双节段人工颈椎间盘置换对邻近上位关节突关节影响的生物力学研究和临床观察
|
摘要
颈椎病是常见的脊柱退行性疾患。经前路减压、椎体间植骨融合术已成为治疗颈椎病的有效手段，然而，大量的临床和实验研究发现该手术方式由于改变了相邻节段椎间盘内压力、节间运动力学和关节突关节应力，从而导致邻近节段退变。人工颈椎间盘置换术是近年发展的新技术，其目的是替代病变的椎间盘并行使其功能，保留运动节段和减少相邻节段继发性退变，为颈椎病治疗提供了新的途径。单节段人工颈椎间盘置换已有较多的生物力学研究和临床报道，但颈椎病变常累及两个或两个以上节段，双节段人工颈椎椎间盘能否达到正常椎间盘的力学性能要求，尚有待进一步的研究。
颈椎关节突关节具有十分重要的生物力学意义，其主要功能是承受压缩、牵拉、剪切及扭转等不同类型的载荷，双侧关节突关节和椎间盘构成了运动节段的稳定。颈椎病手术后关节突关节退变速度和程度是评估疗效的重要指标之一，而关节突关节退变与其生物力学性能密切相关，因此，对关节突关节内压力的研究具有重要意义。目前，国内外尚未见双节段人工颈椎间盘置换对邻近上位节段关节突关节影响的实验和临床研究。
由于颈椎的生理特点，C_(4/5)和C_(5/6)在生理状况下承受的应力最大，因此，颈椎退变最常发生在这两个节段。本课题从生物力学和临床上对C_(4/5)和C_(5/6)双节段人工颈椎间盘置换对关节突关节的影响进行了研究：(1)探讨新鲜尸体标本C_(4/5)和C_(5/6)椎间盘摘除、椎间融合前路内固定和人工椎间盘置换模型在不同载荷下对C_(4/5)和邻近上位节段C_(3/4)关节突关节内压力的影响；(2)观察C_(4/5)～C_(5/6)双节段人工颈椎间盘置换的早期临床疗效和前路椎间融合术的临床疗效，以及对邻近上位节段关节突关节的影响。
第一部分双节段人工颈椎间盘置换对邻近上位关节突关节压力影响的实验研究
目的探讨双节段颈椎椎间盘摘除、人工椎间盘置换和前路椎间融合内固定对邻近上位节段关节突关节内压力的影响，为临床运用双节段人工颈椎间盘置换提供参考依据。
方法取11具新鲜完整的青壮年下颈段标本，按实验先后分别制成C_(4/5)和C_(5/6)完整组、椎间盘摘除组、椎间盘置换组和C_4～C_6椎间融合组共四组标本模型，在标本上施加轴向、侧弯、前屈和后伸分级载荷，采用自行设计的圆片状微型阻电式压力传感器，分别测量各组各分级载荷下C_(4/5)和邻近上位节段C_(3/4)关节突关节内的压力负荷。比较各组间的压力大小，用SPSS11.5统计软件包进行统计学分析。
结果四组标本模型在轴向、侧弯、前屈和后伸四种工况下，C_(4/5)和C_(3/4)关节突关节内的压力变化分别是：①完整组、摘除组、置换组和融合组C_(3/4)(融合上位节段)压力均随载荷增加而增大；②融合组C_(4/5)(融合节段)关节突关节内压力为0；③人工椎间盘置换组与椎间盘完整组压力接近，无统计学差异(P＞0.05)；④载荷在100N以下时，椎间盘摘除组小于完整组和置换组相比，均有显著性差异(P＜0.05)；⑤载荷在100N以上时，椎间盘摘除组大于完整组和置换组，均有显著性差异(P＜0.05)；⑥融合组C_(3/4)关节突关节内的压力明显大于其它各组，均有显著性差异(P＜0.05)。
结论①双节段人工颈椎间盘置换后置换节段C_(4/5)和邻近上位节段C_(3/4)关节突关节内的压力与正常组接近，提示双节段人工颈椎间盘置换符合颈椎正常生物力学要求；②颈椎椎间盘摘除后C_(4/5)和邻近上位节段C_(3/4)关节突关节内的压力在小载荷下降低，但随着载荷增加(大于100N)，其压力大于正常组，提示颈椎间盘摘除后，改变了颈椎应力的分布，可能是导致其发生退变或退变加速的原因之一；③C_4～C_6双节段椎间融合内固定后邻近上位节段C_(3/4)关节突关节压力明显增大，可能是导致其发生退变或退变加速的原因之一。
第二部分双节段人工颈椎间盘置换对邻近上位关节突关节影响的早期临床观察
目的观察C_(4/5)、C_(5/6)双节段人工颈椎间盘置换的早期疗效和双节段颈前路融合内固定术的临床疗效，探讨其对邻近上位关节突关节退变的影响。
方法收集双节段颈椎病变而接受手术病例35例，按照手术方式及随访时间分为三组：(1)C_(4/5)、C_(5/6)双节段人工颈椎间盘置换组5例，随访12个月～22个月，平均14.66个月；(2)前路植骨融合内固定短期随访组(融合组一)15例，随访12个月～30个月，平均15.75个月；(3)前路植骨融合内固定中长期随访组(融合组二)15例，随访5年～8年，平均6.75年。记录术前和6月、12个月、2年、5年、末次随访时的JOA分值、Odom评级，X线观察邻近上位节段C_(3/4)活动度，CT扫描分析术后6月、1年、2年和5年手术邻近上位节段C_(3/4)关节突关节的退变程度。运用SPSS11.5统计软件比较分析各组各时段的JOA评分、Odom评级、邻近上位节段活动度和关节突关节的退变程度。
结果1．三组术后各随访段的JOA评分、Odom评级较术前均有提高，差异有统计学意义(P＜0.05)。2．术后6月人工椎间盘置换组与融合组一的JOA评分、Odom评级、邻近上位节段活动度和关节突关节的退变程度比较均无统计学差异(P＞0.05)。3．融合组一和融合组二术后1年与术后6月的JOA评分、Odom评级和关节突关节的退变程度比较均无统计学差异(P＞0.05)；但邻近上位节段活动度增大(P＜0.05)。4．融合组二术后5年与1年、2年比较，JOA评分、Odom评级改善率降低(P＜0.05)，邻近上位节段活动度增加(P＜0.05)，关节突关节的退变率增加(P＜0.05)。
结论：1．双节段ACDR是治疗多节段颈椎病的有效方法之一，术后早期疗效满意，邻近上位节段活动度良好，邻近上位关节突关节无明显退变。2．双节段颈前路减压椎体间融合内固定术也是治疗多节段颈椎病的有效手段之一，手术早期邻近上位关节突关节无明显退变；中远期邻近上位关节突关节发生退变，长期过度应力积累可能是导致其退变的原因。3．由于我们的临床病例较少，应用时间尚短，因此，双节段人工颈椎问盘置换术中远期疗效是否优于颈椎前路融合内固定术，尚需进一步的研究。
颈椎的侧块分别向头侧突出的上关节突和向尾侧突出的下关节突以及中间的峡部组成，左右各一。颈椎侧块是侧块螺钉固定技术的基础。因此，作者另对颈椎侧块解剖作了相关研究，通过解剖和影像学测量探讨了颈椎侧块与其周围重要毗邻结构的解剖关系，评价颈椎侧块螺钉固定技术的安全性，为临床颈椎侧块螺钉置入提供解剖学依据；
颈椎侧块的应用解剖与影像学测量及其临床意义
目的：观测正常成人C_3～C_7颈椎侧块与周围重要毗邻结构的解剖关系，评价临床颈椎侧块螺钉固定技术的安全性，为临床颈椎侧块螺钉固定术提供解剖学依据
方法：①选取正常成人颈椎新鲜标本11具和防腐标本10具，观测C_3～C_7颈椎侧块与上、下位神经根的解剖关系(D1和D2)；②选取正常成人颈椎侧位X线片40例，测量颈椎侧块上关节突关节面的倾角(α角)；③选取20份正常成人颈椎侧块中点水平CT断层扫描片，以侧块中点内侧1mm为0点，测量0点至横突孔外缘的连线与正中矢状面的夹角(β角)、0点至侧块前外侧缘的距离(D3)以及0点至侧块前外侧缘的连线与正中矢状面的夹角(θ角)。
结果：①颈脊神经根自侧块上关节突前外侧穿出，侧块前外侧缘中点至上位神经根的距离很小，平均为2.38-2.77mm；至下位神经根的距离较远，平均为6.72-7.06mm；②C3-C7上关节面倾角值为50.9-59.1°之间，C3＞C4＞C5＜C6＜C7，C5倾角最小，C7最大；③侧块中点水平CT断层扫描片测量结果显示：侧块后方中点偏内1mm 0点至横突孔外缘的连线与正中矢状面的夹角在C3-C5为向内倾，均值分别为3.0°、3.2°、2.7°，C6为向外倾，均值为7.1°；0点至侧块前外侧缘的距离为11.8-13.5mm；0点至侧块前外侧缘的连线与正中矢状面的夹角为33.4-34.1°
结论：①根据实体解剖学观测结果，颈椎侧块的上关节突距离上位神经根很近，提示上关节突退变易影响上位神经根，导致上位神经根受压；②根据解剖学观测和影像学测量结果，以侧块后方中点或偏内1mm进钉，保持进钉方向头倾35-45°和外倾10-30°，均不会对椎动脉和神经根构成威胁；③由于侧块的个体差异较大，侧块螺钉内固定术中，为使螺钉获得最大的把持力，实行置钉技术的个体化是有必要的。即根据术前影像学测量结果与术中测深相结合的方法选择置钉方向和螺钉长度。
Cervical spondylosis is a common degenerative spinal disease.Anterior cervical decompression and fusion is a effective mean forthe management of cervical spondylosis. But the incidence ofadjacent level intervertebal disc pathology secondary to anteriorcervical fusion, by changing the stress on zygapophyseal joints andthe motional mechanics between levels, has been well reported inclinical and laboratory studies. Artificial cervical discreplacements(ACDR) is a new technique developing in the recentyears to provide a new approach for the treatment of cervicalspondylosis. The purpose of ACDR is to replace degenerative discand exertion its function, and to preserve normal physiologicaloperative level motion and decrease the incidence of adjacent levelpathology secondary to anterior cervical fusion. ACDR at one levelhad a many of biomechanical studies and clinical reports. Butcervical spondylosis commonly involved in two or more level,whether two level ACDR measures up to normal cervicalbiomechanics is needed to further clinical and laboratory research.
The zygapophyseal joints have a very great significance. Theybear different type of loadings such as compression, traction,shearing and torsion. The adjacent level degeneration is closelyrelated to its biomechanical property and it is one of the mostimportant values used in evaluating the outcomes of cervical surgicalinterventions. Therefore, biomechanical research on zygapophysealjoints has great clinical significance. The clinical and laboratoryresearch related with the influence of two level ACDR on superiorzygapophyseal joint had no reported at present.
Cervical degeneration commonly involved in C_(4/5) and C_(5/6) twolevel owing to cervical physiological characteristic. The currentstudy was undertaken to investigate the influence of two level CADR on adjacent superior zygapophyseal joint from the followingbiomechanical and clinical aspects: (1)To investigate the influencearising from ACD, ACDF and ACDR at C_(4/5) and C_(5/6) two level freshcadaveric cervical specimens under various loadings on C_(4/5) and C_(3/4)zygapophyseal joint pressures;(2)To observe the clinical early stageoutcomes of ACDR and clinical outcomes of ACDF at C_(4/5) and C_(5/6)two level, and to investigate their influence on the degeneration ofadjacent superior zygapophyseal joint.
CHAPTER ONE: The Laboratory Investigation of the Influencesof Two Level Cervical Artificial Disc Replacement on Adjacentsuperior Zygapophyseal Joint Pressure
Objectives: To investigate the influence caused by C_(4/5) and C_(5/6)two level ACD, ACDR and ACDF on the pressures at C_(4/5)zygapophyseal joint and adjacent superior zygapophyseal joint C_(3/4), thusto provide references for clinical application of two level ACDR.
Methods: A total of 11 fresh and intact human cadaveric cervicalspines (C_3-T_1) were used in this investigation. According to thesequence of the experiment, all specimens were sequentiallyreconstructed at C_(4/5) and C_(5/6) with four model groups as 1) total discintact, 2) C_(4/5) and C_(5/6) discectomy, 3) C_(4/5) and C_(5/6) ACDR, and 4) C_(4-6)ACDF. Testing was performed in displacement control under axialrotation, lateral bending, flexion and extension loading modes onspecimens. A miniature wafer-like pressure transducers we designed byourselves was inserted to monitor adjacent superior zygapophyseal jointpressures and C_(4/5) zygapophyseal joint under various grades of loading indifferent groups. Various pressures collected from different groups werecompared by statistic analysis through SPSS11.5 for windows solfware.
Results: After the implementation of ACDR, ACD and ACDF at C_(4/5) and C_(5/6) by performing in displacement control under axialrotation, lateral bending, flexion and extension loading modes, the overalltrend of change at C_(3/4) and C_(4/5) zygapophyseal joint pressures is:①Thepressures in different groups were higher as the grades of the loadingwere higher. The pressures of ACDF at C_(4/5) zygapophyseal joint was zero.②The pressures at C_(3/4) and C_(4/5) zygapophyseal joint of the ACDR groupcompared with the total disc intact group had no statistical significance(P＞0.05).③The pressures in C_(3/4) and C_(4/5) zygapophyseal joint of theACD group compared with the total disc intact group and the ACDRgroup were lower in small loadings(under 100N) and higher in largeloadings(beyond 100N). The pressure values of the ACD group comparedwith the total disc intact group and the ACDR group had statisticalsignificance (P＜0.05).④The pressures at C_(3/4) zygapophyseal joint ofACDF group were higher. The pressure values compared with the othershad statistical significance (P＜0.05)
Conclusions: 1. The pressure values of C_(4/5) zygapophyseal jointand adjacent superior level zygapophyseal joint C_(3/4) at two levelACDR compared with the total disc intact group had no statisticalsignificance. Consequently, it suggests that two level ACDRmeasures up to normal cervical biological mechanics. 2. Thepressure values of C_(4/5) zygapophyseal joint and adjacent superiorlevel zygapophyseal joint C_(3/4) in two level ACD decreased in smallloadings, but the pressures were higher as the grades of the loadingwere larger. It suggests this has changed the distribution of stresswithin cervical spines and it is likely to be one of the reasons lead todegeneration of adjacent superior segment. 3. The increase of adjacentsuperior zygapophyseal joint pressure caused by ACDF is likely to be oneof the reasons that cause or accelerate the degeneration of adjacent superiorsegment.
CHAPTER TWO: Clinical Observation of the Influences of Twolevel Cervical Artificial Disc Replacement on adjacentsuperior zygapophyseal joints at the Early Stage.
Objectives: To observe the early stage outcomes of ACDR andthe clinical outcomes of ACDF at C_(4/5) and C_(5/6) two level and toinvestigate their Influences on the degeneration of adjacentsuperior zygapophysealjoints.
Methods: 35 patients who underwent surgical interventions for thetreatment of cervical spondylosis were collected and grouped in threeaccording to the respective ways of surgery they underwent andthe length of following-up study: (1) 5 patients in ACDR groupwith a follow-up study of 12～22 months(average 14.66 months); (2) 15patients in ACDF short term group (ACDF group one) with a follow-upstudy of 1～2.5 years(average 15.75 months); (3) 15 patients in ACDFmedium and long term group (ACDF group two) with afollow-up study of 5～8 years(average 6.75 years). The JapaneseOrthopedics Association Back scores (JOA), the Odom grades and thefull range of motion shown by X ray of adjacent superior segments in bothpre-opemtion and post-operation, i.e., 6 months, 1 year, 2 years and 5 yearsthereafter were analyzed, and the degrees of degeneration revealed by CTscans on adjacent superior zygapophyseal joints at post-operative stage, i.e.,6 months, 1 year, 2 years and 5 years thereafter were analyzed as well.SPSS11.5 for windows software was used to undertake a comparativeanalysis among various groups at various stages.
Results: 1. The post-operative JOA scores and Odom grades haveobviously increased in three groups (P＜0.01). 2. For 6 months afteroperation, the different JOA scores, Odom grades, the ranges of motionof adjacent superior segments and degeneration of adjacent superiorzygapophyseal joints in ACDR group and ACDF group one have no statistic significance (P＞0.05). 3. For 6- month and 12-monthpost-operative follow-up, the different JOA scores, Odom grades anddegeneration of adjacent superior zygapophyseal joints in ACDF groupone and ACDF group two had no statistic difference (P＞0.05);But theranges of motion of adjacent superior segments in two groups haveincreased(P＜0.05). 4. the JOA scores and Odom grades of 5 yearpost-operative compared with 1-year post-operative follow-up and 2-yearpost-operative follow-up in ACDF group two had statisticalsignificance(P＜0.05). The ranges of motion of adjacent superiorsegments had increased(P＜0.05). Degeneration of adjacent superiorzygapophyseal joints finds the increased (P＜0.05).
Conclusions: 1. Two level ACDR is one of effective therapeuticmeans in many segments cervical spondylosis. The clinical therapeuticeffect of the early stage of postoperation is satisfactory. The ranges ofmotion of adjacent superior segments were good. adjacent superiorzygapophyseal joints had no obvious degeneration. 2. Two level ACDF isalso one of effective therapeutic means in many segments cervicalspondylosis. Degeneration of adjacent superior zygapophyseal joints at theearly stage of postoperation are not obvious. Degeneration of adjacentsuperior zygapophyseal joints at the medium and long stage ofpostoperation is likely to be relation with accumulated stress. 2. Themedium and long term Clinical effect of ACDF decreases anddegeneration occurs in adjacent superior zygapophyseal joints. 3. Wehave no enough clinical cases with two level ACDR and the time ofapplication of it is shorter, so a further observation related to medium andlong term Clinical effect of ACDR is necessary.
