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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (4): 728-732. doi: 10.19723/j.issn.1671-167X.2019.04.023

• 论著 • 上一篇    下一篇

单侧半椎板及不同程度小关节切除术对羊颈椎生物力学的影响

吴超1,王振宇1,△(),林国中1,△(),于涛1,刘彬1,司雨1,张一博1,李元超2   

  1. 1.北京大学第三医院神经外科,北京 100191
    2.上海交通大学机械工程学院,上海　200240
  • 收稿日期:2018-03-21 出版日期:2019-08-18 发布日期:2019-09-03
  • 通讯作者: 王振宇,林国中 E-mail:wzyu502@126.com;leenho@163.com
  • 基金资助:
    国家自然科学基金(81441044);北京市自然科学基金(7144253)

Biomechanical changes of sheep cervical spine after unilateral hemilaminectomy and different degrees of facetectomy

Chao WU1,Zhen-yu WANG1,△(),Guo-zhong LIN1,△(),Tao YU1,Bin LIU1,Yu SI1,Yi-bo ZHANG1,Yuan-chao LI2   

  1. 1.Department of Neurosurgery,Peking University Third Hospital,Beijing 100191,China
    2. School of Mechanical Engineering,Shanghai Jiao Tong University, Shanghai 200240,China
  • Received:2018-03-21 Online:2019-08-18 Published:2019-09-03
  • Contact: Zhen-yu WANG,Guo-zhong LIN E-mail:wzyu502@126.com;leenho@163.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81441044);the Natural Science Foundation of Beijing(7144253)

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摘要：

目的:构建颈椎单侧半椎板以及不同程度小关节切除的动物模型,分析单侧半椎板以及不同程度小关节切除对颈椎生物力学的影响。方法:将20只实验羊随机分为A、B、C、D 4组,每组5只。A组为空白对照组,B组实施C4-C6右侧半椎板切除术,C组实施C4-C6 右侧半椎板+50%右侧C4-C5小关节切除术,D组实施C4-C6右侧半椎板+100%右侧C4-C5小关节切除术,各组常规饲养24周后处死并获得新鲜颈椎标本。比较术后24周生物力学改变:在脊柱三维运动试验机上,模拟生理活动状态对A、B、C和D组颈椎标本进行生物力学测定,并比较颈椎活动度差异。结果:(1)术后24周颈椎总活动度:D组在屈伸下的活动度(60.2° ±8.6°)显著大于A组(40.7°±6.4°)和B组(41.2°±13.1°);D组在侧弯状态下的活动度(81.5°±15.7°)显著大于A组(56.7°±12.2°)和B组(57.7°±12.8°);D组在旋转状态下的活动度(38.5°±17.5°)较A组(26.4°±9.9°)和B组(27.1°±10.9°)无明显增加;C组在屈伸状态的活动度(44.1°±11.7°)、侧弯状态下的活动度(73.6°±11.4°)及旋转状态下的活动度(31.3°±11.5°)较A组和B组无明显增加;(2)术后24周节段间活动度:D组在屈伸状态下的C4-C5活动度(20.3°±4.6°)显著大于A组(11.7°±3.4°)和B组(11.9°±2.1°),在侧弯状态下的C4-C5活动度(26.8°±3.5°)显著大于A组(15.2°±3.1°)和B组(16.2°±3.2°),在旋转状态下的C4-C5活动度(15.2°±3.5°)显著大于A组(6.6°±2.3°)和B组(7.1°±1.9°);C组在侧弯状态下的C4-C5活动度(21.2°±4.1°)显著大于A组和B组,在屈伸状态下的C4-C5活动度(15.7°±3.7°)及旋转状态下的C4-C5活动度(10.3°±3.1°)较A组和B组无明显增加。结论:单纯半椎板切除术不影响颈椎稳定性,半椎板合并50%同侧小关节切除不影响术后远期的颈椎稳定性,半椎板合并100%同侧小关节切除会明显降低术后远期在侧弯和屈伸下的颈椎稳定性。

关键词: 颈椎, 半椎板切除, 小关节切除, 生物力学

Abstract:

