (12) : 1156-1157.
[59]娄朝晖,陈安民,吴华,等.磁性生物陶瓷人工椎体靶向治疗椎骨肿瘤的可行性研究与大动物实验.中华物理医学与康复杂志, 2004,26(6): 328-332.
[60] Scoville W B.Tht use of acrylic plastic for vertebral replacement of fixation in metastatic disease of the spine.J Neurosurg,1967,27:274-279.
[61] Ono K,Yonenobu K,Ebara S,et a1.Prosthetic replacement surgery for cervical spine metastasis,Spine 1988,13(7):817—822.
[62]马忠泰,方志伟,栗怀广.自制钢筋水泥人工椎体修复椎体肿瘤切除后骨缺损.中华骨科杂志,1995,1:10.
[63]林明侠,陈剑飞,马业涛等.生物椎体的研制与临床应用,中国矫形外科杂志.2002,10(12):1156-1157.
[64] Hilihrand AS, Yoo JU, Carlson GD. The Success of Anterior Cervical Arthrodesis adjacent to a previous fusion [ J ] .Spine, 1997, 22:1574-1579.
[65] Pospiech J, StolkeD, Wilke HJ Intradiscal pressure recordings in the cervical spine Neurosurgery, [ J ]1999, 44(2):379-384.
[66] Schwab JS, Diangelo DJ, Foley KT. Motion compensation associated with Single Level Cervical Fusion: where does the Lost Motion Go? Spine, 2006; 31: 2439-2448
[67] Zhao M,Ye Q ,Sheng J:Surgical treatment of spinal tumur.Analysis of 52 cases.Clin Med Sci J,1996,1l(3):184.
[68] HarringtonKD.Metastatic disease of the spine.J Bone Joint Surg(Am),1986;68:1110.
[69] Clark C R,KJ Keggi,MM Panjabi,et.al.Methylmethacrylate stabilization of the cervical spine,Bone Joint Surg. Am., 1984; 66:40-6.
[70]梁秋发,原林,王文军,等.1颈椎前路融合术后临近节段退变的MRI分析[J]1医学临床研究, 2005, 22(6):727-729.
[71] Aota Y, Kurnano K, Hirabayashi S. Post fusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar disorders Spinal Discord, [ J ]1995, 8 (6) : 464-466.
[72] Peng B, Hou S, SkiQ, et a1. The relationship between cartilage end2p late calification and disc degeneration: an experiment study Chin Med , [J]2001,114(3):308-312.
[73]王良意,陈德玉,郭永飞等.颈前路可调式融合固定器的研制及生物力学测试.中国矫形外科杂志.2004,12(11):854-857.
[74] Weinhoffer SL, Guyer RD, HerbertM, eta11 Intradiscal pressure measurements above an instrumented fusion: a cadaveric study Spine , [ J ] 1995,20(5):526-528.
[75] Lopez Olivia Munoz F, Garciadelas Heras B, Concejero Lopez V, etal1Comparison of three techniques of anterior fusion in single level cervical disc herniation Euro Spine, [ J ] 1998,7:512-516.
[76] Chen LH, Chen WJ, Niu CC, Shih CH (2000) Anterior reconstruct-tive spinal surgery with Zielke instrumentation for metastatic malignancies of the spine, Arch Orthop Trauma Surg120:27-31.
[77] Geer C, Papadopoulos S1The argument for Single level anterior cervical discectomy and fusion with anterior plate fixation [ J ] Clin Neurosurg,1999, 45: 25-29.
[78] Goffin J, Geusens E,Vantomme N, et al. Long term follow up after inter body fusion of the cervical spine Paper presented at the 28th annual meeting of the Cervical Spine Research Society, 2000, 11: 20-22.
[79]袁文,王新,颈椎病手术治疗的相关问题探讨[J].中国脊柱脊髓杂志, 2006, 16(5):325-329.