Appendix:
Superior and inferior zygapophyseal and medical isthmus make upof the cervical lateral masses. Superior and inferior zygapophysealbetween adjacent segments form the zygapophyseal joint. The bilateralzygapophyseal joints and cervical disc contribute jointly the stability tocervical spine. Cervical lateral mass is the foundation of the technique oflateral mass screw fixation. The purpose of current study is to evaluatethe safety of the technique of the screw fixation of cervical lateral massby observing and measuring the relation between cervical lateralmasses(C_3～C_7) and their adjacent anatomical structures, thus to provideanatomical reference for clinical application of the technique;
The Applied Anatomy and the Radiological Measurementsof the Cervical Lateral Mass and their Clinical significance
Objectives: To evaluate the safety of the technique of the screwfixation of cervical lateral mass by observing and measuring therelation between cervical lateral masses(C_3-C_7) and their adjacentanatomical structures, thus to provide anatomical reference forclinical application of the technique.
Methods:①A total of 21 adult's human cadaveric cervicalspine(Including 11 fresh-frozen cervical spine and 10 preservativecadavers, and C_3～T_1 segment spine)were used in this study toobserve and measure the distances(D_1 and D_2)between C_3～C_7cervical lateral masses and their adjacent cervical nerveroots(including superior nerve roots and inferior nerve roots );②Atotal of 40 adult's lateral cervical radiographs were selected tomeasure the inclination angles of the uparticular facet of lateralmasses(αangle);③A total of 20 CT scanning with mid-line ofadult's cervical lateral mass were used in the study. We defined thelmm point internal of the midpoint of lateral masses as O point and measure the angles(βangles) between the line from O point to theoutskirts of the transverse foramen and sagittal plane; the distancebetween O point and front-outside of lateral masses; and theangles(θangles) between the line from O point to the front-outsideof lateral masses and sagittal plane.
Results:①The cervical nerve roots are traversing from thefront-outsides of the lateral masses. In the up-outside quadrant therearen't nerve roots. The distances(D_1) from the midpoint of front-outsides of lateral masses to the superior nerve roots are small, rangefrom 2.38～2.77mm; The distances(D_2) from the midpoint of thefront-outside of lateral masses to the inferior nerve roots are far from6.72～7.06mm;②The inclination angles of uparticular facet oflateral(αangle) in C_3～C_7 are range from 50.9～59.10°, C_3＞C_4＞C_5＜C_6＜C_7, it is the smallest in C_5 and it is the largest in C_7.③Theoutcomes of CT scanning measurement of the cervical lateral masses:the angles(βangle) between the line from O point to the outsides ofthe transverse foramen and sagittal plane incline to inside in C_3～C_5,average value is respectiveiy 3.0°,3.2°,2.7°. It incline to outside inC_6, average value is 7.1°; The distances from O point to thefront-outside of lateral masses are range from 11.8～13.5mm; Theangles(θangle) between the line from O point to the front-outsideof the lateral masses and sagittal plane are rang from33.4-34.1°.
Conclusions:①According to the anatomical observation andmeasurement of cervical lateral masses, the distance between lateralmass and superior nerve root is small. It suggests the degenerationsof uparticular easily affects the superior nerve root.②According tothe results from the observation of anatomy and the measurement ofradiographs, the screw penetration of cervical lateral massesmaintain ahead-incline 35～45°and outside-incline 10～30°, thevertebral artery and nerve roots don't be injured.③For thedifference of the lateral mass in different person, practising the difference of the screw penetration in the screw fixation of lateralmasses according to different person is necessary for the largestgrisping of the screw.
颈椎关节突关节具有十分重要的生物力学意义，其主要功能是承受压缩、牵拉、剪切及扭转等不同类型的载荷，双侧关节突关节和椎间盘构成了运动节段的稳定。颈椎病手术后关节突关节退变速度和程度是评估疗效的重要指标之一，而关节突关节退变与其生物力学性能密切相关，因此，对关节突关节内压力的研究具有重要意义。目前，国内外尚未见双节段人工颈椎间盘置换对邻近上位节段关节突关节影响的实验和临床研究。
由于颈椎的生理特点，C_(4/5)和C_(5/6)在生理状况下承受的应力最大，因此，颈椎退变最常发生在这两个节段。本课题从生物力学和临床上对C_(4/5)和C_(5/6)双节段人工颈椎间盘置换对关节突关节的影响进行了研究：(1)探讨新鲜尸体标本C_(4/5)和C_(5/6)椎间盘摘除、椎间融合前路内固定和人工椎间盘置换模型在不同载荷下对C_(4/5)和邻近上位节段C_(3/4)关节突关节内压力的影响；(2)观察C_(4/5)～C_(5/6)双节段人工颈椎间盘置换的早期临床疗效和前路椎间融合术的临床疗效，以及对邻近上位节段关节突关节的影响。
第一部分双节段人工颈椎间盘置换对邻近上位关节突关节压力影响的实验研究
目的探讨双节段颈椎椎间盘摘除、人工椎间盘置换和前路椎间融合内固定对邻近上位节段关节突关节内压力的影响，为临床运用双节段人工颈椎间盘置换提供参考依据。
方法取11具新鲜完整的青壮年下颈段标本，按实验先后分别制成C_(4/5)和C_(5/6)完整组、椎间盘摘除组、椎间盘置换组和C_4～C_6椎间融合组共四组标本模型，在标本上施加轴向、侧弯、前屈和后伸分级载荷，采用自行设计的圆片状微型阻电式压力传感器，分别测量各组各分级载荷下C_(4/5)和邻近上位节段C_(3/4)关节突关节内的压力负荷。比较各组间的压力大小，用SPSS11.5统计软件包进行统计学分析。
结果四组标本模型在轴向、侧弯、前屈和后伸四种工况下，C_(4/5)和C_(3/4)关节突关节内的压力变化分别是：①完整组、摘除组、置换组和融合组C_(3/4)(融合上位节段)压力均随载荷增加而增大；②融合组C_(4/5)(融合节段)关节突关节内压力为0；③人工椎间盘置换组与椎间盘完整组压力接近，无统计学差异(P＞0.05)；④载荷在100N以下时，椎间盘摘除组小于完整组和置换组相比，均有显著性差异(P＜0.05)；⑤载荷在100N以上时，椎间盘摘除组大于完整组和置换组，均有显著性差异(P＜0.05)；⑥融合组C_(3/4)关节突关节内的压力明显大于其它各组，均有显著性差异(P＜0.05)。
结论①双节段人工颈椎间盘置换后置换节段C_(4/5)和邻近上位节段C_(3/4)关节突关节内的压力与正常组接近，提示双节段人工颈椎间盘置换符合颈椎正常生物力学要求；②颈椎椎间盘摘除后C_(4/5)和邻近上位节段C_(3/4)关节突关节内的压力在小载荷下降低，但随着载荷增加(大于100N)，其压力大于正常组，提示颈椎间盘摘除后，改变了颈椎应力的分布，可能是导致其发生退变或退变加速的原因之一；③C_4～C_6双节段椎间融合内固定后邻近上位节段C_(3/4)关节突关节压力明显增大，可能是导致其发生退变或退变加速的原因之一。
第二部分双节段人工颈椎间盘置换对邻近上位关节突关节影响的早期临床观察
目的观察C_(4/5)、C_(5/6)双节段人工颈椎间盘置换的早期疗效和双节段颈前路融合内固定术的临床疗效，探讨其对邻近上位关节突关节退变的影响。
方法收集双节段颈椎病变而接受手术病例35例，按照手术方式及随访时间分为三组：(1)C_(4/5)、C_(5/6)双节段人工颈椎间盘置换组5例，随访12个月～22个月，平均14.66个月；(2)前路植骨融合内固定短期随访组(融合组一)15例，随访12个月～30个月，平均15.75个月；(3)前路植骨融合内固定中长期随访组(融合组二)15例，随访5年～8年，平均6.75年。记录术前和6月、12个月、2年、5年、末次随访时的JOA分值、Odom评级，X线观察邻近上位节段C_(3/4)活动度，CT扫描分析术后6月、1年、2年和5年手术邻近上位节段C_(3/4)关节突关节的退变程度。运用SPSS11.5统计软件比较分析各组各时段的JOA评分、Odom评级、邻近上位节段活动度和关节突关节的退变程度。
结果1．三组术后各随访段的JOA评分、Odom评级较术前均有提高，差异有统计学意义(P＜0.05)。2．术后6月人工椎间盘置换组与融合组一的JOA评分、Odom评级、邻近上位节段活动度和关节突关节的退变程度比较均无统计学差异(P＞0.05)。3．融合组一和融合组二术后1年与术后6月的JOA评分、Odom评级和关节突关节的退变程度比较均无统计学差异(P＞0.05)；但邻近上位节段活动度增大(P＜0.05)。4．融合组二术后5年与1年、2年比较，JOA评分、Odom评级改善率降低(P＜0.05)，邻近上位节段活动度增加(P＜0.05)，关节突关节的退变率增加(P＜0.05)。
结论：1．双节段ACDR是治疗多节段颈椎病的有效方法之一，术后早期疗效满意，邻近上位节段活动度良好，邻近上位关节突关节无明显退变。2．双节段颈前路减压椎体间融合内固定术也是治疗多节段颈椎病的有效手段之一，手术早期邻近上位关节突关节无明显退变；中远期邻近上位关节突关节发生退变，长期过度应力积累可能是导致其退变的原因。3．由于我们的临床病例较少，应用时间尚短，因此，双节段人工颈椎问盘置换术中远期疗效是否优于颈椎前路融合内固定术，尚需进一步的研究。
颈椎的侧块分别向头侧突出的上关节突和向尾侧突出的下关节突以及中间的峡部组成，左右各一。颈椎侧块是侧块螺钉固定技术的基础。因此，作者另对颈椎侧块解剖作了相关研究，通过解剖和影像学测量探讨了颈椎侧块与其周围重要毗邻结构的解剖关系，评价颈椎侧块螺钉固定技术的安全性，为临床颈椎侧块螺钉置入提供解剖学依据；
颈椎侧块的应用解剖与影像学测量及其临床意义
目的：观测正常成人C_3～C_7颈椎侧块与周围重要毗邻结构的解剖关系，评价临床颈椎侧块螺钉固定技术的安全性，为临床颈椎侧块螺钉固定术提供解剖学依据
方法：①选取正常成人颈椎新鲜标本11具和防腐标本10具，观测C_3～C_7颈椎侧块与上、下位神经根的解剖关系(D1和D2)；②选取正常成人颈椎侧位X线片40例，测量颈椎侧块上关节突关节面的倾角(α角)；③选取20份正常成人颈椎侧块中点水平CT断层扫描片，以侧块中点内侧1mm为0点，测量0点至横突孔外缘的连线与正中矢状面的夹角(β角)、0点至侧块前外侧缘的距离(D3)以及0点至侧块前外侧缘的连线与正中矢状面的夹角(θ角)。
结果：①颈脊神经根自侧块上关节突前外侧穿出，侧块前外侧缘中点至上位神经根的距离很小，平均为2.38-2.77mm；至下位神经根的距离较远，平均为6.72-7.06mm；②C3-C7上关节面倾角值为50.9-59.1°之间，C3＞C4＞C5＜C6＜C7，C5倾角最小，C7最大；③侧块中点水平CT断层扫描片测量结果显示：侧块后方中点偏内1mm 0点至横突孔外缘的连线与正中矢状面的夹角在C3-C5为向内倾，均值分别为3.0°、3.2°、2.7°，C6为向外倾，均值为7.1°；0点至侧块前外侧缘的距离为11.8-13.5mm；0点至侧块前外侧缘的连线与正中矢状面的夹角为33.4-34.1°
结论：①根据实体解剖学观测结果，颈椎侧块的上关节突距离上位神经根很近，提示上关节突退变易影响上位神经根，导致上位神经根受压；②根据解剖学观测和影像学测量结果，以侧块后方中点或偏内1mm进钉，保持进钉方向头倾35-45°和外倾10-30°，均不会对椎动脉和神经根构成威胁；③由于侧块的个体差异较大，侧块螺钉内固定术中，为使螺钉获得最大的把持力，实行置钉技术的个体化是有必要的。即根据术前影像学测量结果与术中测深相结合的方法选择置钉方向和螺钉长度。
Cervical spondylosis is a common degenerative spinal disease.Anterior cervical decompression and fusion is a effective mean forthe management of cervical spondylosis. But the incidence ofadjacent level intervertebal disc pathology secondary to anteriorcervical fusion, by changing the stress on zygapophyseal joints andthe motional mechanics between levels, has been well reported inclinical and laboratory studies. Artificial cervical discreplacements(ACDR) is a new technique developing in the recentyears to provide a new approach for the treatment of cervicalspondylosis. The purpose of ACDR is to replace degenerative discand exertion its function, and to preserve normal physiologicaloperative level motion and decrease the incidence of adjacent levelpathology secondary to anterior cervical fusion. ACDR at one levelhad a many of biomechanical studies and clinical reports. Butcervical spondylosis commonly involved in two or more level,whether two level ACDR measures up to normal cervicalbiomechanics is needed to further clinical and laboratory research.
The zygapophyseal joints have a very great significance. Theybear different type of loadings such as compression, traction,shearing and torsion. The adjacent level degeneration is closelyrelated to its biomechanical property and it is one of the mostimportant values used in evaluating the outcomes of cervical surgicalinterventions. Therefore, biomechanical research on zygapophysealjoints has great clinical significance. The clinical and laboratoryresearch related with the influence of two level ACDR on superiorzygapophyseal joint had no reported at present.
Cervical degeneration commonly involved in C_(4/5) and C_(5/6) twolevel owing to cervical physiological characteristic. The currentstudy was undertaken to investigate the influence of two level CADR on adjacent superior zygapophyseal joint from the followingbiomechanical and clinical aspects: (1)To investigate the influencearising from ACD, ACDF and ACDR at C_(4/5) and C_(5/6) two level freshcadaveric cervical specimens under various loadings on C_(4/5) and C_(3/4)zygapophyseal joint pressures;(2)To observe the clinical early stageoutcomes of ACDR and clinical outcomes of ACDF at C_(4/5) and C_(5/6)two level, and to investigate their influence on the degeneration ofadjacent superior zygapophyseal joint.
CHAPTER ONE: The Laboratory Investigation of the Influencesof Two Level Cervical Artificial Disc Replacement on Adjacentsuperior Zygapophyseal Joint Pressure
Objectives: To investigate the influence caused by C_(4/5) and C_(5/6)two level ACD, ACDR and ACDF on the pressures at C_(4/5)zygapophyseal joint and adjacent superior zygapophyseal joint C_(3/4), thusto provide references for clinical application of two level ACDR.
Methods: A total of 11 fresh and intact human cadaveric cervicalspines (C_3-T_1) were used in this investigation. According to thesequence of the experiment, all specimens were sequentiallyreconstructed at C_(4/5) and C_(5/6) with four model groups as 1) total discintact, 2) C_(4/5) and C_(5/6) discectomy, 3) C_(4/5) and C_(5/6) ACDR, and 4) C_(4-6)ACDF. Testing was performed in displacement control under axialrotation, lateral bending, flexion and extension loading modes onspecimens. A miniature wafer-like pressure transducers we designed byourselves was inserted to monitor adjacent superior zygapophyseal jointpressures and C_(4/5) zygapophyseal joint under various grades of loading indifferent groups. Various pressures collected from different groups werecompared by statistic analysis through SPSS11.5 for windows solfware.
Results: After the implementation of ACDR, ACD and ACDF at C_(4/5) and C_(5/6) by performing in displacement control under axialrotation, lateral bending, flexion and extension loading modes, the overalltrend of change at C_(3/4) and C_(4/5) zygapophyseal joint pressures is:①Thepressures in different groups were higher as the grades of the loadingwere higher. The pressures of ACDF at C_(4/5) zygapophyseal joint was zero.②The pressures at C_(3/4) and C_(4/5) zygapophyseal joint of the ACDR groupcompared with the total disc intact group had no statistical significance(P＞0.05).③The pressures in C_(3/4) and C_(4/5) zygapophyseal joint of theACD group compared with the total disc intact group and the ACDRgroup were lower in small loadings(under 100N) and higher in largeloadings(beyond 100N). The pressure values of the ACD group comparedwith the total disc intact group and the ACDR group had statisticalsignificance (P＜0.05).④The pressures at C_(3/4) zygapophyseal joint ofACDF group were higher. The pressure values compared with the othershad statistical significance (P＜0.05)
Conclusions: 1. The pressure values of C_(4/5) zygapophyseal jointand adjacent superior level zygapophyseal joint C_(3/4) at two levelACDR compared with the total disc intact group had no statisticalsignificance. Consequently, it suggests that two level ACDRmeasures up to normal cervical biological mechanics. 2. Thepressure values of C_(4/5) zygapophyseal joint and adjacent superiorlevel zygapophyseal joint C_(3/4) in two level ACD decreased in smallloadings, but the pressures were higher as the grades of the loadingwere larger. It suggests this has changed the distribution of stresswithin cervical spines and it is likely to be one of the reasons lead todegeneration of adjacent superior segment. 3. The increase of adjacentsuperior zygapophyseal joint pressure caused by ACDF is likely to be oneof the reasons that cause or accelerate the degeneration of adjacent superiorsegment.
CHAPTER TWO: Clinical Observation of the Influences of Twolevel Cervical Artificial Disc Replacement on adjacentsuperior zygapophyseal joints at the Early Stage.
Objectives: To observe the early stage outcomes of ACDR andthe clinical outcomes of ACDF at C_(4/5) and C_(5/6) two level and toinvestigate their Influences on the degeneration of adjacentsuperior zygapophysealjoints.
