颈椎单椎体次全切除后撑开植骨对颈椎曲度的影响

Effect of Anterior Distraction and Grafting after Subtotal Corpectomy on Cervical Lordosis

目的 :研究中下颈椎前路单椎体次全切减压后 ,不同高度支撑植骨与颈椎曲度变化之间的关系 ,为临床确定合适的植骨高度提供参考。方法 :拍摄 6具颈椎标本正常状态、C5椎体次全切除减压后C4与C6椎体间分别以C5椎体以及上下椎间盘高度之和为基础撑开 0、2、4、6、8mm支撑植骨状态下的颈椎侧位X线片 ,并在图形测量软件中测量颈椎曲度。结果 :C5椎体次全切除减压撑开 4mm及以上植骨状态的颈椎曲度和完整状态与不撑开植骨状态相比有显著增加 (P <0 .0 1) ,减压相邻节段的曲度无明显变化。结论 :中下颈椎前路单椎体次全切除减压后适宜的支撑植骨高度为撑开 4～ 6mm。

Objective:To establish the optimal height of the strut-graft for clinical surgery,and analyze the effect of change in strut-graft height on the lordotic curvatures of cervical spine on which subtotal corpectomy and strut-graft reconstruction with different height graft was performed.Methods:C 5 subtotal corpectomy were performed on six fresh human cervical spine specimens of young cadaver and strut-grafted respectively with a distraction of 0mm,2mm,4mm,6mm and 8mm between C 4 and C 6 vertebra.Plain lateral radiographs were employed to correlate strut-graft height with lordotic curvatures of cervical spine.After the radiographs had been digitized,the angles between the posterior margins of vertebrae were measured in the computer image analysis software.Results:Compared to the intact condition or strut-grafted without distraction,the cervical spine lordotic curvatures of the C 2～7and C 4～6 segments were significantly increased by the application of a strut-graft with a distraction over 4mm(P<0.01).Conclusions:Strut-graft with an appropriate distraction after subtotal corpectomy plays an important role in regain the cervical spine lordotic curvatures.To the surgery with a single vertebra subtotal corpectomy,the proper range of distraction between the superior and inferior vertebra maybe among 4～6 millimeters.