[80] Sundaresan N,Galicich JH,Lane JM,et.al.Harrington rod stabilization for pathological fractures of the spine, J Neurosurg,1984;60:282.
[81] Chen LH, Chen WJ, Niu CC, Shih CH (2000) Anterior reconstruct-tive spinal surgery with Zielke instrumentation for metastatic malignancies of the spine.Arch Orthop Trauma Surg120:27-31.
[82]脊柱先锋,2008,6(3):4.
[83] Clark CR,Keggi KJ,Panjabi MM,et.al.Methylmethacrylate stabilization of the cervical spine, J Bone Joint Surg(Am),1984,66:40.
[84] Schlegel JD, Smith JA, Schleusener RL Lumbarmotion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions [J].Spine, 1996,21 (8):970-981.
[85] Bryan V E J r. Cervical motion segment replacement. Eur Spine J ,2002, 11 Supp l2:92-97.
[86] Kandziora F, Pflugmacher R, Scholz M , et al. Experimental fusion of the sheep cervical spine. Part I: Effect of cage design on interbody fusion. Chirurg, 2002, 73 (9) : 909-917.
[87]章庆峻,罗卓荆.颈椎前路界面固定和带锁钢板内固定的远期疗效比较研究.骨与关节损伤杂志, 2002, 17 (1) : 14-16.
[88] Eysel P, Furderer S, Rooupe JD, et al. Znitial instability of different cage for fusion of the cervical spine. Zentralbl N emrochir, 2000, 61 (4) : 171-176.
[89]毛志国,袁文,贾连顺,等.钛制网笼内植物加前路带锁钢板对颈椎稳定性的生物力学评价.中国脊柱脊髓杂志, 2001,11(6):355-357.
[90] L u J , Ebraheim NA , Huntoon M , et al. Cervical intervertebral disc space narrowing and size of intervertebral for a ina. Clin Orthop Relat Res, 2000, (370) : 259-264.
[91]贾连顺,袁文,倪斌,等.颈椎病外科治疗选择及远期疗效评价.中国矫形外科杂志, 2002,10(13):126021264.
[92]张远鹰,王金成,高忠礼,等.异种无机骨复合自体骨髓移植在颈椎前路融合术中的应用.中国修复重建外科杂志, 2004, 18 (1) : 25-27.
[93]柏传毅,王冲正,魏美钢,等.颈椎钛板2融合固定器的研制及生物力学研究.中国脊柱脊髓杂志, 2004,13(10),608-611.
[94] Chen TY, Crawfo rd NR, Sonntag V K, et al. Biomechanical effects of progressive anterior cervical decompression. Spine,2001, 26(1):6-13.
[95]冯敬,蒋涛,陈良,等.颈椎前路钢板内固定术对维持椎间高度的作用.中国修复重建外科杂志,2004,18(4):344-345.
[2] Young WF, Rosenwasser RH. An early comparative analysis of the use of fibular allograft versus autologous iliac crest graft for interbody fusion after anterior cervical discectomy. Spine.1993 Jul; 18(9):1123-4.
[3] Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958;40:607-24.
[4] Ricciardi JE, Whitecloud TS, Flores AJ. The fate of fibular strut allografts in multiple level anterior cervical fusion: a radiographic analysis. Presentation at the 13th annual meeting of North American Spine Society, San Francisco, CA, October 28–31, 1997.
[5] Emery SE, Bolesta MJ, Banks MA, Jones PK. Robinson anterior cervical fusion comparison of the standard and modified techniques. Spine 1994;19:660-663.
[6] Chi-Chien Niu MD, Yong Hai MD. Anterior cervical corpectomy and strut graft fusion using a different method The Spine JournalVolume 2, Issue 3, May-June 2002, Pages 179-187.
[7] Bernard TN Jr, Whitecloud TS. Cervical spondylotic myelopathy and myeloradiculopathy. Anterior decompression and stabilization with autogenous fibula strut graft. Clin Orthop Relat Res. 1987; Aug; (221):149-60.