Methods: 35 patients who underwent surgical interventions for thetreatment of cervical spondylosis were collected and grouped in threeaccording to the respective ways of surgery they underwent andthe length of following-up study: (1) 5 patients in ACDR groupwith a follow-up study of 12～22 months(average 14.66 months); (2) 15patients in ACDF short term group (ACDF group one) with a follow-upstudy of 1～2.5 years(average 15.75 months); (3) 15 patients in ACDFmedium and long term group (ACDF group two) with afollow-up study of 5～8 years(average 6.75 years). The JapaneseOrthopedics Association Back scores (JOA), the Odom grades and thefull range of motion shown by X ray of adjacent superior segments in bothpre-opemtion and post-operation, i.e., 6 months, 1 year, 2 years and 5 yearsthereafter were analyzed, and the degrees of degeneration revealed by CTscans on adjacent superior zygapophyseal joints at post-operative stage, i.e.,6 months, 1 year, 2 years and 5 years thereafter were analyzed as well.SPSS11.5 for windows software was used to undertake a comparativeanalysis among various groups at various stages.
Results: 1. The post-operative JOA scores and Odom grades haveobviously increased in three groups (P＜0.01). 2. For 6 months afteroperation, the different JOA scores, Odom grades, the ranges of motionof adjacent superior segments and degeneration of adjacent superiorzygapophyseal joints in ACDR group and ACDF group one have no statistic significance (P＞0.05). 3. For 6- month and 12-monthpost-operative follow-up, the different JOA scores, Odom grades anddegeneration of adjacent superior zygapophyseal joints in ACDF groupone and ACDF group two had no statistic difference (P＞0.05);But theranges of motion of adjacent superior segments in two groups haveincreased(P＜0.05). 4. the JOA scores and Odom grades of 5 yearpost-operative compared with 1-year post-operative follow-up and 2-yearpost-operative follow-up in ACDF group two had statisticalsignificance(P＜0.05). The ranges of motion of adjacent superiorsegments had increased(P＜0.05). Degeneration of adjacent superiorzygapophyseal joints finds the increased (P＜0.05).
Conclusions: 1. Two level ACDR is one of effective therapeuticmeans in many segments cervical spondylosis. The clinical therapeuticeffect of the early stage of postoperation is satisfactory. The ranges ofmotion of adjacent superior segments were good. adjacent superiorzygapophyseal joints had no obvious degeneration. 2. Two level ACDF isalso one of effective therapeutic means in many segments cervicalspondylosis. Degeneration of adjacent superior zygapophyseal joints at theearly stage of postoperation are not obvious. Degeneration of adjacentsuperior zygapophyseal joints at the medium and long stage ofpostoperation is likely to be relation with accumulated stress. 2. Themedium and long term Clinical effect of ACDF decreases anddegeneration occurs in adjacent superior zygapophyseal joints. 3. Wehave no enough clinical cases with two level ACDR and the time ofapplication of it is shorter, so a further observation related to medium andlong term Clinical effect of ACDR is necessary.
Appendix:
Superior and inferior zygapophyseal and medical isthmus make upof the cervical lateral masses. Superior and inferior zygapophysealbetween adjacent segments form the zygapophyseal joint. The bilateralzygapophyseal joints and cervical disc contribute jointly the stability tocervical spine. Cervical lateral mass is the foundation of the technique oflateral mass screw fixation. The purpose of current study is to evaluatethe safety of the technique of the screw fixation of cervical lateral massby observing and measuring the relation between cervical lateralmasses(C_3～C_7) and their adjacent anatomical structures, thus to provideanatomical reference for clinical application of the technique;
The Applied Anatomy and the Radiological Measurementsof the Cervical Lateral Mass and their Clinical significance
Objectives: To evaluate the safety of the technique of the screwfixation of cervical lateral mass by observing and measuring therelation between cervical lateral masses(C_3-C_7) and their adjacentanatomical structures, thus to provide anatomical reference forclinical application of the technique.
Methods:①A total of 21 adult's human cadaveric cervicalspine(Including 11 fresh-frozen cervical spine and 10 preservativecadavers, and C_3～T_1 segment spine)were used in this study toobserve and measure the distances(D_1 and D_2)between C_3～C_7cervical lateral masses and their adjacent cervical nerveroots(including superior nerve roots and inferior nerve roots );②Atotal of 40 adult's lateral cervical radiographs were selected tomeasure the inclination angles of the uparticular facet of lateralmasses(αangle);③A total of 20 CT scanning with mid-line ofadult's cervical lateral mass were used in the study. We defined thelmm point internal of the midpoint of lateral masses as O point and measure the angles(βangles) between the line from O point to theoutskirts of the transverse foramen and sagittal plane; the distancebetween O point and front-outside of lateral masses; and theangles(θangles) between the line from O point to the front-outsideof lateral masses and sagittal plane.
Results:①The cervical nerve roots are traversing from thefront-outsides of the lateral masses. In the up-outside quadrant therearen't nerve roots. The distances(D_1) from the midpoint of front-outsides of lateral masses to the superior nerve roots are small, rangefrom 2.38～2.77mm; The distances(D_2) from the midpoint of thefront-outside of lateral masses to the inferior nerve roots are far from6.72～7.06mm;②The inclination angles of uparticular facet oflateral(αangle) in C_3～C_7 are range from 50.9～59.10°, C_3＞C_4＞C_5＜C_6＜C_7, it is the smallest in C_5 and it is the largest in C_7.③Theoutcomes of CT scanning measurement of the cervical lateral masses:the angles(βangle) between the line from O point to the outsides ofthe transverse foramen and sagittal plane incline to inside in C_3～C_5,average value is respectiveiy 3.0°,3.2°,2.7°. It incline to outside inC_6, average value is 7.1°; The distances from O point to thefront-outside of lateral masses are range from 11.8～13.5mm; Theangles(θangle) between the line from O point to the front-outsideof the lateral masses and sagittal plane are rang from33.4-34.1°.
Conclusions:①According to the anatomical observation andmeasurement of cervical lateral masses, the distance between lateralmass and superior nerve root is small. It suggests the degenerationsof uparticular easily affects the superior nerve root.②According tothe results from the observation of anatomy and the measurement ofradiographs, the screw penetration of cervical lateral massesmaintain ahead-incline 35～45°and outside-incline 10～30°, thevertebral artery and nerve roots don't be injured.③For thedifference of the lateral mass in different person, practising the difference of the screw penetration in the screw fixation of lateralmasses according to different person is necessary for the largestgrisping of the screw.
引文
[1] 曾岩，党耕町，马庆军．颈椎前路融合术后颈部运动功能的评价．中华外科杂志，2004，42(24)：1481～1484
[2] Azimi H, Schlenk RP. Surgery for postarthrodesis adjacent-cervical segment degeneration. Neurosurg Focus, 2003, 15 (5): 1～6
[3] 袁文，徐盛明，王新伟，等．前路分节段减压植骨融合术治疗多节段颈椎病的疗效分析．中国脊柱脊髓杂志，2006，16(2)：95～98
[4] Thomas J, Puschak, Rick C et al. Use of artificial disc replacement in degenerative conditions of the cervical spine. Curr Opin Orthop, 2004, 15:175～179
[5] Frank M, Phillips MD, Steven R, et al. Cervical disc replacement.Spine, 2005, 30(17S):S27～S33
[6] Paul A, Anderson, MD, Jeffrey P, et al. Intervertebral Disc Arthroplasty. Spine, 2004, 29(23): 2779～2786
[7] Richard B, Raynor, James P, et al.Cervical facetectomy and its effect on spine strength. JNeurosurg, 1995, 63 (3): 278～282
[8] HolmesA, Wang C, Han ZH, et al. The range and nature of flexion-extension motion in the cervical spine. Spine1994, 19 (22): 2505～2510
[9] Kaneoka K, Ono K, Inami S, Motion analysis of cervical vertebrae during whiplash loading. Spine, 1999, 24 (8): 763～769
[10] Stemper BD, Yoganandan N, Pintar FA. Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading. J Biomech, 2005, 38 (6): 1313～1323
[11] Stemper BD, Yoganandan N, Pintar FA. Gender-and region-dependent local facet joint kinematics in rear impact: implications in whiplash injury. J Spine, 2004, 29 (16): 1764～1771
[12] Malanga G, Peter J. Whiplash injuries. Curr Pain Headache Rep, 2005, 9 (5): 322～325
[13] Manchikanti L, Boswell MV, Singh V, et al. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. J Musculoskelet Disord, 2004, 28 (5): 15～23
[14] Pal GP, Sherk HH. The vertical stability of the cervical spine. Spine. 1988, 13(5): 447～449
[15] Joseph F, Narayan, Yoganandan, et al. Biomechanics of cervical spine faectomy and fixationtechniques.J Spine, 1988, 13 (8): 808～812
[16] Zdeblick TA, Zou D.Cervical stability after foraminotomy.J Bone and joint surg, 1992, 74(1):22～27
[17] 李健．颈椎病的微创治疗．实用医学杂志，2005，4(21)：335～336
[18] Savolainen S, Rinne J, Hemesniemi J. A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery. 1998, 43 (1): 51～55
[19] Hacker RJ, Miller CG. Failed anterior cervical foraminotomy. J Neurosurg, 2003, 98(2 Suppl): 126～130
[20] Limbeek J, Jacobs WC, Anderson PG, et al. A systematic literature review to identify the best method for a single level anterior cervical interbody fusion. J Eur Spine, 2000, 9(2):129～36
[21] Butler D, Trafimow J, Andersson G, et al. Discs degenerate before facets. Spine, 1990, 15(2):111～113
[22] 李康华，王华，雷光华，等．腰椎间盘切除与人工椎间盘对关节突关节内压力的影响，中国临床康复，2003；4(12)：35～36
[23] 李康华，李雄，雷光华．腰椎间盘摘除与人工椎间盘置换后下位椎间隙内压力的变化．中华实验外科杂志，2005，6(22)：176～177
[24] 胡新佳，李康华．腰椎间盘切除与人工椎间盘置换前后上位关节突关节内压力改变．中国修复重建外科杂志，2005，6(19)：231～232
[25] 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，2002，10：1260-1262．
[26] 鲍圣德。颈椎病手术治疗的现状。中国微侵袭神经外科杂志，2004，9(11)：481-483
[27] 倪斌，贾连顺，肖建如等。颈前路减压植骨钢板内固定术治疗脊髓型颈椎病的初步疗效。中国脊柱脊髓杂志，2000，10(4)：212-215；
[28] 袁文，贾连顺，等倪斌等。前路开槽式减压几带锁钢板内固定治疗多节段脊髓型颈椎病。中国脊柱脊髓杂志，2000，10(3)：136-138；
[29] 赵剑，贾连顺，陈雄生等。单间隙颈椎前路减压单纯植骨融合与加用钢板的疗效比较。中国脊柱脊髓杂志，2001，11(5)：269-271；
[30] Gore DR, Sepic SB.Anterior discectomy and fusion for painful cervical disc disease: Areport of 50 patients with an average follow up of 21 years.J Spine, 1998, 23 (19): 2047～2051
[31] Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5-to 11-year radiologic and clinical follow-upstudy. Spine, 2005, 30 (19): 2138-2144
[32] 李云峰，侯铁胜，李明等。颈椎病前路减压融合后相邻节段退变原因分析。中国脊柱脊髓杂志，2002，12(4)：298-299；
[33] 罗卓荆，李明全，雷伟，等．前路手术治疗多节段颈椎退变的临床及生物力学研究。中华神经外科疾病研究杂志，2004，3(2)：114～116
[34] Maiman DJ, Kumaresan S, Yoganandan N, et al. Biomechanical effect of anterior cervical spine fusion on adjacent-segments. Biomed Mater Eng, 1999, 9(1): 27～38
[35] Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent level intradiscal pressure and segmental motion. Spine, 2002; 27(22): 2431～2434;
[36] 樊仕才，刘成恩，王宏波，等．颈椎前路手术后邻近节段运动变化的生物力学研究．中华创伤骨科杂志，2005，7(10)：924～926
[37] Charles A, John A, Lyndon MS, et al. Changes in segmental intervertebral motion adjacent to cervical arthrodesis: a prospective study. Spine, 2004; 29(2): 221～226
[38] Margareta N, Victor HEBasic biomechanics of the musculoskeletal system. Lippincott Williams & Wikins, 2000; 3: 286～318
[39] Chow DHK, Luk KDK,Evans, et al. Effect of short anterior lumbar interbody fusion on biomechanics of neighboring unfused segments. Spine, 1996, 21(5): 549～552
[40] Iseda T, Goya T, Nakano S,et al .Serial changes in signal intensities of the adjacent discs on T2-weighted sagittal images after surgical treatment of cervical spondylosis:anterior interbody fusion versus expansive.Springer Verlag Wien, 2001; 143 (7): 707～710
[41] Shono Y, Kaneda K,Abumi K, et al. Stability of posterior spinal instrumentation and its effects on adjacent motion segments in the lumbosacral spine. Spine, 1998, 23(14): 1550～1558
[42] 曹师锋，贾连顺，赵卫东．颈椎前路融合后相邻节段的即刻运动范围．中国矫形外科杂志，2002，13(11)：1319～1321
[43] Goto S, Mochizuki M,Watanabe T, et al.long-term follow-up study of anterior surgery for cervical spondylotic myelopathy with special reference to magnetic resonance imaging findings in 52 cases.Clin Orthop, 1993, 291: 142～153
[44] Katsuura A, Hukuda S, Saruhashi Y, et al. Kyphotic malalignment after anterir cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral level. Eur Spine, 2001;10(4):320～324
[45] Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone and Joint Surg Am, 1999, 81 (4):519～528
[46] 梁秋发，原林，王文军，等．颈椎前路融合术后临近节段退变的MRl分析．医学临床研究，2005，22(6)：727～729
[47] Pointillart V, Carlier Y, Pedram P, et al. Long-term outcome of adjacent levels after anterior cervical arthrodesis. J Bone and Joint (Br), 2004; 86: 27～32
[48] 李康华，林涨源，雷光华，等．ZEPHIR颈椎前路钢板系统在脊髓型颈椎病手术中的应用，湖南医科大学学报，2003 8，28(4)：395～397
[49] Lafuente J, Casey AT, Petzold A, et al.The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis. J Bone Joint Surg Br, 2005; 87(4): 508～512
[50] McAfee PC, Cunningham B, Dmitriev A, et al. Cervical disc replacement-Porous Coated Motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine 2003, 28(20): S176～S185
[51] Hallab N, Link HD, McAfee PC.Biomaterial optimization in total disc arthroplasty. Spine, 2003, 28 (20): S139～S152
[52] MeNally DS, Adams MA, Goodship AE. Development and validation of a new transducer for intradiscal pressure measurement. J Biomed Eng. 1992, 14(6):495～498.
