颈椎间盘摘除对颈椎稳定性及其生物力学变化的研究

Effect of cervical discectomy on cervical stability and biomechanical changes

目的:探讨摘除1～3个颈椎椎间盘对颈椎稳定性的影响,以及椎体间使用植骨及内固定后对恢复颈椎稳定性的作用。方法:10具新鲜成年男性尸体颈椎标本依次进行完整颈椎、环锯法摘除颈椎间盘(C3～6)标本、三面为皮质骨的骨栓椎间隙(C3～6)植骨标本、在植骨基础上行颈椎(C3～6)前路ORION内固定标本进行测试。测试为对颈椎标本进行轴向压缩(300N)、侧弯(2Nm)及轴向扭转(2Nm)。结果:椎间盘切除后,造成颈椎在多个方向的严重不稳定,单纯椎间隙植骨后稳定性仍低于完整颈椎,安置颈椎前路内固定后,颈椎不稳定现象明显改善,在3种载荷作用下,稳定性与完整颈椎无显著差异(P>0.05),且部分指标优于完整颈椎。结论:颈椎前路减压植骨后,尤其是多节段切除椎间盘后,应使用颈椎前路内固定加强稳定性。

AIM:To explore the effect of the removal of 1-3 cervical intervertebral disks on the cervical stability,and to study the influence of bone grafting and internal fixation on the recovery of cervical stability. METHODS:C3-6 disk of 10 cervical spine samples of fresh adult male corpses were removed using trephine,the end plates of the neighbour cervical vertebrum were reserved.Biodynamic detection was progressed after the cortical bone plug was transplanted into the intervertebral space and the ORION plate was fixed anteriorly. The detection includes axial compression(300 N),lateral bending(2 Nm) and axial twisting(2 Nm). RESULTS:Severe instability in multiple directions was caused after cervical discectomy.The capability of anti axial compression after simple bone transplantation was less than that of the intact cervical spine.After the anterior internal fixation,the instability of the cervical spine was obviously improved.The capability anti axial compression,anti twisting and anti lateral bending had no obvious difference in the intact cervical spine among the three groups(P >0.05),and part of indexes were better than those of the intact cervical spine. CONCLUSION:Anterior internal fixation should be applied to strengthen the cervical stability after decompression and bone transplantation,especially after mutli cervical intervertebral disks are removed.