[8] Hanai K, Fujiyoshi F, Kamei K. Subtotal vertebrectomy and spinal fusionfor cervical spondylotic myelopathy. Spine.1986 May;11(4):310–5.
[9] Robinson RA, Walker AE, Ferlic DC, Wiecking DK. The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg. Am. 1962;44:1569-86.
[10] Lbere Riberio Jair Ortiz.Anterir cervical fusion by the Smith-Robinson Artrodesis cervical anterior por la tecnica de Smith-Robinson. COLUNA/COLUMNA. 2008;7(1):40-44.
[11] Emery SE, Bohlman HH, Bolesta MJ, Jones PK. Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. J Bone Joint Surg (Am) 1998;80:941-51.
[12] Herkowitz HN. The surgical management of cervical spondylotic radiculopathy and myelopathy. Clin Orthop Relat Res .1989 Feb; (239):94-108.
[13] Kojima T, Waga S, Kubo Y, Kanamaru K, Shimosaka S, Shimizu T. Anterior cervical vertebrectomy and interbody fusion for multi-level spondylosis and ossification of the posterior longitudinal ligament. Neurosurgery 24:864-72.1989.
[14] Saunders RL, Bernini PM, Shirreffs TG, Reeves AG. Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 1991Feb;74(2):163-70.
[15] Seifert V. Anterior decompressive microsurgery and osteosynthesis for the treatment of multi-segmental cervical spondylosis, Pathophysiological Considerations, Surgical indications, Results and Complications: a survey. Acta Neurochir 1995;135:105-121.
[16] Zdeblick TA, Bohlman HH. Cervical kyphosis and myelopathy, treatment by anterior corpectomy and strut-grafting. J Bone. Joint Surg (Am)71:170-182,1989.
[17] Connolly PJ, Esses SI, Kostuik JP. Anterior cervical fusion: outcome analysis of patients fused with and without anterior cervical plates.[J].Spinal Disord,1996,9:202-206.
[18] Emery SE ,Bolesta MJ . Robinson anterior cervical fusion Comparison of standard and modified techingues. Spine 1994;19:660-663.
[19] Yoo Yu ,Bayley J ,Zou D , et al . Effect of cervical spine motion on beuro foramina digmengions. Spine , 1996 ,17 (21) :1131.
[20] Caspar W, Barbier DD, Klara PM, et al. Anterior cervical fusion and Caspar plate stabilization for cervical trauma Neurosurgery 25:491-502,1989.
[21] Leize EM,Hemmerle J . Voegel JC. Characterization analyses of a corlcollagen compostre used for bone replacement graft material. J Mater Med ,1999,10(12):47-51.
[22]王以进,王介鳞.骨科生物力学[M].北京:人民军医出版社,1989,239.
[23]王以进.骨科生物力学实验统计和实施[J].中国矫形外科杂志,2005,13:69-71.
[24]俞杭平,唐天驷,王以进等.颈前路单椎间减压植骨融合与加用钛板内固定的比较研究[J].中华骨科杂志,2003,23:549-553.
[25]郭翔,倪斌.颈椎生物力学模型的应力及进展,[J].中国矫形外科杂志,2006,14:1225-1227.
[26]王小红.骨修复材料的研究进展,生物医学工程学杂志2001 ,18(4):647-652.
[27]陈峰,陈兴,康发军,等.无机骨粒与羟基磷灰石复合材料在颈椎前路手术中的应用.中国矫形外科杂志,2001,8(4):408.
[28] Connolly PJ, Esses SI, Kostuik JP.Anterior cervical fusion analysis of patients fused with and without anterior cervical plates[J].Orthop Trans,1994,18:7.
[29]胡蕴玉,陆裕朴,刘伟,等.重组合异种骨的实验研究与临床应用.中华外科杂志,1993 ,31(12):709-712.
[30]张旭.前路减压固定带血管蒂肋骨瓣植骨治疗胸腰椎骨折.中国修复重建外科杂志.2001,15,1.