[53] Anton E, Dmitriev MS, Bryan W, et al. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty. Spine, 2005, 30(10):1165～1172
[54] Trouillier H, Kern P, Refior HJ, et al. A prospective morphological study of facet joint integrity following intervertebral disc replacement with the CHARITE(trade mark) artificial disc. J Eur Spine, 2005, 7 (9): Epub ahead of print
[55] Goffin J, Casey A, Kehr P. Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery, 2002, 51: 840～847
[56] Goffin J, Van Calenbergh F, Van Loon J, et al. Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine, 2003, 28: 2673～2678
[57] 孙宇，潘胜发，张凤山，等．颈椎人工椎间盘置换术治疗颈椎间盘疾患的早期临床观察．中国脊柱脊髓杂志，2006，16(2)：85～89
[58] Robert J, Kowalski, Lisa A, et al.Biomechanics of the Spine.J Neurosurg, 2005, 15 (1): 42～59
[59] Lafuente J, Casey AT, Petzold A, et al. The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis: 46 consecutive cases.J Bone Joint Surg Br. 2005;87(4):508～12
[1] 贾连顺．注重颈椎病的临床研究，提高远期疗效．中华骨科杂志，2003，23(9)：547～548
[2] 曾岩，党耕町，马庆军．颈椎前路融合术后颈部运动功能的评价．中华外科杂志，2004，42(24)：1481～1484
[3] Azimi H, Schlenk RP. Surgery for postarthrodesis adjacent-cervical segment degeneration. Neurosurg Focus, 2003, 15 (5): 1～6
[4] Thomas J, Puschak, Rick C et al. Use of artificial disc replacement in degenerative conditions of the cervical spine. Curr Opin Orthop, 2004, 15:175～179
[5] Robert J, Kowalski, Lisa A, et al.Biomechanics of the Spine.J Neurosurg, 2005, 15 (1): 42～59
[6] Lafuente J, Casey AT, Petzold A, et al. The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis: 46 consecutive cases.J Bone Joint Surg Br. 2005; 87(4):508～512
[7] Frank M, Phillips MD, Steven R, et al. Cervical disc replacement.Spine, 2005, 30(17S):S27～S33
[8] Ono K, Ebara S, Fuji T, et al. New clinical signs of cervical cord damage. J Bone and Joint Surg(Br), 1987, 69(2):215～219
[9] Odom G, Finney W, Woodhall B.Cervical disk lesions.JAMA, 1958, 166: 23～28
[10] 侯树勋，邱贵兴，陈仲强。脊柱外科学，第一版，人民军医出版社，2005，9
[11] Dominik W, March Z, Norbert B, et al. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol, 1999, 28: 215～219
[12] Pal GP, Routal RV, Saggu SK. The orientation of the articular facets of the zygapophyseal joints at the cervical and upper thoracic. J Anat, 2001, 198 (4): 431～441
[13] Yoganandan N, Knowles SA, Maiman DJ, et al. Anatomic study of the morphology of human cervical facet joint. Spine, 2003, 28 (20): 2317～2323
[14] 孟庆兰．颈椎间关节面的形态和面积与颈椎病的关系．中国康复理论与实践，2002，8(2)：134～135
[15] Inarni S, Kaneoka K, Hayashi K, et al. Types of synovial fold in the cervical facet joint. J Orthop Sci, 2000, 5 (5): 475～480
[16] Winkelstein B, McLendon R, Barbir A, et al. An anatomical investigation of the human cervical facet capsule, quantifying muscle insertion area. J Anat. 2001, 198 (4): 455～461
[17] Lu Y, Chen C, Kallakuri S, et al.Neurophysiological and biomechanical characterization of goat cervical facet joint capsules. J Orthop Res, 2005, 23 (4) 779～787
[18] Ohtori S, Takahashi K, Chiba T, et al. Sensory innervation of the cervical facet jointsinrats. Spine, 2001, 26 (2): 147～150
[19] Tanaka N, Fujimoto Y, An HS, et, al. The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine. 2000;25(3): 286～291
[20] Ruhli F J, Henneberg M. Clinical perspectives on secular trends of intervertebral foramen diameters in an industrialized European society. J Eur Spine, 2004, 13(8): 733～739
[21] Holmes A, Wang C, Han ZH, et al. The range and nature of flexion-extension motion in the cervical spine.Spinel994, 19 (22): 2505～2510
[22] Pal GP, Sherk HH. The vertical stability of the cervical spine. Spine. 1988, 13(5):447～449
[23] Kaneoka K, Ono K, Inami S, Motion analysis of cervical vertebrae during whiplash loading. Spine, 1999, 24 (8): 763～769
[24] Stemper BD, Yoganandan N, Pintar FA. Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading. JBiomech, 2005, 38 (6): 1313～1323
[25] Stemper BD, Yoganandan N, Pintar FA. Gender-and region-dependent local facet joint kinematics in rear impact: implications in whiplash injury. J Spine, 2004, 29 (16): 1764～1771
[26] Richard B, Raynor, James P, et al.Cervical facetectomy and its effect on spine strength. J Neurosurg, 1995, 63 (3): 278～282
[27] Joseph F, Narayan, Yoganandan, et al.Biomechanics of cervical spine faectomy and fixationtechniques.J Spine, 1988, 13 (8): 808～812
[28] Zdeblick TA, Zou D.Cervical stability after foraminotomy.J Bone and joint surg, 1992, 74(1):22～27
[29] Butler D, Trafimow J, Andersson G, et al. Discs degenerate before facets. Spine, 1990, 15(2):111～113
[30] 孙宇．颈椎病外科治疗中的若干问题，中华外科杂，2004；23(42)：1238～1440
[31] Bolesta MJ, Rechtine GR Chrin AM. One-and two-level anterior cervical discectomy and fusion: the effect of plate fixation. Spine J. 2002, 2(3): 197～203
[32] Shad A, Leach JC, Teddy PJ, Cadoux-Hudson TA. Use of the Solis cage and local autologous bone graft for anterior cervical discectomy and fusion: early technical experience. J Neurosurg Spine. 2005, 2(2): 116～22
[33] 鲍圣德。颈椎病手术治疗的现状。中国微侵袭神经外科杂志，2004，9(11)：481-483
[34] 倪斌，贾连顺，肖建如等。颈前路减压植骨钢板内固定术治疗脊髓型颈椎病的初步疗效。中国脊柱脊髓杂志，2000，10(4)：212-215；
[35] 袁文，贾连顺，等倪斌等。前路开槽式减压几带锁钢板内固定治疗多节段脊髓型颈椎病。中国脊柱脊髓杂志，2000，10(3)：136-138；
[36] 何洪波，李康华，雷光华，等．不同术式治疗单间隙脊髓型颈椎病的疗效比较，中国脊柱脊髓杂志，2005，15(2)：80～82
[37] Bolesta MJ, Rechtine GR Chrin AM. One-and two-level anterior cervical discectomy and fusion: the effect of plate fixation. Spine J. 2002, 2(3): 197～203
[38] 赵剑，贾连顺，陈雄生等。单间隙颈椎前路减压单纯植骨融合与加用钢板的疗效比较。中国脊柱脊髓杂志，2001，11(5)：269-271；
[39] Shad A, Leach JC, Teddy PJ, Cadoux-Hudson TA. Use of the Solis cage and local autologous bone graft for anterior cervical discectomy and fusion: early technical experience. J Neurosurg Spine. 2005, 2(2): 116～22
[40] Lee MJ, Bazaz R, Furey CG; et al. Influence of anterior cervical plate design on Dysphagia: a 2-year prospective longitudinal follow-up study.J Spinal Disord Tech. 2005, 18(5):406～409.
[41] Rapoff AJ, Conrad BP, Johnson WM, et al. Load sharing in Premier and Zephir anterior cervical plates. Spine. 2003, 28(24): 2648～50
[42] Margareta N, Victor HEBasic biomechanics of the musculoskeletal system. Lippincott Williams & Wikins, 2000, 3: 286～318
[43] Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent level intradiscal pressure and segmental motion. Spine, 2002, 27(22): 2431～2434
[44] Charles A, John A, Lyndon MS, et al.Changes in segmental intervertebral motion adjacent to cervical arthrodesis:a prospective study. Spine, 2004;29(2): 221～226
[45] Pointillart V, Carlier Y, Pedram P, et al.Long-term outcome of adjacent levels after anterior cervical arthrodesis. J Bone and Joint (Br), 2004;86:27～32
[46] Gore DR, Sepic SB.Anterior discectomy and fusion for painful cervical disc disease: A report of 50 patients with an average follow up of 21 years.J Spine, 1998, 23 (19): 2047～2051
[47] Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone and Joint SurgAm, 1999, 81 (4):519～528
[48] Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5-to 11-year radiologic and clinical follow-up study. Spine, 2005, 30 (19): 2138～2144
[49] Baba H, Furusawa N, Imura S, et al.Later radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. J Spine, 1993, 18 (19): 2167～2173
[50] 曾岩，党耕町，马庆军．颈椎前路融合术后颈部运动功能的评价．中华外科杂志，2004，42(24)：1481～1484
[51] Katsuura A, Hukuda S, Saruhashi Y, et al.Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral level. Eur Spine, 2001; 10(4):320～324
[52] Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone and Joint Surg Am, 1999, 81 (4):519～528
[53] 梁秋发，原林，王文军，等．颈椎前路融合术后临近节段退变的MRl分析．医学临床研究，2005，22(6)：727～729
[54] Aota Y, Kumano K, Hirrabayashi S, et al.Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders.J Spine Disord, 1995; 8(6): 464～473
[55] 张正丰，梅芳瑞，周跃．颈椎椎间融合术后邻近节段椎间盘退变的临床观察．中国矫形外科杂志，2001，8(1)：74～75
[56] Pointillart V,Carlier Y,Pedram P,et al.Long-term outcome of adjacent levels after anterior cervical arthrodesis. J Bone and Joint (Br),2004;86:27～32
[57] Neil MD, Robert H, Chamberlain MS, et al. Unilateral Cervical Facet Dislocation:Biomechanics of Fixation .Spine, 2005, 30 (7): 164-168
[58] Cusick JF, Pintar FA, Yoganandan N, et al. Wire fixation techniques of the cervical facets. Spine, 1997, 22(9): 970-976
[59] Ohtori S, Takahashi K, Chiba T,et al.Sensory innervation of the cervical facet joints in rats. Spine, 2001, 26 (2): 147-150
[60] Goto S,Mochizuki M,Watanabe T,et al.long-term follow-up study of anterior surgery for cervical spondylotic myelopathy with special reference to magnetic resonance imaging findings in 52 cases.Clin Orthop, 1993, 291: 142-153
[61] Phillip FM,Carlson QEmery SE,et al .Anterior cervical pseudarthrosis:natural history and treatment.Spine ,1997;22(14):1585～1589
[62] Emery SE, Fisher JR, Bohlman HH. Three-level anterior cervical discectomy and fusion:radiographic and clinical results.Spine ,1997;22(22): 2622-2625
[63] Kim WJ, Lee SH, Kim SS, et al.Treatment of juxtafusional degeneration with artificial disc replacement(ADR) : preliminary results of an ongoing prospective study.J Spinal disord and tech, 2003, 16(4): 390-397
[64] Cummins BH,Robertson JT,Gill SS. Surgical experience with an implanted artificial cervical jointJ Neurosurg, 1998, 88:943-948
[65] Reitz H, Joubert MJ. Intractable headache and cervico-brachialgla treated by complete replacement of cervical intervertebral discs with a metal prosthesis.S Afr Med J. 1964;38(7):881～884
[66] Wigfield CC, Gill S, Nelson RJ, et al. Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg, 2002,96(1 suppl): 17-21
[67] Wigfield CC , Skrzypiec D, Jackowski A. Internal stress distribution in cervical intervertebral discs : the influence of an artificial cervical joint and simulated anterior interbody fusion. J Spinal Disord Tech, 2003 ,16(6) :441-449
[68] Wigfield CC, Gill SS, Nelson RJ, et al. The new Frenchary artificial cervical joint: results from a two-year pilot study. Spine, 2002, 27: 2446-2452
[69] [69] Pointillart V. Cervical disc prosthesis in humans: first fail-ure. Spine, 2001,26: 90-92
[70] McAfee PC, Cunningham B, Dmitriev A, et al. Cervical disc replacement porous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal Iigment.Spine, 2003, 28: 176～185
[71] Bryan VE. Cervical motion segment replacement. Eur Spine J, 2002, 11( 2 suppl): 92～97
[72] Goffin J, Casey A, Kehr E Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery, 2002, 51:840～847
[73] Goffin J, Van Calenbergh F, Van Loon J, et al. Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine, 2003, 28:2673～2678
[74] 孙宇，潘胜发，张凤山，等．颈椎人工椎间盘置换术治疗颈椎间盘疾患的早期临床观察．中国脊柱脊髓杂志，2006，16(2)：85～89
[75] 邹德威，谭荣，张瑞娟，等．人工椎间盘置换术治疗颈椎病疾患的早期观察．中国脊柱脊髓杂志，2006，16(2)：90～94
[1] 马向阳，尹庆水，钟世镇。颈椎侧块钢板螺钉内固定的研究进展[J]。中国脊柱脊髓杂志。2003，13(1)：53-55；
[2] E. Ladd Jones, Heller JG. Cervical Pedicle Screw Versus Lateral Mass Screws[J]. Spine 1997, 22: 977—982.
[3] Weis JC, chanical vical stabilization[J]. Spine 1996, 21: 2108—2114.
[4] Roy-Camille R.Saillant G.Maiel C.et al.Intemal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws.The cervical spine.philadelphia JB. Lippincott.CO. 1989:309-403
[5] Anderson PA, Henley MB, Grady MS, et al. Posterior cervical arthrodesis with AO reconstruction plates and bonegraft[J].Spine, 1991, 16:72—79.
[6] Heller JG, Carlson GD, Abitbol JJ, et al. Anatomic tle Roy-Camille and Magral techniques for screw placement in the lower eervical[J].spine, 1991, 16, 552—557
[7] Smith ME, Cibischino M. Study of a Cervical Spine Stabilization Device: Roy-Camille Plates[J]. Spine 1997, 22:38—43.
[8] Swank ML, Sutterlin CE. Rigid internal fixation with lateral massplates in multilevel anterior and posterior reconstraction of the cervical spine[J]. Spine 1997, 22:274—282.
[9] 徐荣明，马维虎，Ebraheim NA。颈椎侧块螺钉技术在下颈椎不稳中的应用。脊柱外科杂志。2003，1(2)：75-77
[10] 刘峰，张佐伦，秦德安等。颈椎侧块钢板固定术治疗下颈椎骨折脱位。中国矫形外科杂志，2004，12(3、4)：197-199
[11] 镇万新，朱杰诚，王巨等。颈椎侧块钢板固定术在颈椎骨折脱位治疗中的应用。中华骨科杂志。2003，23(3)：133-136
[12] 孙宇，王超，党耕町等。颈椎侧块钢板螺钉内固定治疗下颈椎骨折脱位。中华骨科杂志。2000，20(3)：150-153
[13] 严军，郑祖根，董启榕等。颈椎侧块固定治疗下颈椎骨折脱位。颈腰痛杂志。2003，24(6)：331-333
[14] 尹庆水，张余，刘景发等。Axis系统治疗下颈椎不稳的解剖学研究和临床应用[J]。中国脊柱脊髓杂志，2001，11(1)：16-18：
[15] Feings MG.Cooper PR.Errco TJ.et al.Posterior Plates in the management of cervical instability:long-term results in 44 patients[J]. Neurosurg, 1994, 81 (3):341-349;
[16] Nazarian SM.Louis RP.Posterior intemal fixation in traumatic lesions of the cervical spine[J].spine, 1991, 16 (3 supple): S64-S71
[17] 刘恩志，蔡维山，郭东明等。颈椎侧块钢板在脊髓型颈椎病治疗中应用。颈腰痛杂志，2003，24(5)：265-267
[18] 周忠，徐皓，林建华。颈椎侧块钢板在颈椎后纵韧带骨化症后路减压中应用的探讨。中国矫形外科杂志，2004，12(3、4)：216-218；
[19] 张余，尹庆水，刘景发等。AXIS内固定系统在颈椎肿瘤手术中的应用。中国脊柱脊髓杂志，2003，13(12)：746-748；
[20] Lowery GL.Swank ML.McDonough RF.Surgical revision for failed anterior cervical fusions.Articular pillar plating or anterior revision. Spine. 1995.20 (22):2436.
[21] Brodsky AE.Khali MA.Sassard MR.et al.Repair of symptomatic pseudarthrosis of anterior cervical fusion:posterior versus anterior repair. Spine. 1992.17(10): 1137
[22] Pait TG.MeAllister PV.Kaufinan HH.Quadrant anatomy of the articular pillars(lateral cervical mass) of the cervical spine[J].J Neurosurg, 1995, 82:1011-1014.
[23] Ebraheim NA.Xu R, Yeasting RA. The locatin of the vertebral artery foramen and its relation to posterior lateral mass screw fixation[J]. Spine 1996, 21:1291—1295.
[24] 魏亦兵，顾玉东，周建伟等。下颈椎侧块螺钉固定与椎动脉、神经根的解剖关系及评价。中华外科杂志。2003，41(8)：586-590
[25] 魏亦兵，周建伟，张志玉等。下颈椎侧块螺钉固定安全性的解剖学研究。中华实验外科杂志。2004，21(1)：97-98．
[26] Xu R, Ebraheim NA, Nadaud MC, Yeasting RA, Stanescu S.The Location of the Cervical Nerve Roots on the Posterior As-pect of the Cervical Spine[J]. Spine 1995, 20:2 267—71.
[27] An HS.Gordin R.Renner K. Anatomic consideration for Plate-Screw Fixation of the Cervical Spine[J]. Spine 1991, 16:548—551.
[28] Heller JG, Estes BT. Biomechanical Study of Screws in the Lateral Masses: Variables Affecting Pull—out Resistance[J]. J Bone and Joint surg Sep 1996, 78—A:1315—1320
[29] 贾玉华，赵成茂，孙海涛。颈椎侧块的X线和CT测量及其意义。中国医学影像学杂志。2004，12(1)：69-70
[30] Ebraheim NA, Klausner T, Xu R, et al.Safe lateral-mass screw lengths in the Roy-Camille and Magerl lechniques.Ananatomic study[J].Spine, 1998, 23(16): 1739-1742
[31] Magerl F, Seeman PS.Stable posterior fusion of the atlas and axis by transarticular screw fixation[M].In:Kehr P, Weidner A, Cervical Spine in New York:Spring-Verlag, 1987:217-322
[32] 吉立新，宋祥平，黄海。颈椎侧块的形态学测量及其在临床上的应用[J]。中国解剖与临床，2000，5(4}：207-208；
[33] 黄韶荣。颈椎侧块的应用解剖测量及其意义[J]。中国临床解剖学杂志，1999，17(4)：350；
[34] 谢宁，贾连顺，李家顺等。颈椎后路钢板内固定的应用解剖学[J]。中国临床解剖学杂志，2000，18(1)：5-7；
[35] 章庆峻，罗卓荆，李明全。颈椎侧块的应用解剖及其在后路钢板螺钉内固定术中的意义。中国临床解剖学杂志，2003，21(1)：19-21；
[1] 刘景发，尹庆水主编．临床颈椎外科学．第一版．北京：人民军医出版社，2005：158．
[2] 潘之清 等主编．颈椎病．济南：山东科学技术出版社．1980：42
[3] 潘福琼．颈椎病的病因、诊断及治疗进展．现代康复，2001，5(4)：86-87．
[4] 吴毅文．颈椎病病因、分型、诊断与治疗．中国运动医学杂志，1999，18(2)：157-158．
[5] 胥少汀，葛宝丰，徐印坎主编．实用骨科学．第二版．北京：人民军医出版社， 1999：1462．
[6] 云利欣，张浩玲，邢淑霞．颈椎病病因与分型鉴别探讨．现代康复，2000，4(12)：61．
[7] 贾连顺．颈椎病的现代概念．脊柱外科杂志，2004，2(2)：123-126．
[8] 杨克勤，张之虎．颈椎病的病理及病理生理．颈椎病．北京：人民卫生出版社，1981：56
[9] Callaghan JP, McGill SM. Intervertebral disc herniation: studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clinical Biomechanics, 2001, 16:28-37.
