颈椎椎体斜形切除减压对颈椎稳定性影响的生物力学研究

Biomechanical effects of one ｏｒ two level cervical oblique corpectomy

中文关键词:  椎体斜形切除  颈椎不稳  生物力学

英文关键词:Oblique corpectomy  cervical instability  Biomechanics

中文摘要:

  【摘要】 目的：研究单节段和双节段椎体斜形切除对颈椎生物力学稳定性的影响。方法：6具中老年（年龄53～65岁）尸体新鲜颈椎标本，采用脊柱三维运动试验机依次测定正常状态、C4椎体斜形切除后及C4、C5双椎体斜形切除后的三维活动度，计算出各向运动中性区（NZ）及运动范围（ROM），所得数据进行统计学处理，比较各组间差异。结果：C4椎体斜形切除后，C3/4、C4/5、C5/6节段间的屈伸、侧弯、旋转ROM均有不同程度增加，但和正常组相比，差异无显著性（Ｐ>0.05）；C3～6整体屈伸ROM增加9.6%，侧弯ROM增加13%，旋转ROM增加12.5%；NZ分别增加8%、11%和11%，ROM及NZ和正常标本相比，差异均无显著性（Ｐ>0.05）；C4、C5两个椎体斜形切除后，C3/4、C4/5、C5/6节段间的各向ROM均有增加，但和正常相比，差异仍无显著性（Ｐ>0.05）；但C3～C6整体屈伸ROM增加28.5%，侧弯ROM增加32.4%，旋转ROM增加34.8%，和正常及C4单椎体斜形切除相比，差异具有显著性（Ｐ<0.01）；C3～C6节段间NZ的变化，和正常相比，差异有显著性（Ｐ<0.01），和C4单椎体斜型切除相比，差异无显著性。结论：颈椎单椎体斜形切除术，并不改变生理载荷下颈椎各个方向的稳定性，而C4、C5两个节段椎体斜形切除后，C3～C6整体屈伸、侧弯和旋转活动度均增加，稳定性降低。

英文摘要:

  【Abstract】 Objective：To compare ｔｈｅ　changes in cervical biomechanical stability associated with one and two levels cervical oblique corpectomy.Method：Six aged human cadaveric cervical spine specimens（C3-T1，age 53-65） were tested：（1） normal；（2） after C4 oblique corpectomy；（3） after C4 and C5 oblique corpectomy.Pure moments were applied to induce flexion，extension，lateral bending，and axial rotation.The motion of all direction was recorded stereophotogrammetrically while the load were applied to the specimens.Result：Compared to normal，although the range of motion and neutral zone after one level oblique corpectomy increased during flexion/extension，lateral bending and axial rotation，the difference between the two group was not significant.The two level cervical oblique corpectomy caused much more alterations in the range of motion and neutral zone between C3 and C6 compared with the intact specimens.Conclusion：One level cervical oblique corpectomy does not induce significantly instability compared with normal.While the two level cervical oblique corpectomy causes significantly increase in the range of motion and neutral zone between C3 and C6.