CAJ | 학술논문

背景:国内外尚未见双节段Bryan颈人工椎间盘置换后邻近节段关节突关节内压力的测量研究.目的:观察轴向载荷对双节段颈椎人工椎间盘置换和前路椎间融合内固定对邻下位节段关节突关节内压力的影响,以期为双节段人工颈椎间盘置换的临床应用提供生物力学依据.设计、时间及地点:体外对比观察,生物力学测定实验,于2006-01/02在中南大学材料科学与工程学院国家重点实验室完成.材料:取新鲜人体尸体颈椎标本11具,节段包括C_3T_1),剔除肌肉组织保留椎间盘、韧带和关节囊结构的完整.方法:取11具新鲜完整的成人下颈段标本,分别制成C_(4～5),C_(5～6)椎间盘完整、椎间盘置换、椎间融合3个模型组,在标本上施加轴向分级载荷,将微型阻电式压力传感器置入C_(5～6),C_(6～7)关节突关节内.主要观察指标:测量各组于25,50,75,100,125和150 N载荷下C_(5～6),C_(6～7)关节突关节内的压力.结果:在轴向加载下,下位节段关节突关节内的压力随着施加载荷的增大而增大.C_(4～5),C_(5～6)双节段人工椎间盘置换组与椎间盘完整组相比,下位置换节段和邻近下位节段关节突关节内的压力变化相近,差异无显著性意义(P>0.05).C_(4～5),C_(5～6)椎间融合组与人工椎间盘置换组、椎间盘完整组相比邻近下位节段关节突关节内的压力显著增高(P<0.05).结论:颈椎双节段人工椎间盘置换后置换下位节段和邻近下位节段关节突关节内压力与完整标本相近,提示颈椎双节段人工椎间盘置换能够重建颈椎生物力学性能.颈椎双节段椎间盘摘除融合内固定后邻近下位关节突关节压力增加,可能是多节段颈椎融合后邻近节段发生退行性变或退行性变加速的原因之一.
배경:국내외상미견쌍절단Bryan경인공추간반치환후린근절단관절돌관절내압력적측량연구.목적:관찰축향재하대쌍절단경추인공추간반치환화전로추간융합내고정대린하위절단관절돌관절내압력적영향,이기위쌍절단인공경추간반치환적림상응용제공생물역학의거.설계、시간급지점:체외대비관찰,생물역학측정실험,우2006-01/02재중남대학재료과학여공정학원국가중점실험실완성.재료:취신선인체시체경추표본11구,절단포괄C_3T_1),척제기육조직보류추간반、인대화관절낭결구적완정.방법:취11구신선완정적성인하경단표본,분별제성C_(4～5),C_(5～6)추간반완정、추간반치환、추간융합3개모형조,재표본상시가축향분급재하,장미형조전식압력전감기치입C_(5～6),C_(6～7)관절돌관절내.주요관찰지표:측량각조우25,50,75,100,125화150 N재하하C_(5～6),C_(6～7)관절돌관절내적압력.결과:재축향가재하,하위절단관절돌관절내적압력수착시가재하적증대이증대.C_(4～5),C_(5～6)쌍절단인공추간반치환조여추간반완정조상비,하위치환절단화린근하위절단관절돌관절내적압력변화상근,차이무현저성의의(P>0.05).C_(4～5),C_(5～6)추간융합조여인공추간반치환조、추간반완정조상비린근하위절단관절돌관절내적압력현저증고(P<0.05).결론:경추쌍절단인공추간반치환후치환하위절단화린근하위절단관절돌관절내압력여완정표본상근,제시경추쌍절단인공추간반치환능구중건경추생물역학성능.경추쌍절단추간반적제융합내고정후린근하위관절돌관절압력증가,가능시다절단경추융합후린근절단발생퇴행성변혹퇴행성변가속적원인지일.
BACKGROUND:There is no study about adjacent zygapophyseal joint stress distribution following two level artificial disc replacement (ADR) in China.OBJECTIVE:To explore cervical adjacent zygapophyseal joint stress distribution following two level ADR and anterior cervical discectomy and fusion (ACDF),so as to provide biomechanical reference for clinical application of two level ADR.DESIGN,TIME AND SETTING:In vitro contrast observation and biomechanical detection were performed at the National Key Laboratory of College of Material Science and Engineering,Central South University from January to February 2006.MATERIALS:A total of 11 fresh adult corpse cervical samples with intact cervical disc and ligament and the facet joint capsule ranged from C_3 to T_1 segment.METHODS:A total of 11 intact adult fresh-frozen multi-segmental cervical spine segments were utilized and biomechanically evaluated under the following C_(4～5),C_(5～6) cervical disc conditions:intact spine (intact group),Bryan disc prosthesis implantation (ACDR group) and intervertebral fusion (ACDF group).The testing was performed under axial load (25 N-150 N) on each group.The stress changes of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint was tested.MAIN OUTCOME MEASURES:The pressure of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint.RESULTS:Under axial loading,stress of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint increased with the load and showed no difference between the intact group and ACDR group (P>0.05).Under axial loading,the ACDF group resulted in significant increase of the stress of the caudad (C_(5～6),C_(6～7)) zygapophyseal joint compared with intact group and ACDR group (P<0.05).CONCLUSION:Two level artificial cervical disc replacement can maintain stress in the caudad (C_(5～6),C_(6～7)) zygapophyseal joint,thus reconstruct biomechanical property of cervical spine.Two level cervical discectomy and fusion can increase stress in the caudad (C_(5～6),C_(6～7)) zygapophyseal joint,which may be one of the causes for adjacent cervical spondyiosis postoperatively.