[10] 侯靖边，王湘平，汪洪，等．颈椎病的病因探讨及防治．西南国防医药，1996，6(5)：314-316．
[11] 余家阔，吴毅文，汪发贵，等．实验性颈椎应力应变分布对颈椎病组织结构的影响．中华外科杂志，1993，31(8)：26-27．
[12] 余家阔，吴毅文．椎动脉型颈椎病及其研究进展．安徽医科大学学报，1990，25(1)：71-74．
[13] 王拥军，万超．颈椎病病因病机的再认识．上海中医药大学学报，1999，3(1)：37-38．
[14] 裴仁和．青年人颈椎病病因及临床特点探讨．中国中医骨伤科杂志，2002，10(4)：56-58．
[15] 孙静宜．发育性颈椎管狭窄与颈椎病的关系．中华外科杂志，1985，5(3)：142
[16] 王秋泰，杨克勤，张潭澄，等．发育性颈椎管狭窄与脊髓型颈椎病关系．中华外科杂志，1983，3(4)：257．
[17] 金峥，曹晓建．多节段脊髓型颈椎病诊疗进展．医学综述，2005，11(9)：793-796．
[18] 胥少汀，葛宝丰，徐印坎主编．实用骨科学．第二版．北京：人民军医出版社，1999：1463．
[19] 刘植珊．椎动脉减压术治疗椎动脉型颈椎病．中华外科杂志，1984，2(2)：711．
[20] 徐德水，栾红梅．椎动脉型颈椎病发病因素与检查方法的探索．临床放射学杂志，1998，17(6)：371．
[21] 张杰，范炳华．椎动脉型颈椎病诊治的研究进展．现代中西医结合杂志，2004，13(5)：690-691，694．
[22] 贾连顺，朱海波，袁文，等．发育性颈椎管狭窄合并颈椎病的诊断和治疗．骨与关节损伤杂志，1995，10(1)：34-37．
[23] 贾连顺．颈椎病研究的现状进展和展望．中国矫形外科杂志，2001，8(8)：733-734
[24] Hoff J. The role of ischmic in the pathogenesis of cervical spondylotic myelopathy. Spine, 1977;2(2): 100.
[25] Smith G W, Robinson RA. The treatment of certain cervical spine disorder by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg, 1958, 40-A(3):607.
[26] Robinson RA, et al. The results of anterior interbody fusion of the cervical spine. J Bone Joint surg, 1962;44-A(8): 1567.
[27] Clowerd RB. The anterir approach for removal of ruptured cervical disks. J Neurosurg, 1956; 15:602.
[28] Grandall PH, Batgdert U. Long-term following of surgical treatment of cervical spondylotic myelopathy. J Neurosurg, 1966; 25: 57.
[29] Rafadl G, Devut T. Anterior disc excision with interbody fusion in cervical spondylotic myelopathy and rhizopathy. J Neurosurg, 1968; 28: 305.
[30] 李垠，盛路新．颈椎前路减压手术治疗颈椎病疗效观察．江苏医药，2002，28(8)：630-631．
[31] Goffin J, Geusens E, Vantomme N. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech, 2004, 17:79-85.
[32] 刘洪智，李明，汤继文．神经根型颈椎病的前路手术治疗．中国矫形外科杂志，2005，13(9)：653-655．
[33] 赵定鳞，主编。脊柱外科学。上海：上海科学技术文献出版社。1997：233
[34] 刘建文，顾夙，李振武．Glissin枕颌带牵引治疗颈型颈椎病的疗效观察．中医正骨，2005，17(8)：40，42．
[35] 冯世庆，杨敏杰．108例椎动脉型颈椎病的治疗探讨．西安医科大学学报，1996，17(2)：228-230．
[36] 徐德水，栾红梅．椎动脉型颈椎病发病因素与检查方法的探索．临床放射学杂志，1998，17(6)：371．
[37] 王清，党耕町．阶段性不稳定在脊髓性颈椎病发病中的作用．中华骨科杂志，1997，17(8)：482-484．
[38] 刘成，陈德玉．脊髓型颈椎病的诊断及进展．骨与关节损伤杂志，2002，17(1)：74-76．
[39] 陈刚，李叔强，谷贵山，等．颈椎不稳与交感神经型颈椎病发病的关系．中风与神经疾病杂志，2001，18(3)：171．
[40] 杜世新，贾艳丽，于镜贺，等．肌萎缩型颈椎病．中国脊柱脊髓杂志，2000，10(3)：178-180．
[41] 李岩，王克亚．肌萎缩型颈椎病．中国矫形外科杂志，2001，8(6)：528-530．
[42] 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，2002，10：1260-1262．
[43] 鲍圣德。颈椎病手术治疗的现状。中国微侵袭神经外科杂志，2004，9(11)：481-483
[44] 倪斌，贾连顺，肖建如等。颈前路减压植骨钢板内固定术治疗脊髓型颈椎病的初步疗效。中国脊柱脊髓杂志，2000，10(4)：212-215；
[45] 袁文，贾连顺，等倪斌等。前路开槽式减压几带锁钢板内固定治疗多节段脊髓型颈椎病。中国脊柱脊髓杂志，2000，10(3)：136-138；
[46] 赵剑，贾连顺，陈雄生等。单间隙颈椎前路减压单纯植骨融合与加用钢板的疗效比较。中国脊柱脊髓杂志，2001，11(5)：269-271；
[47] 李云峰，侯铁胜，李明等。颈椎病前路减压融合后相邻节段退变原因分析。中国脊柱脊髓杂志，2002，12(4)：298-299；
[48] Gore DR, Sepic SB.Anterior discectomy and fusion for painful cervical disc disease: Areport of 50 patients with an average follow up of 21 years.J Spine, 1998, 23 (19): 2047～2051
[49] Yue WM, Brodner W, Highland TR. Long-term results after anteriorcervical discectomy and fusion with allograft and plating: a 5-to 11-year radiologic and clinical follow-up study. Spine, 2005, 30 (19): 2138～2144
[50] Maiman DJ, Kumaresan S, Yoganandan N, et al. Biomechanical effect of anterior cervical spine fusion on adjacent-segrnents.Biomed Mater Eng, 1999, 9(1): 27～38
[51] Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent level intradiscal pressure and segmental motion. Spine, 2002;27(22):2431～2434
[52] Margareta N, Victor HF.Basic biomechanics of the musculoskeletal system. Lippincott Williams & Wikins, 2000;3: 286～318
[53] Chow DHK, Luk KDK, Evans, et al. Effect of short anterior lumbar interbody fusion on biomechanics of neighboring unfused segments.Spine, 1996, 21 (5): 549～552
[54] Iseda T, Goya T, Nakano S, et al. Serial changes in signal intensities of the adjacent discs on T2-weighted sagittal images after surgical treatment of cervical spondylosis:anterior interbody fusion versus expansive.Springer Verlag Wien, 2001;143(7):707～710
[55] 梁秋发，原林，王文军，等．颈椎前路融合术后临近节段退变的MRl分析．医学临床研究，2005，22(6)：727～729
[56] 樊仕才，刘成恩，王宏波，等．颈椎前路手术后邻近节段运动变化的生物力学研究．中华创伤骨科杂志，2005，7(10)：924～926
[57] Charles A, John A, Lyndon MS, et al. Changes in segmental intervertebral motion adjacent to cervical arthrodesis:a prospective study. Spine, 2004; 29(2): 221～226
[58] 曾岩，党耕町，马庆军．颈椎前路融合术后颈部运动功能的评价．中华外科杂志，2004，42(24)：1481～1484
[59] Shono Y, Kaneda K, Abumi K, et al.Stability of posterior spinal instrumentation and its effects on adjacent motion segments in the lumbosacral spine. Spine, 1998, 23(14): 1550～1558
[60] 曹师锋，贾连顺，赵卫东．颈椎前路融合后相邻节段的即刻运动范围．中国矫形外科杂志，2002，13(11)：1319～1321
[61] Goto S, Mochizuki M, Watanabe T, et al.long-term follow-up study of anterior surgery for cervical spondylotic myelopathy with special reference to magnetic resonance imaging findings in 52 cases.Clin Orthop, 1993, 291:142～153
[62] Katsuura A, Hukuda S, Sartthashi Y, et al.Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral level. Eur Spine, 2001; 10(4): 320～324
[63] Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone and Joint Surg Am, 1999, 81 (4): 519～528
[64] 梁秋发，原林，王文军，等．颈椎前路融合术后临近节段退变的MRl分析．医学临床研究，2005，22(6)：727～729
[65] Aota Y, Kumano K, Hirrabayashi S, et al.Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders.J Spine Disord, 1995; 8(6): 464～473
[66] 张正丰，梅芳瑞，周跃．颈椎椎间融合术后邻近节段椎间盘退变的临床观察．中国矫形外科杂志，2001，8(1)：74～75
[67] Pointillart V, Carlier Y, Pedram P, et al. Long-term outcome of adjacent levels after anterior cervical arthrodesis. J Bone and Joint (Br), 2004; 86: 27～32
[68] Teramoto T, Ohmofi K, Takatsu T, et al. Long-term results of the anterior cervical spondylodesis.Neurosurg, 1994; 35 (1): 64～68
[69] Urban MR, Fairbank JC, Bibby SR. Intervertebral disc composition in neuromuscular scoliosis: changes in cell density and glycosaminoglycan concentration at the curve apex.Spine, 2001; 26 (6): 610～617
[70] Liu GZ, Ishihara H, Osda R, et al.Nitric oxide mediates the changes of proteoglycan synthesis in the human lumbar intervertebral disc in response to hydrostatic pressure. Spine, 2001;26 (2):134～141
[71] 李永刚，候筱魁，辛兵．脊柱内固定导致邻近节段椎间盘胶原变化的实验研究．中国矫形外科杂志，2001，8(5)：475～477
[72] Baba H, Furusawa N, Imura S, et al.Later radiographic timings after anterior cervical fusion for spondylotic myeloradiculopathy.J Spine, 1993, 18 (19): 2167～2173
[73] Goffin J, Geusens E, Vantomme N, et al. Long-term follow-up after interbody fusion of the cervical spine. Spine Disord Tech, 2004, 17(2):79～85
[74] Phillip FM, Carlson G, Emery SE, et al.Anterior cervical pseudarthrosis:namral history and treatment.Spine, 1997; 22(14):1585～1589
[75] Emery SE, Fisher JR, Bohlman HH.Three-level anterior cervical discectomy and fusion:radiographic and clinical results.Spine, 1997; 22(22): 2622～2625
[76] Weinhoffer SL, Guyer RD, Herbert M, et al. Intradisc pressure measurements above an instrumented fusion:a cadaveric study.Spine, 1995;20 (5):526～528
[77] 罗卓荆，李明全，雷伟，等．前路手术治疗多节段颈椎退变的临床及生物力学研究．中华神经外科疾病研究杂志，2004，3(2)：114～116
[78] Hilibrand AS, Carlson GD, Palumbo M, et al. Radicnlopathy and myelopathy at segments adjacent to the site of a previous anterior Cervical arthrodesis. J Bone Joint Surg Am, 1999, 81 (4): 519-528.
[79] Katsuura A, Hukuda S, Saruhashi Y, et al. Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J, 2001, 10: 320-324.
[80] Thomas J, Puschak, Rick C, et al. Use of artificial disc replacement in degenerative conditions of the cervical spine. Curr Opin Orthop, 2004, 15:175～179
[81] Lafuente J, Casey AT, Petzold A, et al.The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis. J Bone Joint Surg Br, 2005;87(4): 508～512
[82] McAfee PC, Cunningham B, Dmitriev A, et al. Cervical disc replacement-Porous Coated Motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine 2003; 28(20): S176～S185
[83] Trouillier H, Kern P, Refior HJ, et al.A prospective morphological study of facet joint integrity following intervertebral disc replacement with the CHARITE(trade mark) Artificial Disc. J Eur Spine, 2005, 7 (9): Epub ahead of print
[84] Wigfield CC, Skrzypiec D, Jackowski A, et al.Internal stress distribution in cervical intervertebral discs: the influence of an artificial cervical joint and simulated anterior interbody fusion.Spinal Disord Tech, 2003, 16 (5) 441～119.
[85] Hallab N, Link HD, McAfee PC.Biomaterial optimization in total disc arthroplasty. Spine, 2003, 28 (20): S139～S152
[86] Robert J, Kowalski, Lisa A, et al.Biomechanics of the Spine.J Neurosurg, 2005, 15 (1): 42～59
[87] Lafuente J, Casey AT, Petzold A, et al. The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis: 46 consecutive cases.J Bone Joint Surg Br. 2005;87(4):508～512
[88] Frank M, Phillips MD, Steven R, et al. Cervical disc replacement.Spine, 2005, 30(17S):S27～S33
[89] 吴战勇，孙先泽，孔建军，等．影响颈椎病后路手术疗效因素分析．中国骨伤，2002，15(1)：7-9．
[90] 侯铁胜，傅强。颈椎后路内固定技术及其进展。中国脊柱脊髓杂志，2000，10(6)：376-378：
[91] Hukubo A. Trans-unco-discol approach a combined anterior and lateral approach to cervical disc. J Neurosurg, 1976, 38(2): 285.
[1] Jasephs. Torg. Athletic Injuries to the Head Neck and Face [M]. second edition 1991, 372—373.
[2] 马向阳，尹庆水，钟世镇。颈椎侧块钢板螺钉内固定的研究进展[J]。中国脊柱脊髓杂志。2003，13(1)：53-55：
[3] Palt TG.MeAllister PV.Kaufinan HH.Quadrant anatomy of the articular pillars(lateral cervical mass) of the cervical spine[J].J Neurosurg, 1995, 82: 1011-1014.
[4] Ebraheim NA.Xu R, Yeasting RA. The locatin of the vertebral artery foramen and its relation to posterior lateral mass screw fixation[J]. Spine 1996, 21:1291—1295.
[5] Xu R, Ebraheim NA, Nadaud MC, Yeasting RA, Stanescu S.The Location of the Cervical Nerve Roots on the Posterior As-pect of the Cervical Spine[J]. Spine 1995, 20:2 267—71.
[6] An HS.Gordin R.Renner K. Anatomic consideration for Plate-Screw Fixation of the Cervical Spine[J]. Spine 1991, 16:548—551.
[7] Ebraheim NA, Haman ST, Xu R, Yeasting RA.The Anatomic Location of the Dorsal Ramus of the Superior Articular Process of the lateral Mass[J]. Spine 1998, 23:1968—71.
[8] 孙宇，王志国．颈椎椎弓根的观察及其临床意义[J]．北京医科大学学报，1993，25(4)：279—280．
[9] E. Ladd Jones, Heller JG. Cervical Pedicle Screw Versus Lateral Mass Screws [J]. Spine 1997, 22: 977—982.
[10] 王东来，唐天驷，黄士中，等．下颈椎椎弓根内固定的解剖学研究与临床应用[J]．中华骨科杂志，1998，18：659—662．
[11] Zdeblick TA, Zou D, et al. Cervical Stability after Foraminotomy J[J]. Bone and Joint Surg 1992, 74—A:22—27.
[12] Callahan RA. Johnson RM. Margolis et al. Cervical Facet Fusion for Control of Instability Following Laminectomy [J]. J. Bone and Joint Surg 1997, 59—A:991—1002
[13] Raynor RB. Pugh J.Shapiro I.etal. Cervical Facetectomy and its Effect on Spine Strength[J]. J Neurosurg Aug 1995, 63: 278—282.
[14] Cusick JF.Yoganandan N.Pintar.et al. Biomechanics of Cervical Spine Facetectomy and Fixation Techniques [J]. Spine 1988, 13: 808—812.
[15] Voo LM. Kumaresan S. Yoganandan N. et al. Finite element analysis of Cervical Facetectomy[J]. Spine 1997, 22: 964—969.
[16] Gill K, Puschal S. Posterior Plating of the Cervical Spine-A Biomechanical Comparison of Different Posterior Fusion Tech—niques [J]. Spine 1988, 13:813—816.
[17] Weis JC, chanical vical stabilization[J]. Spine 1996, 21:2108—2114.
[18] Roy-Camille R.Saillant G.Maiel C.et al.Intemal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws.The cervical spine.philadelphia JB.Lippincott. CO. 1989:309-403
[19] Cusick JF, Pintar FA. Yoganandan N. et al. Wire fixation techniques of the cervial facets[J]. Spine 1997, 22: 970—976.
[20] Anderson PA, Henley MB, Grady MS, et al. Posterior cervical arthrodesis with AO reconstruction plates and bonegraft [J].Spine, 1991, 16:72—79.
[21] Coe JD, Warden KE. et al. Biomechanical Evaluatin of Cervical Spinal Stabilization Methods in a human cadaveric model[J].Spine 1989, 14:1122— 1130.
[22] Heller JG, Carlson GD, Abitbol JJ, et al. Anatomic tie Roy-Camille and Magral techniques for screw placement in the lower cervical[J].spine, 1991, 16, 552—557
[23] Smith ME, Cibischino M, Study of a Cervical Spine Stabilization Device: Roy-Camille Plates[J]. Spine 1997, 22:38—43.
[24] Swank ML, Suttedin CE. Rigid internal fixation with lateral massplates in multilevel anterior and posterior reconstraction of the cervical spine[J]. Spine 1997, 22:274—282.
[25] 徐荣明，马维虎，Ebraheim NA。颈椎侧块螺钉技术在下颈椎不稳中的应用。脊柱外科杂志。2003，1(2)：75-77
[26] 刘峰，张佐伦，秦德安等。颈椎侧块钢板固定术治疗下颈椎骨折脱位。中国矫形外科杂志，2004，12(3、4)：197-199
[27] 镇万新，朱杰诚，王巨等。颈椎侧块钢板固定术在颈椎骨折脱位治疗中的应用。中华骨科杂志。2003，23(3)：133-136
[28] 孙宇，王超，党耕町等。颈椎侧块钢板螺钉内固定治疗下颈椎骨折脱位。中华骨科杂志。2000，20(3)：150-153
[29] 严军，郑祖根，董启榕等。颈椎侧块固定治疗下颈椎骨折脱位。颈腰痛杂志。2003，24(6)：331-333
[30] 尹庆水，张余，刘景发等。Axis系统治疗下颈椎不稳的解剖学研究和临床应用[J]。中国脊柱脊髓杂志，2001，11(1)：16-18；
[31] Feings MG. Cooper PR. Errco TJ. et al.Posterior Plates in the management of cervical instability:long-term results in 44 patients[J].Neurosurg, 1994, 81 (3): 341-349;
[32] Nazadan SM.Louis RP.Posterior internal fixation in traumatic lesions of the cervical spine[J].spine, 1991, 16 (3 supple): S64-S71
[33] 刘恩志，蔡维山，郭东明等。颈椎侧块钢板在脊髓型颈椎病治疗中应用。颈腰痛杂志，2003，24(5)：265-267
[34] 周忠，徐皓，林建华。颈椎侧块钢板在颈椎后纵韧带骨化症后路减压中应用的探讨。中国矫形外科杂志，2004，12(3、4)：216-218；
[35] 张余，尹庆水，刘景发等。AXIS内固定系统在颈椎肿瘤手术中的应用。中国脊柱脊髓杂志，2003，13(12)：746-748；
[36] Levine AM.Matel C.Roy-camille R.management of fractttre separatious of the articular mass using posterior cervical plating.Spine. 1992. 17(10s):447.