Objective: To establish animal models and investigate the impact of unilateral hemilaminectomy(ULHL) and different degrees of facetectomy (FT) on the cervical spinal biomechanics.Methods: Twenty sheep were randomly and evenly divided into 4 groups. No operation was performed for group A, right C4-C6 ULHL was performed for group B, right C4-C6 ULHL and 50% ipsilateral C4-C5 FT was performed for group C, right C4-C6 ULHL and 100% ipsilateral C4-C5 FT was performed for group D. Animals of group A, B, C and D were sacrificed 24 weeks after operating and fresh cervical spine specimens were acquired, biomechanically tested and these data were compared to determine whether ULHL and different degrees of FT led to long-term differences in range of motion.Results: (1) Changes of the total range of motion of cervical spine 24 weeks after surgery: the total range of motion of group D (60.2°±8.6°) was significantly greater than group A (40.7°±6.4°) and group B (41.2°±13.1°) under flexion-extension station,the total range of motion of group D (81.5°±15.7°) was significantly greater than that of group A (56.7°±12.2°) and group B (57.7°±12.8°) under lateral bending station,and the total range of motion of group D (38.5°±17.5°) had no obvious increase compared with group A (26.4°±9.9°) and group B (27.1°±10.9°) under axial rotation station. The total range of motion of group C had no obvious increase compared with group A and group B under flexion-extension station (44.1°±11.7°), lateral bending station (73.6°±11.4°) and axial rotation station (31.3°±11.5°). (2) Changes of the intersegmental motion 24 weeks after surgery: the intersegmental motion of group D (20.3°±4.6°) at C4-C5 was significantly greater than that of group A (11.7°±3.4°) and group B (11.9°±2.1°) under flexion-extension station, the intersegmental motion of group D (26.8°±3.5°) at C4-C5 was significantly greater than that of group A (15.2°±3.1°) and group B (16.2°±3.2°) under lateral bending station, the intersegmental motion of group D (15.2°±3.5°) at C4-C5 was significantly greater than that of group A (6.6°±2.3°) and group B (7.1°±1.9°) under axial rotation station. The intersegmental motion of group C (21.2°±4.1°) at C4-C5 was significantly greater than that of group A and group B under lateral bending station, the intersegmental motion of group C at C4-C5 had no obvious increase compared with group A and group B under flexion-extension station (15.7°±3.7°) and axial rotation station (10.3°±3.1°).Conclusion: ULHL does not affect cervical stability, ULHL and 50% ipsilateral FT does not affect the long-term cervical stability, ULHL and 100% ipsilateral FT can lead to long-term instability under lateral bending and flexion-extension station.

Key words: Cervical spine, Hemilaminectomy, Facetectomy, Biomechanics

中图分类号: 

  • R681.5

表1

不同组的术后24周颈椎总活动度/(°)"

Group Group A Group B Group C Group D F value P value
Flexion-extension 40.7±6.4 41.2±13.1 44.1±11.7 60.2±8.6*# 4.026 0.03
Lateral bending 56.7±12.2 57.7±12.8 73.6±11.4 81.5±15.7*# 4.314 0.02
Axial rotation 26.4±9.9 27.1±10.9 31.3±11.5 38.5±17.5 0.941 0.44

表2

不同组的术后24周C3-C4节段间活动度/(°)"

Group Group A Group B Group C Group D F value P value
Flexion-extension 7.1±2.1 7.3±3.1 7.6±1.7 8.0±2.6 0.129 0.94
Lateral bending 12.3±2.3 12.7±2.6 16.3±4.3 18.5±5.7 2.806 0.07
Axial rotation 7.2±2.4 7.5±2.2 8.3±2.1 9.6±2.7 1.033 0.41

表3

不同组的术后24周C4-C5节段间活动度/(°)"

Group Group A Group B Group C Group D F value P value
Flexion-extension 11.7±3.4 11.9±2.1 15.7±3.7 20.3±4.6*# 6.433 0.005
Lateral bending 15.2±3.1 16.2±3.2 21.2±4.1*# 26.8±3.5*# 11.594 0.001
Axial rotation 6.6±2.3 7.1±1.9 10.3±3.1 15.2±3.5*# 10.072 0.001

表4

不同组的术后24周C5-C6节段间活动度/(°)"

Group Group A Group B Group C Group D F value P value
Flexion-extension 12.7±2.4 13.2±3.1 13.4±2.7 15.2±3.6 0.667 0.58
Lateral bending 15.7±3.2 17.3±2.8 19.6±3.4 20.5±3.1 2.428 0.10
Axial rotation 7.1±2.6 7.3±3.1 9.3±2.5 11.5±3.5 2.425 0.10

表5

不同组的术后24周C6-C7节段间活动度/(°)"

Group Group A Group B Group C Group D F value P value
Flexion-extension 10.0±2.4 11.2±2.7 12.1±2.7 14.3±2.5 2.482 0.098
Lateral bending 15.1±2.2 17.5±2.6 18.6±3.4 19.5±2.7 2.374 0.109
Axial rotation 5.7±2.1 6.1±2.3 8.2±2.5 8.9±2.4 2.260 0.124
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