[31]赵筑川,曹永飞,彭智,等.颈椎前路钛网钢板内固定及自体髂骨植骨在不同颈椎节段中的生物力学研究.中国修复重建外科杂志2006,20(11): 1076-1079.
[32] Traynelis VC,Donaher PA,Roach RM,et al.Biomechanical comparison of anterior Caspar plate and three-level posterior fixation techniques in a human cadaveric model.J Neurosurg,1993;79:96-103.
[33] Bose B. Anterior cervical fusion using Caspar plating: analysis of results and review of the literature[J].Surg Neurol, 1998,49:25-31.
[34]袁文,贾连顺,戴力扬,等.AO纯钛带锁钢板在颈椎前路固定的初步报告[J].中国脊柱脊髓杂志,1996,6(4):161-163.
[35] Aebi M,Zuber K,Marchesi D. Treatment of cervical spine injuries with anterior plating:indications, techniques, and results. Spine,1991,16 suppl3: 38-45.
[36]罗家明,郭春生,颈椎前路钢板在颈椎病中的应用[J].淮海医药,2009,3(2):185-186
[37] Hartington KD.Anterior cord decompression and spinal stabilization for patients with metastatic lesions of the spine.J. Neurosurg.1984;61:107-117.
[38] Smith MD, Bolesta MJ. Esophageal perforation after anterior cervical plate fixation: a report of two cases [J]. J Spinal Disorders5:357-362,1992.
[39]瞿东滨,朱青安,钟世镇.脊柱融合术后邻近节段退变及其机制[J].中国脊柱脊髓杂志,1998,8(6):344-346.
[40] Randle MJ, Wolf A, Levi L, et al. The use of anterior Caspar plate fixation in acute cervical injury .Surg Neurol. 1991;36:181-189.
[41] Heidecke V, Rainov NG, Burket W. Anterior cervical fusion with the Orion locking plate system. [J]. Spine,1998,23:1796-1803.
[42] Fidler MW.Pathological fractures of the cervical spine palliative surgical treatment.J Bone Joint Surg(Br),1985,67:352-357.
[43] Hartington KD .The use of methylmethacrylate for vertebral-body replacement and anterior stabilization of pathological fracture-dislocations of the spine due to metastatic malignant disease.J Bone Joint Surg Am. 1981 Jan;63(1):36-46.
[44] Hamdi. FA. Prosthesis for an excised lumbar vertebra .A preliminary report.[J]. Can Med Assoc J,1969,100:576.
[45]卢公标,权正学,蒋电明,人工椎体的发展及在脊柱外科中的应用[J]中国修复重建外科杂志,2006,20(4):419-422.
[46]吴志宏,叶启彬,邱贵兴等.“自锁式”人工椎体在脊柱肿瘤综合治疗中的应用.中国医学科学院学报,1997,19(4):288-292
[47] A rbit E, Galicich JH. Vertebral body reconstruction with a modified Harrington rod distraction system fo r stabilization of the spine affected with metastatic disease. J Neurosurg, 83(4):617-620,1995.
[48] Lowery GL , Harm s J. T itanium surgicalmesh for vertebral defect replacement and intervertebral spacers. In: Thalgott JS, AebI M, eds. Manual of Internal Fixation of the Spine. Philadelphia: Lippincott-Raven Publishers,1996:127–46.
[49]原林,戴景兴.人工椎体的结构和界面之生物力学设计.生物医学工程学杂志,1999,16(增刊):29-30.
[50]原林,郝松林,钟世镇.弹性活动式人工椎体构形及其力学性能.医用生物力学.1995,10(4):245-247.
[51] John S. Thalgott, MD,Chen Xiongsheng, MD,James M. Giuffre, BA Single stage anterior cervical reconstruction with titanium mesh cages, local bone graft, and anterior plating, Spine Journal 3(2003):294-300.