[37] Lowery GL.Swank ML.McDonough RF.Surgical revision for failed anterior cervical fusions.Articular pillar plating or anterior revision.Spine. 1995.20(22): 2436.
[38] Brodsky AE.Khali MA.Sassard MR.et al.Repair of symptomatic pseudarthrosis of anterior cervical fusion:posterior versus anterior repair. Spine 1992.17(10):1137
[39] Ebraheim NA, Klausner T, Xu R, et al.Safe lateral-mass screw lengths in the Roy-Camille and Magerl lechniques.Ananatomic study[J].Spine, 1998, 23(16): 1739-1742
[40] Magerl F, Seeman PS.Stable posterior fusion of the atlas and axis by transarticular screw fixation[M].In:Kehr P, Weidner &Cervical Spine in New York: Spring-Verlag, 1987:217-322
[41] 吉立新，宋祥平，黄海。颈椎侧块的形态学测量及其在临床上的应用[J]。中国解剖与临床，2000，5(4}：207-208；
[42] 黄韶荣。颈椎侧块的应用解剖测量及其意义[J]。中国临床解剖学杂志，1999，17(4)：350；
[43] 谢宁，贾连顺，李家顺等。颈椎后路钢板内固定的应用解剖学[J]。中国临床解剖学杂志，2000，18(1)：5-7；
[44] 章庆峻，罗卓荆，李明全。颈椎侧块的应用解剖及其在后路钢板螺钉内固定术中的意义。中国临床解剖学杂志，2003，21(1)：19-21；
[45] 贾玉华，赵成茂，孙海涛。颈椎侧块的X线和CT测量及其意义。中国医学影像学杂志。2004，12(1)：69-70
[46] Heller JG, Estes BT. Biomechanical Study of Screws in the Lat-eralMasses: Variables Affecting Pull--out Resistance[J]. J Bone and Joint surg Sep 1996, 78—A:1315—1320
[47] 魏亦兵，顾玉东，周建伟等。下颈椎侧块螺钉固定与椎动脉、神经根的解剖关系及评价。中华外科杂志。2003，41(8)：586-590
[48] 魏亦兵，周建伟，张志玉等。下颈椎侧块螺钉固定安全性的解剖学研究。中华实验外科杂志。2004，21(1)：97-98
[2] Azimi H, Schlenk RP. Surgery for postarthrodesis adjacent-cervical segment degeneration. Neurosurg Focus, 2003, 15 (5): 1～6
[3] 袁文，徐盛明，王新伟，等．前路分节段减压植骨融合术治疗多节段颈椎病的疗效分析．中国脊柱脊髓杂志，2006，16(2)：95～98
[4] Thomas J, Puschak, Rick C et al. Use of artificial disc replacement in degenerative conditions of the cervical spine. Curr Opin Orthop, 2004, 15:175～179
[5] Frank M, Phillips MD, Steven R, et al. Cervical disc replacement.Spine, 2005, 30(17S):S27～S33
[6] Paul A, Anderson, MD, Jeffrey P, et al. Intervertebral Disc Arthroplasty. Spine, 2004, 29(23): 2779～2786
[7] Richard B, Raynor, James P, et al.Cervical facetectomy and its effect on spine strength. JNeurosurg, 1995, 63 (3): 278～282
[8] HolmesA, Wang C, Han ZH, et al. The range and nature of flexion-extension motion in the cervical spine. Spine1994, 19 (22): 2505～2510
[9] Kaneoka K, Ono K, Inami S, Motion analysis of cervical vertebrae during whiplash loading. Spine, 1999, 24 (8): 763～769
[10] Stemper BD, Yoganandan N, Pintar FA. Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading. J Biomech, 2005, 38 (6): 1313～1323
[11] Stemper BD, Yoganandan N, Pintar FA. Gender-and region-dependent local facet joint kinematics in rear impact: implications in whiplash injury. J Spine, 2004, 29 (16): 1764～1771
[12] Malanga G, Peter J. Whiplash injuries. Curr Pain Headache Rep, 2005, 9 (5): 322～325
[13] Manchikanti L, Boswell MV, Singh V, et al. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. J Musculoskelet Disord, 2004, 28 (5): 15～23
[14] Pal GP, Sherk HH. The vertical stability of the cervical spine. Spine. 1988, 13(5): 447～449
[15] Joseph F, Narayan, Yoganandan, et al. Biomechanics of cervical spine faectomy and fixationtechniques.J Spine, 1988, 13 (8): 808～812
[16] Zdeblick TA, Zou D.Cervical stability after foraminotomy.J Bone and joint surg, 1992, 74(1):22～27
[17] 李健．颈椎病的微创治疗．实用医学杂志，2005，4(21)：335～336
[18] Savolainen S, Rinne J, Hemesniemi J. A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery. 1998, 43 (1): 51～55
[19] Hacker RJ, Miller CG. Failed anterior cervical foraminotomy. J Neurosurg, 2003, 98(2 Suppl): 126～130
[20] Limbeek J, Jacobs WC, Anderson PG, et al. A systematic literature review to identify the best method for a single level anterior cervical interbody fusion. J Eur Spine, 2000, 9(2):129～36
[21] Butler D, Trafimow J, Andersson G, et al. Discs degenerate before facets. Spine, 1990, 15(2):111～113
[22] 李康华，王华，雷光华，等．腰椎间盘切除与人工椎间盘对关节突关节内压力的影响，中国临床康复，2003；4(12)：35～36
[23] 李康华，李雄，雷光华．腰椎间盘摘除与人工椎间盘置换后下位椎间隙内压力的变化．中华实验外科杂志，2005，6(22)：176～177
[24] 胡新佳，李康华．腰椎间盘切除与人工椎间盘置换前后上位关节突关节内压力改变．中国修复重建外科杂志，2005，6(19)：231～232
[25] 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，2002，10：1260-1262．
[26] 鲍圣德。颈椎病手术治疗的现状。中国微侵袭神经外科杂志，2004，9(11)：481-483
[27] 倪斌，贾连顺，肖建如等。颈前路减压植骨钢板内固定术治疗脊髓型颈椎病的初步疗效。中国脊柱脊髓杂志，2000，10(4)：212-215；
[28] 袁文，贾连顺，等倪斌等。前路开槽式减压几带锁钢板内固定治疗多节段脊髓型颈椎病。中国脊柱脊髓杂志，2000，10(3)：136-138；
[29] 赵剑，贾连顺，陈雄生等。单间隙颈椎前路减压单纯植骨融合与加用钢板的疗效比较。中国脊柱脊髓杂志，2001，11(5)：269-271；
[30] Gore DR, Sepic SB.Anterior discectomy and fusion for painful cervical disc disease: Areport of 50 patients with an average follow up of 21 years.J Spine, 1998, 23 (19): 2047～2051
[31] Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5-to 11-year radiologic and clinical follow-upstudy. Spine, 2005, 30 (19): 2138-2144
[32] 李云峰，侯铁胜，李明等。颈椎病前路减压融合后相邻节段退变原因分析。中国脊柱脊髓杂志，2002，12(4)：298-299；
[33] 罗卓荆，李明全，雷伟，等．前路手术治疗多节段颈椎退变的临床及生物力学研究。中华神经外科疾病研究杂志，2004，3(2)：114～116
[34] Maiman DJ, Kumaresan S, Yoganandan N, et al. Biomechanical effect of anterior cervical spine fusion on adjacent-segments. Biomed Mater Eng, 1999, 9(1): 27～38
[35] Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent level intradiscal pressure and segmental motion. Spine, 2002; 27(22): 2431～2434;
[36] 樊仕才，刘成恩，王宏波，等．颈椎前路手术后邻近节段运动变化的生物力学研究．中华创伤骨科杂志，2005，7(10)：924～926
[37] Charles A, John A, Lyndon MS, et al. Changes in segmental intervertebral motion adjacent to cervical arthrodesis: a prospective study. Spine, 2004; 29(2): 221～226
[38] Margareta N, Victor HEBasic biomechanics of the musculoskeletal system. Lippincott Williams & Wikins, 2000; 3: 286～318
[39] Chow DHK, Luk KDK,Evans, et al. Effect of short anterior lumbar interbody fusion on biomechanics of neighboring unfused segments. Spine, 1996, 21(5): 549～552
[40] Iseda T, Goya T, Nakano S,et al .Serial changes in signal intensities of the adjacent discs on T2-weighted sagittal images after surgical treatment of cervical spondylosis:anterior interbody fusion versus expansive.Springer Verlag Wien, 2001; 143 (7): 707～710
[41] Shono Y, Kaneda K,Abumi K, et al. Stability of posterior spinal instrumentation and its effects on adjacent motion segments in the lumbosacral spine. Spine, 1998, 23(14): 1550～1558
[42] 曹师锋，贾连顺，赵卫东．颈椎前路融合后相邻节段的即刻运动范围．中国矫形外科杂志，2002，13(11)：1319～1321
[43] Goto S, Mochizuki M,Watanabe T, et al.long-term follow-up study of anterior surgery for cervical spondylotic myelopathy with special reference to magnetic resonance imaging findings in 52 cases.Clin Orthop, 1993, 291: 142～153
[44] Katsuura A, Hukuda S, Saruhashi Y, et al. Kyphotic malalignment after anterir cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral level. Eur Spine, 2001;10(4):320～324
[45] Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone and Joint Surg Am, 1999, 81 (4):519～528
[46] 梁秋发，原林，王文军，等．颈椎前路融合术后临近节段退变的MRl分析．医学临床研究，2005，22(6)：727～729
[47] Pointillart V, Carlier Y, Pedram P, et al. Long-term outcome of adjacent levels after anterior cervical arthrodesis. J Bone and Joint (Br), 2004; 86: 27～32
[48] 李康华，林涨源，雷光华，等．ZEPHIR颈椎前路钢板系统在脊髓型颈椎病手术中的应用，湖南医科大学学报，2003 8，28(4)：395～397
[49] Lafuente J, Casey AT, Petzold A, et al.The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis. J Bone Joint Surg Br, 2005; 87(4): 508～512
[50] McAfee PC, Cunningham B, Dmitriev A, et al. Cervical disc replacement-Porous Coated Motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine 2003, 28(20): S176～S185
[51] Hallab N, Link HD, McAfee PC.Biomaterial optimization in total disc arthroplasty. Spine, 2003, 28 (20): S139～S152
[52] MeNally DS, Adams MA, Goodship AE. Development and validation of a new transducer for intradiscal pressure measurement. J Biomed Eng. 1992, 14(6):495～498.
[53] Anton E, Dmitriev MS, Bryan W, et al. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty. Spine, 2005, 30(10):1165～1172
[54] Trouillier H, Kern P, Refior HJ, et al. A prospective morphological study of facet joint integrity following intervertebral disc replacement with the CHARITE(trade mark) artificial disc. J Eur Spine, 2005, 7 (9): Epub ahead of print
[55] Goffin J, Casey A, Kehr P. Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery, 2002, 51: 840～847
[56] Goffin J, Van Calenbergh F, Van Loon J, et al. Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine, 2003, 28: 2673～2678
[57] 孙宇，潘胜发，张凤山，等．颈椎人工椎间盘置换术治疗颈椎间盘疾患的早期临床观察．中国脊柱脊髓杂志，2006，16(2)：85～89
[58] Robert J, Kowalski, Lisa A, et al.Biomechanics of the Spine.J Neurosurg, 2005, 15 (1): 42～59
[59] Lafuente J, Casey AT, Petzold A, et al. The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis: 46 consecutive cases.J Bone Joint Surg Br. 2005;87(4):508～12
[1] 贾连顺．注重颈椎病的临床研究，提高远期疗效．中华骨科杂志，2003，23(9)：547～548
[2] 曾岩，党耕町，马庆军．颈椎前路融合术后颈部运动功能的评价．中华外科杂志，2004，42(24)：1481～1484
[3] Azimi H, Schlenk RP. Surgery for postarthrodesis adjacent-cervical segment degeneration. Neurosurg Focus, 2003, 15 (5): 1～6
[4] Thomas J, Puschak, Rick C et al. Use of artificial disc replacement in degenerative conditions of the cervical spine. Curr Opin Orthop, 2004, 15:175～179
[5] Robert J, Kowalski, Lisa A, et al.Biomechanics of the Spine.J Neurosurg, 2005, 15 (1): 42～59
[6] Lafuente J, Casey AT, Petzold A, et al. The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis: 46 consecutive cases.J Bone Joint Surg Br. 2005; 87(4):508～512
[7] Frank M, Phillips MD, Steven R, et al. Cervical disc replacement.Spine, 2005, 30(17S):S27～S33
[8] Ono K, Ebara S, Fuji T, et al. New clinical signs of cervical cord damage. J Bone and Joint Surg(Br), 1987, 69(2):215～219
[9] Odom G, Finney W, Woodhall B.Cervical disk lesions.JAMA, 1958, 166: 23～28
[10] 侯树勋，邱贵兴，陈仲强。脊柱外科学，第一版，人民军医出版社，2005，9
[11] Dominik W, March Z, Norbert B, et al. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol, 1999, 28: 215～219
[12] Pal GP, Routal RV, Saggu SK. The orientation of the articular facets of the zygapophyseal joints at the cervical and upper thoracic. J Anat, 2001, 198 (4): 431～441
[13] Yoganandan N, Knowles SA, Maiman DJ, et al. Anatomic study of the morphology of human cervical facet joint. Spine, 2003, 28 (20): 2317～2323
[14] 孟庆兰．颈椎间关节面的形态和面积与颈椎病的关系．中国康复理论与实践，2002，8(2)：134～135
[15] Inarni S, Kaneoka K, Hayashi K, et al. Types of synovial fold in the cervical facet joint. J Orthop Sci, 2000, 5 (5): 475～480
[16] Winkelstein B, McLendon R, Barbir A, et al. An anatomical investigation of the human cervical facet capsule, quantifying muscle insertion area. J Anat. 2001, 198 (4): 455～461
[17] Lu Y, Chen C, Kallakuri S, et al.Neurophysiological and biomechanical characterization of goat cervical facet joint capsules. J Orthop Res, 2005, 23 (4) 779～787
[18] Ohtori S, Takahashi K, Chiba T, et al. Sensory innervation of the cervical facet jointsinrats. Spine, 2001, 26 (2): 147～150
[19] Tanaka N, Fujimoto Y, An HS, et, al. The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine. 2000;25(3): 286～291
[20] Ruhli F J, Henneberg M. Clinical perspectives on secular trends of intervertebral foramen diameters in an industrialized European society. J Eur Spine, 2004, 13(8): 733～739
[21] Holmes A, Wang C, Han ZH, et al. The range and nature of flexion-extension motion in the cervical spine.Spinel994, 19 (22): 2505～2510
[22] Pal GP, Sherk HH. The vertical stability of the cervical spine. Spine. 1988, 13(5):447～449
[23] Kaneoka K, Ono K, Inami S, Motion analysis of cervical vertebrae during whiplash loading. Spine, 1999, 24 (8): 763～769
[24] Stemper BD, Yoganandan N, Pintar FA. Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading. JBiomech, 2005, 38 (6): 1313～1323
[25] Stemper BD, Yoganandan N, Pintar FA. Gender-and region-dependent local facet joint kinematics in rear impact: implications in whiplash injury. J Spine, 2004, 29 (16): 1764～1771
[26] Richard B, Raynor, James P, et al.Cervical facetectomy and its effect on spine strength. J Neurosurg, 1995, 63 (3): 278～282
[27] Joseph F, Narayan, Yoganandan, et al.Biomechanics of cervical spine faectomy and fixationtechniques.J Spine, 1988, 13 (8): 808～812
[28] Zdeblick TA, Zou D.Cervical stability after foraminotomy.J Bone and joint surg, 1992, 74(1):22～27
[29] Butler D, Trafimow J, Andersson G, et al. Discs degenerate before facets. Spine, 1990, 15(2):111～113
[30] 孙宇．颈椎病外科治疗中的若干问题，中华外科杂，2004；23(42)：1238～1440
[31] Bolesta MJ, Rechtine GR Chrin AM. One-and two-level anterior cervical discectomy and fusion: the effect of plate fixation. Spine J. 2002, 2(3): 197～203
[32] Shad A, Leach JC, Teddy PJ, Cadoux-Hudson TA. Use of the Solis cage and local autologous bone graft for anterior cervical discectomy and fusion: early technical experience. J Neurosurg Spine. 2005, 2(2): 116～22
[33] 鲍圣德。颈椎病手术治疗的现状。中国微侵袭神经外科杂志，2004，9(11)：481-483
[34] 倪斌，贾连顺，肖建如等。颈前路减压植骨钢板内固定术治疗脊髓型颈椎病的初步疗效。中国脊柱脊髓杂志，2000，10(4)：212-215；
[35] 袁文，贾连顺，等倪斌等。前路开槽式减压几带锁钢板内固定治疗多节段脊髓型颈椎病。中国脊柱脊髓杂志，2000，10(3)：136-138；
[36] 何洪波，李康华，雷光华，等．不同术式治疗单间隙脊髓型颈椎病的疗效比较，中国脊柱脊髓杂志，2005，15(2)：80～82
[37] Bolesta MJ, Rechtine GR Chrin AM. One-and two-level anterior cervical discectomy and fusion: the effect of plate fixation. Spine J. 2002, 2(3): 197～203
[38] 赵剑，贾连顺，陈雄生等。单间隙颈椎前路减压单纯植骨融合与加用钢板的疗效比较。中国脊柱脊髓杂志，2001，11(5)：269-271；
[39] Shad A, Leach JC, Teddy PJ, Cadoux-Hudson TA. Use of the Solis cage and local autologous bone graft for anterior cervical discectomy and fusion: early technical experience. J Neurosurg Spine. 2005, 2(2): 116～22
[40] Lee MJ, Bazaz R, Furey CG; et al. Influence of anterior cervical plate design on Dysphagia: a 2-year prospective longitudinal follow-up study.J Spinal Disord Tech. 2005, 18(5):406～409.
