人工颈椎间盘置换后邻近下位椎间孔形态改变的生物力学研究与临床观察
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摘要
颈椎病、颈椎不稳、退变性椎管狭窄等颈椎退行性疾病常由于突出的椎间盘、增生的骨赘、增厚的韧带等结构压迫脊髓或神经根产生临床症状。颈前路减压植骨融合术是治疗颈椎退变性疾病、创伤、肿瘤等疾病最有效治疗手段，但颈椎间融合后，导致邻近节段的活动度增大，促使邻近节段发生退变或原有退变加重。人工颈椎间盘置换术(cervical artificial disc replacement，CADR)近年发展迅速，其目的是代替病变的椎间盘并行使其功能，保留病变阶段的运动和减少邻近节段继发性退变。颈椎间孔大小对椎间孔狭窄和神经根型颈椎病的诊断具有决定性意义。颈椎间孔形态改变与其生物力学性能密切相关，又是评估临床疗效的重要指标之一。因此，对颈椎间孔形态的研究具有重要意义。但颈椎人工椎间盘能否恢复正常的椎间盘功能，以及对邻近节段有无影响，尤其是CADR后对邻近下位椎间孔影响的生物力学实验和临床研究尚未见报道。
本课题从以下三个方面对颈椎间孔进行研究：(1)观测尸体标本和成人X线颈椎间孔，并进行比较，为实验和临床提供资料。(2)探讨C_(5／6)ADR组、椎间盘完整组、椎间盘摘除组、前路椎间植骨融合组不同状态不同载荷下，对邻近下位(C_(6／7))椎间孔的影响。(3)观察9例C_(5／6)ADR和30例同阶段前路植骨融合内固定术后的临床疗效，比较两种手术方式对邻近下位椎间孔形态的影响。
第一章 颈椎间孔的解剖学测量
目的 为生物力学研究和临床颈部疾患诊治提供解剖学和影像学资料。
方法 陈旧防腐标本15具，标本男10具，女5具。对C_2～T_1颈椎间孔高度和宽度进行观测；30名成人，男15，女15，行颈椎双斜位X线测量。对测量结果用SPSS11.5软件进行统计分析，检验水准为α=0.05。
结果 1、颈椎间孔高度平均值为7.31±0.80，宽度平均值为5.23±0.42；颈椎间孔X线测量高度平均值为11.04±1.11，宽度平均值为6.69±0.76。X线宽度自上向下逐渐减小。2、尸体解剖和X
Herniated cervical intervertebral disk, osteophyte, and incrassate ligaments resulted from cervical degenerative diseases compress spinal cord and nerve roots and produce clinical symptom. The cervical degenerative diseases generally include the cervical spondylosis, the cervical unsteadiness and degenerative spinal stenosis. Anterior cervical decompression and fusion is an effective therapeutic method for cervical degenerative diseases, trauma, and tumor. Adjacent cervical segments degeneration develop after fusion because of increased movement. Cervical artificial disc replacement (CADR) is a new technique to replace the affected disc and exercise its function, with reservation of the movement of corresponding segment, and decrease adjacent degeneration. The intervertebral foramen dimension possesses decisive significance for the diagnosis of cervical intervertebral foramen stenosis and cervicalspondylotic radiculopathy. The study on the morphometric change of cervical intervertebral foramen has important significance because it is closely related to biomechanical characters and is one of the important indexes for evaluation of clinical efficiency. However there is no report whether the artificial disc can fulfill all function of the disc, or have side effect on the adjacent disc or intervertebral foramen, especially the inferior one.
The study is to perform from the following three aspects: (1) To provide data for experiment and clinic through the observation and comparison of the cervical intervertebral foramen of cadaver and adults' X ray. (2) To explore the morphometric change of inferior(C_(6/7)) intervertebral foramen under different status and loading among groups of C_(5/6)ADR, normal disc, discectomy, anterior fusion. (3) To compare the morphometric change of inferior (C_(6/7)) intervertebral foramen after C_(5/6)ADR and anterior fusion at same level.
Chapter One: The Anatomic Measurement of the Cervical
Intervertebral Foramen
本课题从以下三个方面对颈椎间孔进行研究：(1)观测尸体标本和成人X线颈椎间孔，并进行比较，为实验和临床提供资料。(2)探讨C_(5／6)ADR组、椎间盘完整组、椎间盘摘除组、前路椎间植骨融合组不同状态不同载荷下，对邻近下位(C_(6／7))椎间孔的影响。(3)观察9例C_(5／6)ADR和30例同阶段前路植骨融合内固定术后的临床疗效，比较两种手术方式对邻近下位椎间孔形态的影响。
第一章 颈椎间孔的解剖学测量
目的 为生物力学研究和临床颈部疾患诊治提供解剖学和影像学资料。
方法 陈旧防腐标本15具，标本男10具，女5具。对C_2～T_1颈椎间孔高度和宽度进行观测；30名成人，男15，女15，行颈椎双斜位X线测量。对测量结果用SPSS11.5软件进行统计分析，检验水准为α=0.05。
结果 1、颈椎间孔高度平均值为7.31±0.80，宽度平均值为5.23±0.42；颈椎间孔X线测量高度平均值为11.04±1.11，宽度平均值为6.69±0.76。X线宽度自上向下逐渐减小。2、尸体解剖和X
Herniated cervical intervertebral disk, osteophyte, and incrassate ligaments resulted from cervical degenerative diseases compress spinal cord and nerve roots and produce clinical symptom. The cervical degenerative diseases generally include the cervical spondylosis, the cervical unsteadiness and degenerative spinal stenosis. Anterior cervical decompression and fusion is an effective therapeutic method for cervical degenerative diseases, trauma, and tumor. Adjacent cervical segments degeneration develop after fusion because of increased movement. Cervical artificial disc replacement (CADR) is a new technique to replace the affected disc and exercise its function, with reservation of the movement of corresponding segment, and decrease adjacent degeneration. The intervertebral foramen dimension possesses decisive significance for the diagnosis of cervical intervertebral foramen stenosis and cervicalspondylotic radiculopathy. The study on the morphometric change of cervical intervertebral foramen has important significance because it is closely related to biomechanical characters and is one of the important indexes for evaluation of clinical efficiency. However there is no report whether the artificial disc can fulfill all function of the disc, or have side effect on the adjacent disc or intervertebral foramen, especially the inferior one.
The study is to perform from the following three aspects: (1) To provide data for experiment and clinic through the observation and comparison of the cervical intervertebral foramen of cadaver and adults' X ray. (2) To explore the morphometric change of inferior(C_(6/7)) intervertebral foramen under different status and loading among groups of C_(5/6)ADR, normal disc, discectomy, anterior fusion. (3) To compare the morphometric change of inferior (C_(6/7)) intervertebral foramen after C_(5/6)ADR and anterior fusion at same level.
Chapter One: The Anatomic Measurement of the Cervical
Intervertebral Foramen
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