[52]赵定麟,陈德玉,赵杰等.可调式中空人工椎体的研制与临床应用[J].中华骨科杂志,2001,21(4):222-224.
[53]王新伟,赵定麟,陈德玉等.可调式中空钛合金人工椎体动物实验研究.第二军医大学学报.2003,24(9):1013-1015.
[54]王新伟,赵定麟,陈德玉等.可调式中空钛合金人工椎体的生物力学评价.中华实验外科杂志.2003,20(6):550-552.
[55]王新伟,赵定麟,陈德玉等.牛胸腰椎椎体切除后不同内植物的极限力学性能测试.中国矫形外科杂志.2002,10(13):1322-1323.
[56]杨瑞甫,王臻,李涤尘等.自固定式人工椎体的设计及生物力学分析.中国矫形外科杂志.2003,ll(12):817-820
[57] ItohS, KikuchiM , Koyama Y, et al. Development of an artificial vertebral body using a novel biomaterial, hydroxyl apatite collagen composite. Biomaterials, 2002, 23 (19):3919-3926.
[58]林明侠,陈剑飞,马业淘,等.生物椎体的研制与临床应用.中国矫形外科杂志, 2002, 9 (12) : 1156-1157.
[59]娄朝晖,陈安民,吴华,等.磁性生物陶瓷人工椎体靶向治疗椎骨肿瘤的可行性研究与大动物实验.中华物理医学与康复杂志, 2004,26(6): 328-332.
[60] Scoville W B.Tht use of acrylic plastic for vertebral replacement of fixation in metastatic disease of the spine.J Neurosurg,1967,27:274-279.
[61] Ono K,Yonenobu K,Ebara S,et a1.Prosthetic replacement surgery for cervical spine metastasis,Spine 1988,13(7):817—822.
[62]马忠泰,方志伟,栗怀广.自制钢筋水泥人工椎体修复椎体肿瘤切除后骨缺损.中华骨科杂志,1995,1:10.
[63]林明侠,陈剑飞,马业涛等.生物椎体的研制与临床应用,中国矫形外科杂志.2002,10(12):1156-1157.
[64] Hilihrand AS, Yoo JU, Carlson GD. The Success of Anterior Cervical Arthrodesis adjacent to a previous fusion [ J ] .Spine, 1997, 22:1574-1579.
[65] Pospiech J, StolkeD, Wilke HJ Intradiscal pressure recordings in the cervical spine Neurosurgery, [ J ]1999, 44(2):379-384.
[66] Schwab JS, Diangelo DJ, Foley KT. Motion compensation associated with Single Level Cervical Fusion: where does the Lost Motion Go? Spine, 2006; 31: 2439-2448
[67] Zhao M,Ye Q ,Sheng J:Surgical treatment of spinal tumur.Analysis of 52 cases.Clin Med Sci J,1996,1l(3):184.
[68] HarringtonKD.Metastatic disease of the spine.J Bone Joint Surg(Am),1986;68:1110.
[69] Clark C R,KJ Keggi,MM Panjabi,et.al.Methylmethacrylate stabilization of the cervical spine,Bone Joint Surg. Am., 1984; 66:40-6.
[70]梁秋发,原林,王文军,等.1颈椎前路融合术后临近节段退变的MRI分析[J]1医学临床研究, 2005, 22(6):727-729.
[71] Aota Y, Kurnano K, Hirabayashi S. Post fusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar disorders Spinal Discord, [ J ]1995, 8 (6) : 464-466.
[72] Peng B, Hou S, SkiQ, et a1. The relationship between cartilage end2p late calification and disc degeneration: an experiment study Chin Med , [J]2001,114(3):308-312.
[73]王良意,陈德玉,郭永飞等.颈前路可调式融合固定器的研制及生物力学测试.中国矫形外科杂志.2004,12(11):854-857.
[74] Weinhoffer SL, Guyer RD, HerbertM, eta11 Intradiscal pressure measurements above an instrumented fusion: a cadaveric study Spine , [ J ] 1995,20(5):526-528.
