现实虚拟互动技术对角度牵引治疗根型颈椎病研究

Evaluation of Therapeutic Effect of Traction at Different Angles for Cervical Spondylotic Radiculopathy by Using Real-Virtual Interaction Technique

【目的】比较不同角度牵引治疗神经根型颈椎病的生物力学差异,探讨角度牵引治疗神经根型颈椎病的合适方式,为临床应用提供理论依据。【方法】符合纳入标准的33例病例实验前均拍摄颈椎CT片。患者分别接受前屈位、中立位及后伸位角度牵引,牵引前后均拍摄标准颈椎侧位X光片,测量牵引前后各节段椎间前、后隙高度的变化;对其中1位患者的颈椎CT片进行三维有限元分析,并模拟不同角度受力下颈椎的生物力学变化。【结果】不同角度牵引下椎间前、后隙高度的变化均以前屈位最为显著,从C2/3至C6/7,前屈位组各节段的椎间前、后隙高度增加值均显著大于中立位组和后伸位组(P﹤0.01),而其中中立位组又显著大于后伸位组(P﹤0.01),三者关系为:前屈位组>中立位组>后伸位组。三维有限元分析结果显示:无论是椎间后隙或是椎间前隙,均以前屈位增加最为显著。但与在体实验相比,后伸位受力分析却显示出几乎相反的结果。【结论】单从椎间隙高度增加的角度来看,前屈位角度牵引对于神经根型颈椎病的治疗最为有利,并可以推测,C3/4、C4/5节段病变的神经根型颈椎病患者可能最适宜接受前屈位角度牵引;另一方面,建议神经根型颈椎病患者应该慎用后伸位角度牵引。

Objective To compare the differences of biomechanics at different traction angles for nerve root type cervical spondylosis, and to optimize the traction angle. Methods Thirtythree qualified patients were enrolled into the study, and took the cervical computer tomography （CT） before experiment. The patients were given traction at anterior flexion, neutral position and posterior flexion, respectively. Before and after traction, standard lateral cervical Xrays image was carried out for the measurement of intervertebral gap height, and the cervical CT of one of the patients was chosen for threedimensional finite element analysis to simulate the cervical biomechanical changes induced by different traction angles. Results The change of anterior and posterior intervertebral gap height was obvious in the patients receiving traction at anterior flexion. From C2/3 to C6/7, the increase value of anterior and posterior intervertebral gap height of various vertebral segments was larger by traction at anterior flexion than that by neutral position and posterior flexion （P 〈 0.01 ） , and the value at neutral position was larger than that at posterior flexion （P 〈0.01 ）. The results of threedimensional finite element analysis showed that both anterior and posterior intervertebral gap height was increased obviously at anterior flexion. In the invivo experiment, posterior biomechanics analysis showed the opposite results. Conclusion When only taking the consideration of intervertebral gap height, traction at anterior flexion is the optimal traction for nerve root type cervical spondylosis, in particular for the cervical spondylosis at the segments of C3/4 and C4/5. On the other hand, traction at posterior flexion should be avoided in the patients with nerve root type cervical spondylosis.