[41] Rapoff AJ, Conrad BP, Johnson WM, et al. Load sharing in Premier and Zephir anterior cervical plates. Spine. 2003, 28(24): 2648～50
[42] Margareta N, Victor HEBasic biomechanics of the musculoskeletal system. Lippincott Williams & Wikins, 2000, 3: 286～318
[43] Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent level intradiscal pressure and segmental motion. Spine, 2002, 27(22): 2431～2434
[44] Charles A, John A, Lyndon MS, et al.Changes in segmental intervertebral motion adjacent to cervical arthrodesis:a prospective study. Spine, 2004;29(2): 221～226
[45] Pointillart V, Carlier Y, Pedram P, et al.Long-term outcome of adjacent levels after anterior cervical arthrodesis. J Bone and Joint (Br), 2004;86:27～32
[46] Gore DR, Sepic SB.Anterior discectomy and fusion for painful cervical disc disease: A report of 50 patients with an average follow up of 21 years.J Spine, 1998, 23 (19): 2047～2051
[47] Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone and Joint SurgAm, 1999, 81 (4):519～528
[48] Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5-to 11-year radiologic and clinical follow-up study. Spine, 2005, 30 (19): 2138～2144
[49] Baba H, Furusawa N, Imura S, et al.Later radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. J Spine, 1993, 18 (19): 2167～2173
[50] 曾岩，党耕町，马庆军．颈椎前路融合术后颈部运动功能的评价．中华外科杂志，2004，42(24)：1481～1484
[51] Katsuura A, Hukuda S, Saruhashi Y, et al.Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral level. Eur Spine, 2001; 10(4):320～324
[52] Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone and Joint Surg Am, 1999, 81 (4):519～528
[53] 梁秋发，原林，王文军，等．颈椎前路融合术后临近节段退变的MRl分析．医学临床研究，2005，22(6)：727～729
[54] Aota Y, Kumano K, Hirrabayashi S, et al.Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders.J Spine Disord, 1995; 8(6): 464～473
[55] 张正丰，梅芳瑞，周跃．颈椎椎间融合术后邻近节段椎间盘退变的临床观察．中国矫形外科杂志，2001，8(1)：74～75
[56] Pointillart V,Carlier Y,Pedram P,et al.Long-term outcome of adjacent levels after anterior cervical arthrodesis. J Bone and Joint (Br),2004;86:27～32
[57] Neil MD, Robert H, Chamberlain MS, et al. Unilateral Cervical Facet Dislocation:Biomechanics of Fixation .Spine, 2005, 30 (7): 164-168
[58] Cusick JF, Pintar FA, Yoganandan N, et al. Wire fixation techniques of the cervical facets. Spine, 1997, 22(9): 970-976
[59] Ohtori S, Takahashi K, Chiba T,et al.Sensory innervation of the cervical facet joints in rats. Spine, 2001, 26 (2): 147-150
[60] Goto S,Mochizuki M,Watanabe T,et al.long-term follow-up study of anterior surgery for cervical spondylotic myelopathy with special reference to magnetic resonance imaging findings in 52 cases.Clin Orthop, 1993, 291: 142-153
[61] Phillip FM,Carlson QEmery SE,et al .Anterior cervical pseudarthrosis:natural history and treatment.Spine ,1997;22(14):1585～1589
[62] Emery SE, Fisher JR, Bohlman HH. Three-level anterior cervical discectomy and fusion:radiographic and clinical results.Spine ,1997;22(22): 2622-2625
[63] Kim WJ, Lee SH, Kim SS, et al.Treatment of juxtafusional degeneration with artificial disc replacement(ADR) : preliminary results of an ongoing prospective study.J Spinal disord and tech, 2003, 16(4): 390-397
[64] Cummins BH,Robertson JT,Gill SS. Surgical experience with an implanted artificial cervical jointJ Neurosurg, 1998, 88:943-948
[65] Reitz H, Joubert MJ. Intractable headache and cervico-brachialgla treated by complete replacement of cervical intervertebral discs with a metal prosthesis.S Afr Med J. 1964;38(7):881～884
[66] Wigfield CC, Gill S, Nelson RJ, et al. Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease. J Neurosurg, 2002,96(1 suppl): 17-21
[67] Wigfield CC , Skrzypiec D, Jackowski A. Internal stress distribution in cervical intervertebral discs : the influence of an artificial cervical joint and simulated anterior interbody fusion. J Spinal Disord Tech, 2003 ,16(6) :441-449
[68] Wigfield CC, Gill SS, Nelson RJ, et al. The new Frenchary artificial cervical joint: results from a two-year pilot study. Spine, 2002, 27: 2446-2452
[69] [69] Pointillart V. Cervical disc prosthesis in humans: first fail-ure. Spine, 2001,26: 90-92
[70] McAfee PC, Cunningham B, Dmitriev A, et al. Cervical disc replacement porous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal Iigment.Spine, 2003, 28: 176～185
[71] Bryan VE. Cervical motion segment replacement. Eur Spine J, 2002, 11( 2 suppl): 92～97
[72] Goffin J, Casey A, Kehr E Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery, 2002, 51:840～847
[73] Goffin J, Van Calenbergh F, Van Loon J, et al. Intermediate follow-up after treatment of degenerative disc disease with the Bryan Cervical Disc Prosthesis: single-level and bi-level. Spine, 2003, 28:2673～2678
[74] 孙宇，潘胜发，张凤山，等．颈椎人工椎间盘置换术治疗颈椎间盘疾患的早期临床观察．中国脊柱脊髓杂志，2006，16(2)：85～89
[75] 邹德威，谭荣，张瑞娟，等．人工椎间盘置换术治疗颈椎病疾患的早期观察．中国脊柱脊髓杂志，2006，16(2)：90～94
[1] 马向阳，尹庆水，钟世镇。颈椎侧块钢板螺钉内固定的研究进展[J]。中国脊柱脊髓杂志。2003，13(1)：53-55；
[2] E. Ladd Jones, Heller JG. Cervical Pedicle Screw Versus Lateral Mass Screws[J]. Spine 1997, 22: 977—982.
[3] Weis JC, chanical vical stabilization[J]. Spine 1996, 21: 2108—2114.
[4] Roy-Camille R.Saillant G.Maiel C.et al.Intemal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws.The cervical spine.philadelphia JB. Lippincott.CO. 1989:309-403
[5] Anderson PA, Henley MB, Grady MS, et al. Posterior cervical arthrodesis with AO reconstruction plates and bonegraft[J].Spine, 1991, 16:72—79.
[6] Heller JG, Carlson GD, Abitbol JJ, et al. Anatomic tle Roy-Camille and Magral techniques for screw placement in the lower eervical[J].spine, 1991, 16, 552—557
[7] Smith ME, Cibischino M. Study of a Cervical Spine Stabilization Device: Roy-Camille Plates[J]. Spine 1997, 22:38—43.
[8] Swank ML, Sutterlin CE. Rigid internal fixation with lateral massplates in multilevel anterior and posterior reconstraction of the cervical spine[J]. Spine 1997, 22:274—282.
[9] 徐荣明，马维虎，Ebraheim NA。颈椎侧块螺钉技术在下颈椎不稳中的应用。脊柱外科杂志。2003，1(2)：75-77
[10] 刘峰，张佐伦，秦德安等。颈椎侧块钢板固定术治疗下颈椎骨折脱位。中国矫形外科杂志，2004，12(3、4)：197-199
[11] 镇万新，朱杰诚，王巨等。颈椎侧块钢板固定术在颈椎骨折脱位治疗中的应用。中华骨科杂志。2003，23(3)：133-136
[12] 孙宇，王超，党耕町等。颈椎侧块钢板螺钉内固定治疗下颈椎骨折脱位。中华骨科杂志。2000，20(3)：150-153
[13] 严军，郑祖根，董启榕等。颈椎侧块固定治疗下颈椎骨折脱位。颈腰痛杂志。2003，24(6)：331-333
[14] 尹庆水，张余，刘景发等。Axis系统治疗下颈椎不稳的解剖学研究和临床应用[J]。中国脊柱脊髓杂志，2001，11(1)：16-18：
[15] Feings MG.Cooper PR.Errco TJ.et al.Posterior Plates in the management of cervical instability:long-term results in 44 patients[J]. Neurosurg, 1994, 81 (3):341-349;
[16] Nazarian SM.Louis RP.Posterior intemal fixation in traumatic lesions of the cervical spine[J].spine, 1991, 16 (3 supple): S64-S71
[17] 刘恩志，蔡维山，郭东明等。颈椎侧块钢板在脊髓型颈椎病治疗中应用。颈腰痛杂志，2003，24(5)：265-267
[18] 周忠，徐皓，林建华。颈椎侧块钢板在颈椎后纵韧带骨化症后路减压中应用的探讨。中国矫形外科杂志，2004，12(3、4)：216-218；
[19] 张余，尹庆水，刘景发等。AXIS内固定系统在颈椎肿瘤手术中的应用。中国脊柱脊髓杂志，2003，13(12)：746-748；
[20] Lowery GL.Swank ML.McDonough RF.Surgical revision for failed anterior cervical fusions.Articular pillar plating or anterior revision. Spine. 1995.20 (22):2436.
[21] Brodsky AE.Khali MA.Sassard MR.et al.Repair of symptomatic pseudarthrosis of anterior cervical fusion:posterior versus anterior repair. Spine. 1992.17(10): 1137
[22] Pait TG.MeAllister PV.Kaufinan HH.Quadrant anatomy of the articular pillars(lateral cervical mass) of the cervical spine[J].J Neurosurg, 1995, 82:1011-1014.
[23] Ebraheim NA.Xu R, Yeasting RA. The locatin of the vertebral artery foramen and its relation to posterior lateral mass screw fixation[J]. Spine 1996, 21:1291—1295.
[24] 魏亦兵，顾玉东，周建伟等。下颈椎侧块螺钉固定与椎动脉、神经根的解剖关系及评价。中华外科杂志。2003，41(8)：586-590
[25] 魏亦兵，周建伟，张志玉等。下颈椎侧块螺钉固定安全性的解剖学研究。中华实验外科杂志。2004，21(1)：97-98．
[26] Xu R, Ebraheim NA, Nadaud MC, Yeasting RA, Stanescu S.The Location of the Cervical Nerve Roots on the Posterior As-pect of the Cervical Spine[J]. Spine 1995, 20:2 267—71.
[27] An HS.Gordin R.Renner K. Anatomic consideration for Plate-Screw Fixation of the Cervical Spine[J]. Spine 1991, 16:548—551.
[28] Heller JG, Estes BT. Biomechanical Study of Screws in the Lateral Masses: Variables Affecting Pull—out Resistance[J]. J Bone and Joint surg Sep 1996, 78—A:1315—1320
[29] 贾玉华，赵成茂，孙海涛。颈椎侧块的X线和CT测量及其意义。中国医学影像学杂志。2004，12(1)：69-70
[30] Ebraheim NA, Klausner T, Xu R, et al.Safe lateral-mass screw lengths in the Roy-Camille and Magerl lechniques.Ananatomic study[J].Spine, 1998, 23(16): 1739-1742
[31] Magerl F, Seeman PS.Stable posterior fusion of the atlas and axis by transarticular screw fixation[M].In:Kehr P, Weidner A, Cervical Spine in New York:Spring-Verlag, 1987:217-322
[32] 吉立新，宋祥平，黄海。颈椎侧块的形态学测量及其在临床上的应用[J]。中国解剖与临床，2000，5(4}：207-208；
[33] 黄韶荣。颈椎侧块的应用解剖测量及其意义[J]。中国临床解剖学杂志，1999，17(4)：350；
[34] 谢宁，贾连顺，李家顺等。颈椎后路钢板内固定的应用解剖学[J]。中国临床解剖学杂志，2000，18(1)：5-7；
[35] 章庆峻，罗卓荆，李明全。颈椎侧块的应用解剖及其在后路钢板螺钉内固定术中的意义。中国临床解剖学杂志，2003，21(1)：19-21；
[1] 刘景发，尹庆水主编．临床颈椎外科学．第一版．北京：人民军医出版社，2005：158．
[2] 潘之清 等主编．颈椎病．济南：山东科学技术出版社．1980：42
[3] 潘福琼．颈椎病的病因、诊断及治疗进展．现代康复，2001，5(4)：86-87．
[4] 吴毅文．颈椎病病因、分型、诊断与治疗．中国运动医学杂志，1999，18(2)：157-158．
[5] 胥少汀，葛宝丰，徐印坎主编．实用骨科学．第二版．北京：人民军医出版社， 1999：1462．
[6] 云利欣，张浩玲，邢淑霞．颈椎病病因与分型鉴别探讨．现代康复，2000，4(12)：61．
[7] 贾连顺．颈椎病的现代概念．脊柱外科杂志，2004，2(2)：123-126．
[8] 杨克勤，张之虎．颈椎病的病理及病理生理．颈椎病．北京：人民卫生出版社，1981：56
[9] Callaghan JP, McGill SM. Intervertebral disc herniation: studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clinical Biomechanics, 2001, 16:28-37.
[10] 侯靖边，王湘平，汪洪，等．颈椎病的病因探讨及防治．西南国防医药，1996，6(5)：314-316．
[11] 余家阔，吴毅文，汪发贵，等．实验性颈椎应力应变分布对颈椎病组织结构的影响．中华外科杂志，1993，31(8)：26-27．
[12] 余家阔，吴毅文．椎动脉型颈椎病及其研究进展．安徽医科大学学报，1990，25(1)：71-74．
[13] 王拥军，万超．颈椎病病因病机的再认识．上海中医药大学学报，1999，3(1)：37-38．
[14] 裴仁和．青年人颈椎病病因及临床特点探讨．中国中医骨伤科杂志，2002，10(4)：56-58．
[15] 孙静宜．发育性颈椎管狭窄与颈椎病的关系．中华外科杂志，1985，5(3)：142
[16] 王秋泰，杨克勤，张潭澄，等．发育性颈椎管狭窄与脊髓型颈椎病关系．中华外科杂志，1983，3(4)：257．
[17] 金峥，曹晓建．多节段脊髓型颈椎病诊疗进展．医学综述，2005，11(9)：793-796．
[18] 胥少汀，葛宝丰，徐印坎主编．实用骨科学．第二版．北京：人民军医出版社，1999：1463．
[19] 刘植珊．椎动脉减压术治疗椎动脉型颈椎病．中华外科杂志，1984，2(2)：711．
[20] 徐德水，栾红梅．椎动脉型颈椎病发病因素与检查方法的探索．临床放射学杂志，1998，17(6)：371．
[21] 张杰，范炳华．椎动脉型颈椎病诊治的研究进展．现代中西医结合杂志，2004，13(5)：690-691，694．
[22] 贾连顺，朱海波，袁文，等．发育性颈椎管狭窄合并颈椎病的诊断和治疗．骨与关节损伤杂志，1995，10(1)：34-37．
[23] 贾连顺．颈椎病研究的现状进展和展望．中国矫形外科杂志，2001，8(8)：733-734
[24] Hoff J. The role of ischmic in the pathogenesis of cervical spondylotic myelopathy. Spine, 1977;2(2): 100.
[25] Smith G W, Robinson RA. The treatment of certain cervical spine disorder by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg, 1958, 40-A(3):607.
[26] Robinson RA, et al. The results of anterior interbody fusion of the cervical spine. J Bone Joint surg, 1962;44-A(8): 1567.
[27] Clowerd RB. The anterir approach for removal of ruptured cervical disks. J Neurosurg, 1956; 15:602.
[28] Grandall PH, Batgdert U. Long-term following of surgical treatment of cervical spondylotic myelopathy. J Neurosurg, 1966; 25: 57.
[29] Rafadl G, Devut T. Anterior disc excision with interbody fusion in cervical spondylotic myelopathy and rhizopathy. J Neurosurg, 1968; 28: 305.
[30] 李垠，盛路新．颈椎前路减压手术治疗颈椎病疗效观察．江苏医药，2002，28(8)：630-631．
[31] Goffin J, Geusens E, Vantomme N. Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech, 2004, 17:79-85.