[75] Lopez Olivia Munoz F, Garciadelas Heras B, Concejero Lopez V, etal1Comparison of three techniques of anterior fusion in single level cervical disc herniation Euro Spine, [ J ] 1998,7:512-516.
[76] Chen LH, Chen WJ, Niu CC, Shih CH (2000) Anterior reconstruct-tive spinal surgery with Zielke instrumentation for metastatic malignancies of the spine, Arch Orthop Trauma Surg120:27-31.
[77] Geer C, Papadopoulos S1The argument for Single level anterior cervical discectomy and fusion with anterior plate fixation [ J ] Clin Neurosurg,1999, 45: 25-29.
[78] Goffin J, Geusens E,Vantomme N, et al. Long term follow up after inter body fusion of the cervical spine Paper presented at the 28th annual meeting of the Cervical Spine Research Society, 2000, 11: 20-22.
[79]袁文,王新,颈椎病手术治疗的相关问题探讨[J].中国脊柱脊髓杂志, 2006, 16(5):325-329.
[80] Sundaresan N,Galicich JH,Lane JM,et.al.Harrington rod stabilization for pathological fractures of the spine, J Neurosurg,1984;60:282.
[81] Chen LH, Chen WJ, Niu CC, Shih CH (2000) Anterior reconstruct-tive spinal surgery with Zielke instrumentation for metastatic malignancies of the spine.Arch Orthop Trauma Surg120:27-31.
[82]脊柱先锋,2008,6(3):4.
[83] Clark CR,Keggi KJ,Panjabi MM,et.al.Methylmethacrylate stabilization of the cervical spine, J Bone Joint Surg(Am),1984,66:40.
[84] Schlegel JD, Smith JA, Schleusener RL Lumbarmotion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions [J].Spine, 1996,21 (8):970-981.
[85] Bryan V E J r. Cervical motion segment replacement. Eur Spine J ,2002, 11 Supp l2:92-97.
[86] Kandziora F, Pflugmacher R, Scholz M , et al. Experimental fusion of the sheep cervical spine. Part I: Effect of cage design on interbody fusion. Chirurg, 2002, 73 (9) : 909-917.
[87]章庆峻,罗卓荆.颈椎前路界面固定和带锁钢板内固定的远期疗效比较研究.骨与关节损伤杂志, 2002, 17 (1) : 14-16.
[88] Eysel P, Furderer S, Rooupe JD, et al. Znitial instability of different cage for fusion of the cervical spine. Zentralbl N emrochir, 2000, 61 (4) : 171-176.
[89]毛志国,袁文,贾连顺,等.钛制网笼内植物加前路带锁钢板对颈椎稳定性的生物力学评价.中国脊柱脊髓杂志, 2001,11(6):355-357.
[90] L u J , Ebraheim NA , Huntoon M , et al. Cervical intervertebral disc space narrowing and size of intervertebral for a ina. Clin Orthop Relat Res, 2000, (370) : 259-264.
[91]贾连顺,袁文,倪斌,等.颈椎病外科治疗选择及远期疗效评价.中国矫形外科杂志, 2002,10(13):126021264.
[92]张远鹰,王金成,高忠礼,等.异种无机骨复合自体骨髓移植在颈椎前路融合术中的应用.中国修复重建外科杂志, 2004, 18 (1) : 25-27.
[93]柏传毅,王冲正,魏美钢,等.颈椎钛板2融合固定器的研制及生物力学研究.中国脊柱脊髓杂志, 2004,13(10),608-611.
[94] Chen TY, Crawfo rd NR, Sonntag V K, et al. Biomechanical effects of progressive anterior cervical decompression. Spine,2001, 26(1):6-13.
[95]冯敬,蒋涛,陈良,等.颈椎前路钢板内固定术对维持椎间高度的作用.中国修复重建外科杂志,2004,18(4):344-345.