[32] 刘洪智，李明，汤继文．神经根型颈椎病的前路手术治疗．中国矫形外科杂志，2005，13(9)：653-655．
[33] 赵定鳞，主编。脊柱外科学。上海：上海科学技术文献出版社。1997：233
[34] 刘建文，顾夙，李振武．Glissin枕颌带牵引治疗颈型颈椎病的疗效观察．中医正骨，2005，17(8)：40，42．
[35] 冯世庆，杨敏杰．108例椎动脉型颈椎病的治疗探讨．西安医科大学学报，1996，17(2)：228-230．
[36] 徐德水，栾红梅．椎动脉型颈椎病发病因素与检查方法的探索．临床放射学杂志，1998，17(6)：371．
[37] 王清，党耕町．阶段性不稳定在脊髓性颈椎病发病中的作用．中华骨科杂志，1997，17(8)：482-484．
[38] 刘成，陈德玉．脊髓型颈椎病的诊断及进展．骨与关节损伤杂志，2002，17(1)：74-76．
[39] 陈刚，李叔强，谷贵山，等．颈椎不稳与交感神经型颈椎病发病的关系．中风与神经疾病杂志，2001，18(3)：171．
[40] 杜世新，贾艳丽，于镜贺，等．肌萎缩型颈椎病．中国脊柱脊髓杂志，2000，10(3)：178-180．
[41] 李岩，王克亚．肌萎缩型颈椎病．中国矫形外科杂志，2001，8(6)：528-530．
[42] 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，2002，10：1260-1262．
[43] 鲍圣德。颈椎病手术治疗的现状。中国微侵袭神经外科杂志，2004，9(11)：481-483
[44] 倪斌，贾连顺，肖建如等。颈前路减压植骨钢板内固定术治疗脊髓型颈椎病的初步疗效。中国脊柱脊髓杂志，2000，10(4)：212-215；
[45] 袁文，贾连顺，等倪斌等。前路开槽式减压几带锁钢板内固定治疗多节段脊髓型颈椎病。中国脊柱脊髓杂志，2000，10(3)：136-138；
[46] 赵剑，贾连顺，陈雄生等。单间隙颈椎前路减压单纯植骨融合与加用钢板的疗效比较。中国脊柱脊髓杂志，2001，11(5)：269-271；
[47] 李云峰，侯铁胜，李明等。颈椎病前路减压融合后相邻节段退变原因分析。中国脊柱脊髓杂志，2002，12(4)：298-299；
[48] Gore DR, Sepic SB.Anterior discectomy and fusion for painful cervical disc disease: Areport of 50 patients with an average follow up of 21 years.J Spine, 1998, 23 (19): 2047～2051
[49] Yue WM, Brodner W, Highland TR. Long-term results after anteriorcervical discectomy and fusion with allograft and plating: a 5-to 11-year radiologic and clinical follow-up study. Spine, 2005, 30 (19): 2138～2144
[50] Maiman DJ, Kumaresan S, Yoganandan N, et al. Biomechanical effect of anterior cervical spine fusion on adjacent-segrnents.Biomed Mater Eng, 1999, 9(1): 27～38
[51] Eck JC, Humphreys SC, Lim TH, et al. Biomechanical study on the effect of cervical spine fusion on adjacent level intradiscal pressure and segmental motion. Spine, 2002;27(22):2431～2434
[52] Margareta N, Victor HF.Basic biomechanics of the musculoskeletal system. Lippincott Williams & Wikins, 2000;3: 286～318
[53] Chow DHK, Luk KDK, Evans, et al. Effect of short anterior lumbar interbody fusion on biomechanics of neighboring unfused segments.Spine, 1996, 21 (5): 549～552
[54] Iseda T, Goya T, Nakano S, et al. Serial changes in signal intensities of the adjacent discs on T2-weighted sagittal images after surgical treatment of cervical spondylosis:anterior interbody fusion versus expansive.Springer Verlag Wien, 2001;143(7):707～710
[55] 梁秋发，原林，王文军，等．颈椎前路融合术后临近节段退变的MRl分析．医学临床研究，2005，22(6)：727～729
[56] 樊仕才，刘成恩，王宏波，等．颈椎前路手术后邻近节段运动变化的生物力学研究．中华创伤骨科杂志，2005，7(10)：924～926
[57] Charles A, John A, Lyndon MS, et al. Changes in segmental intervertebral motion adjacent to cervical arthrodesis:a prospective study. Spine, 2004; 29(2): 221～226
[58] 曾岩，党耕町，马庆军．颈椎前路融合术后颈部运动功能的评价．中华外科杂志，2004，42(24)：1481～1484
[59] Shono Y, Kaneda K, Abumi K, et al.Stability of posterior spinal instrumentation and its effects on adjacent motion segments in the lumbosacral spine. Spine, 1998, 23(14): 1550～1558
[60] 曹师锋，贾连顺，赵卫东．颈椎前路融合后相邻节段的即刻运动范围．中国矫形外科杂志，2002，13(11)：1319～1321
[61] Goto S, Mochizuki M, Watanabe T, et al.long-term follow-up study of anterior surgery for cervical spondylotic myelopathy with special reference to magnetic resonance imaging findings in 52 cases.Clin Orthop, 1993, 291:142～153
[62] Katsuura A, Hukuda S, Sartthashi Y, et al.Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral level. Eur Spine, 2001; 10(4): 320～324
[63] Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone and Joint Surg Am, 1999, 81 (4): 519～528
[64] 梁秋发，原林，王文军，等．颈椎前路融合术后临近节段退变的MRl分析．医学临床研究，2005，22(6)：727～729
[65] Aota Y, Kumano K, Hirrabayashi S, et al.Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders.J Spine Disord, 1995; 8(6): 464～473
[66] 张正丰，梅芳瑞，周跃．颈椎椎间融合术后邻近节段椎间盘退变的临床观察．中国矫形外科杂志，2001，8(1)：74～75
[67] Pointillart V, Carlier Y, Pedram P, et al. Long-term outcome of adjacent levels after anterior cervical arthrodesis. J Bone and Joint (Br), 2004; 86: 27～32
[68] Teramoto T, Ohmofi K, Takatsu T, et al. Long-term results of the anterior cervical spondylodesis.Neurosurg, 1994; 35 (1): 64～68
[69] Urban MR, Fairbank JC, Bibby SR. Intervertebral disc composition in neuromuscular scoliosis: changes in cell density and glycosaminoglycan concentration at the curve apex.Spine, 2001; 26 (6): 610～617
[70] Liu GZ, Ishihara H, Osda R, et al.Nitric oxide mediates the changes of proteoglycan synthesis in the human lumbar intervertebral disc in response to hydrostatic pressure. Spine, 2001;26 (2):134～141
[71] 李永刚，候筱魁，辛兵．脊柱内固定导致邻近节段椎间盘胶原变化的实验研究．中国矫形外科杂志，2001，8(5)：475～477
[72] Baba H, Furusawa N, Imura S, et al.Later radiographic timings after anterior cervical fusion for spondylotic myeloradiculopathy.J Spine, 1993, 18 (19): 2167～2173
[73] Goffin J, Geusens E, Vantomme N, et al. Long-term follow-up after interbody fusion of the cervical spine. Spine Disord Tech, 2004, 17(2):79～85
[74] Phillip FM, Carlson G, Emery SE, et al.Anterior cervical pseudarthrosis:namral history and treatment.Spine, 1997; 22(14):1585～1589
[75] Emery SE, Fisher JR, Bohlman HH.Three-level anterior cervical discectomy and fusion:radiographic and clinical results.Spine, 1997; 22(22): 2622～2625
[76] Weinhoffer SL, Guyer RD, Herbert M, et al. Intradisc pressure measurements above an instrumented fusion:a cadaveric study.Spine, 1995;20 (5):526～528
[77] 罗卓荆，李明全，雷伟，等．前路手术治疗多节段颈椎退变的临床及生物力学研究．中华神经外科疾病研究杂志，2004，3(2)：114～116
[78] Hilibrand AS, Carlson GD, Palumbo M, et al. Radicnlopathy and myelopathy at segments adjacent to the site of a previous anterior Cervical arthrodesis. J Bone Joint Surg Am, 1999, 81 (4): 519-528.
[79] Katsuura A, Hukuda S, Saruhashi Y, et al. Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J, 2001, 10: 320-324.
[80] Thomas J, Puschak, Rick C, et al. Use of artificial disc replacement in degenerative conditions of the cervical spine. Curr Opin Orthop, 2004, 15:175～179
[81] Lafuente J, Casey AT, Petzold A, et al.The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis. J Bone Joint Surg Br, 2005;87(4): 508～512
[82] McAfee PC, Cunningham B, Dmitriev A, et al. Cervical disc replacement-Porous Coated Motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine 2003; 28(20): S176～S185
[83] Trouillier H, Kern P, Refior HJ, et al.A prospective morphological study of facet joint integrity following intervertebral disc replacement with the CHARITE(trade mark) Artificial Disc. J Eur Spine, 2005, 7 (9): Epub ahead of print
[84] Wigfield CC, Skrzypiec D, Jackowski A, et al.Internal stress distribution in cervical intervertebral discs: the influence of an artificial cervical joint and simulated anterior interbody fusion.Spinal Disord Tech, 2003, 16 (5) 441～119.
[85] Hallab N, Link HD, McAfee PC.Biomaterial optimization in total disc arthroplasty. Spine, 2003, 28 (20): S139～S152
[86] Robert J, Kowalski, Lisa A, et al.Biomechanics of the Spine.J Neurosurg, 2005, 15 (1): 42～59
[87] Lafuente J, Casey AT, Petzold A, et al. The Bryan cervical disc prosthesis as an alternative to arthrodesis in the treatment of cervical spondylosis: 46 consecutive cases.J Bone Joint Surg Br. 2005;87(4):508～512
[88] Frank M, Phillips MD, Steven R, et al. Cervical disc replacement.Spine, 2005, 30(17S):S27～S33
[89] 吴战勇，孙先泽，孔建军，等．影响颈椎病后路手术疗效因素分析．中国骨伤，2002，15(1)：7-9．
[90] 侯铁胜，傅强。颈椎后路内固定技术及其进展。中国脊柱脊髓杂志，2000，10(6)：376-378：
[91] Hukubo A. Trans-unco-discol approach a combined anterior and lateral approach to cervical disc. J Neurosurg, 1976, 38(2): 285.
[1] Jasephs. Torg. Athletic Injuries to the Head Neck and Face [M]. second edition 1991, 372—373.
[2] 马向阳，尹庆水，钟世镇。颈椎侧块钢板螺钉内固定的研究进展[J]。中国脊柱脊髓杂志。2003，13(1)：53-55：
[3] Palt TG.MeAllister PV.Kaufinan HH.Quadrant anatomy of the articular pillars(lateral cervical mass) of the cervical spine[J].J Neurosurg, 1995, 82: 1011-1014.
[4] Ebraheim NA.Xu R, Yeasting RA. The locatin of the vertebral artery foramen and its relation to posterior lateral mass screw fixation[J]. Spine 1996, 21:1291—1295.
[5] Xu R, Ebraheim NA, Nadaud MC, Yeasting RA, Stanescu S.The Location of the Cervical Nerve Roots on the Posterior As-pect of the Cervical Spine[J]. Spine 1995, 20:2 267—71.
[6] An HS.Gordin R.Renner K. Anatomic consideration for Plate-Screw Fixation of the Cervical Spine[J]. Spine 1991, 16:548—551.
[7] Ebraheim NA, Haman ST, Xu R, Yeasting RA.The Anatomic Location of the Dorsal Ramus of the Superior Articular Process of the lateral Mass[J]. Spine 1998, 23:1968—71.
[8] 孙宇，王志国．颈椎椎弓根的观察及其临床意义[J]．北京医科大学学报，1993，25(4)：279—280．
[9] E. Ladd Jones, Heller JG. Cervical Pedicle Screw Versus Lateral Mass Screws [J]. Spine 1997, 22: 977—982.
[10] 王东来，唐天驷，黄士中，等．下颈椎椎弓根内固定的解剖学研究与临床应用[J]．中华骨科杂志，1998，18：659—662．
[11] Zdeblick TA, Zou D, et al. Cervical Stability after Foraminotomy J[J]. Bone and Joint Surg 1992, 74—A:22—27.
[12] Callahan RA. Johnson RM. Margolis et al. Cervical Facet Fusion for Control of Instability Following Laminectomy [J]. J. Bone and Joint Surg 1997, 59—A:991—1002
[13] Raynor RB. Pugh J.Shapiro I.etal. Cervical Facetectomy and its Effect on Spine Strength[J]. J Neurosurg Aug 1995, 63: 278—282.
[14] Cusick JF.Yoganandan N.Pintar.et al. Biomechanics of Cervical Spine Facetectomy and Fixation Techniques [J]. Spine 1988, 13: 808—812.
[15] Voo LM. Kumaresan S. Yoganandan N. et al. Finite element analysis of Cervical Facetectomy[J]. Spine 1997, 22: 964—969.
[16] Gill K, Puschal S. Posterior Plating of the Cervical Spine-A Biomechanical Comparison of Different Posterior Fusion Tech—niques [J]. Spine 1988, 13:813—816.
[17] Weis JC, chanical vical stabilization[J]. Spine 1996, 21:2108—2114.
[18] Roy-Camille R.Saillant G.Maiel C.et al.Intemal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws.The cervical spine.philadelphia JB.Lippincott. CO. 1989:309-403
[19] Cusick JF, Pintar FA. Yoganandan N. et al. Wire fixation techniques of the cervial facets[J]. Spine 1997, 22: 970—976.
[20] Anderson PA, Henley MB, Grady MS, et al. Posterior cervical arthrodesis with AO reconstruction plates and bonegraft [J].Spine, 1991, 16:72—79.
[21] Coe JD, Warden KE. et al. Biomechanical Evaluatin of Cervical Spinal Stabilization Methods in a human cadaveric model[J].Spine 1989, 14:1122— 1130.
[22] Heller JG, Carlson GD, Abitbol JJ, et al. Anatomic tie Roy-Camille and Magral techniques for screw placement in the lower cervical[J].spine, 1991, 16, 552—557
[23] Smith ME, Cibischino M, Study of a Cervical Spine Stabilization Device: Roy-Camille Plates[J]. Spine 1997, 22:38—43.
[24] Swank ML, Suttedin CE. Rigid internal fixation with lateral massplates in multilevel anterior and posterior reconstraction of the cervical spine[J]. Spine 1997, 22:274—282.
[25] 徐荣明，马维虎，Ebraheim NA。颈椎侧块螺钉技术在下颈椎不稳中的应用。脊柱外科杂志。2003，1(2)：75-77
[26] 刘峰，张佐伦，秦德安等。颈椎侧块钢板固定术治疗下颈椎骨折脱位。中国矫形外科杂志，2004，12(3、4)：197-199
[27] 镇万新，朱杰诚，王巨等。颈椎侧块钢板固定术在颈椎骨折脱位治疗中的应用。中华骨科杂志。2003，23(3)：133-136
[28] 孙宇，王超，党耕町等。颈椎侧块钢板螺钉内固定治疗下颈椎骨折脱位。中华骨科杂志。2000，20(3)：150-153
[29] 严军，郑祖根，董启榕等。颈椎侧块固定治疗下颈椎骨折脱位。颈腰痛杂志。2003，24(6)：331-333
[30] 尹庆水，张余，刘景发等。Axis系统治疗下颈椎不稳的解剖学研究和临床应用[J]。中国脊柱脊髓杂志，2001，11(1)：16-18；
[31] Feings MG. Cooper PR. Errco TJ. et al.Posterior Plates in the management of cervical instability:long-term results in 44 patients[J].Neurosurg, 1994, 81 (3): 341-349;
[32] Nazadan SM.Louis RP.Posterior internal fixation in traumatic lesions of the cervical spine[J].spine, 1991, 16 (3 supple): S64-S71
[33] 刘恩志，蔡维山，郭东明等。颈椎侧块钢板在脊髓型颈椎病治疗中应用。颈腰痛杂志，2003，24(5)：265-267
[34] 周忠，徐皓，林建华。颈椎侧块钢板在颈椎后纵韧带骨化症后路减压中应用的探讨。中国矫形外科杂志，2004，12(3、4)：216-218；
[35] 张余，尹庆水，刘景发等。AXIS内固定系统在颈椎肿瘤手术中的应用。中国脊柱脊髓杂志，2003，13(12)：746-748；
[36] Levine AM.Matel C.Roy-camille R.management of fractttre separatious of the articular mass using posterior cervical plating.Spine. 1992. 17(10s):447.
[37] Lowery GL.Swank ML.McDonough RF.Surgical revision for failed anterior cervical fusions.Articular pillar plating or anterior revision.Spine. 1995.20(22): 2436.
[38] Brodsky AE.Khali MA.Sassard MR.et al.Repair of symptomatic pseudarthrosis of anterior cervical fusion:posterior versus anterior repair. Spine 1992.17(10):1137
[39] Ebraheim NA, Klausner T, Xu R, et al.Safe lateral-mass screw lengths in the Roy-Camille and Magerl lechniques.Ananatomic study[J].Spine, 1998, 23(16): 1739-1742
[40] Magerl F, Seeman PS.Stable posterior fusion of the atlas and axis by transarticular screw fixation[M].In:Kehr P, Weidner &Cervical Spine in New York: Spring-Verlag, 1987:217-322
[41] 吉立新，宋祥平，黄海。颈椎侧块的形态学测量及其在临床上的应用[J]。中国解剖与临床，2000，5(4}：207-208；
[42] 黄韶荣。颈椎侧块的应用解剖测量及其意义[J]。中国临床解剖学杂志，1999，17(4)：350；
[43] 谢宁，贾连顺，李家顺等。颈椎后路钢板内固定的应用解剖学[J]。中国临床解剖学杂志，2000，18(1)：5-7；
[44] 章庆峻，罗卓荆，李明全。颈椎侧块的应用解剖及其在后路钢板螺钉内固定术中的意义。中国临床解剖学杂志，2003，21(1)：19-21；
[45] 贾玉华，赵成茂，孙海涛。颈椎侧块的X线和CT测量及其意义。中国医学影像学杂志。2004，12(1)：69-70
[46] Heller JG, Estes BT. Biomechanical Study of Screws in the Lat-eralMasses: Variables Affecting Pull--out Resistance[J]. J Bone and Joint surg Sep 1996, 78—A:1315—1320
[47] 魏亦兵，顾玉东，周建伟等。下颈椎侧块螺钉固定与椎动脉、神经根的解剖关系及评价。中华外科杂志。2003，41(8)：586-590
[48] 魏亦兵，周建伟，张志玉等。下颈椎侧块螺钉固定安全性的解剖学研究。中华实验外科杂志。2004，21(1)：97-98