非连续性颈椎间盘置换术与非连续性颈椎间盘切除融合术治疗非连续性退行性椎间盘疾病的生物力学比较:有限元分析。

PubMed ID
发表日期 2020年Jan月

原始出处 骨科外科与研究杂志
Journal of orthopaedic surgery and research
作者 Sun  Xiangyao  Sun  Siyuan  Zhang  Tongtong  Kong  Chao  Wang  Wei  Lu  Shibao 

文献标题 非连续性颈椎间盘置换术与非连续性颈椎间盘切除融合术治疗非连续性退行性椎间盘疾病的生物力学比较:有限元分析。
Biomechanical comparison of noncontiguous cervical disc arthroplasty and noncontiguous cervical discectomy and fusion in the treatment of noncontinuous cervical degenerative disc disease: a finite element analysis.

文献摘要 BACKGROUND

非连续性ACDF和非连续性CDA治疗非连续性颈椎退行性椎间盘疾病的生物力学特性尚不清楚。本研究旨在比较这两种治疗方法的差异,并验证Prodisc-C治疗非连续性CDA的有效性。

METHODS

根据8例轻度CDDD志愿者的CT图像,建立8个颈椎股骨(C2-C7)。关节成形术组在C3/4和C5/6植入Prodisc-C。融合组在C3/4和C5/6植入CoRoent®轮廓和NuVasive®Helix ACP。用75 N的初始载荷模拟头部重量和肌肉力。在C2椎体顶部施加1.0 N m力矩,以产生全方位的运动。使用STATA版本14.0(STATA Corp LP,College Station,Texas,USA)进行统计分析。统计学意义设为P<0.05。

RESULTS

C2/3(P<0.001,P=0.005,P<0.001,P<0.001,P<0.001),C4/5(P<0.001)和C6/7(P<0.001)的IDPs在屈曲、伸展、侧弯和轴向旋转方面均显著低于融合组。关节置换组C2/3(P<0.001,P=0.001,P<0.001,P<0.001),C4/5(P<0.001),C6/7(P<0.001)的IDPs在屈曲、伸展、侧弯和轴向旋转方面均明显低于融合组。关节成形术组C2/3关节突关节接触力(P=0.010)明显小于完整组。关节成形术组C2/3(P<0.001)、C4/5(P<0.001)、C6/7(P<0.001)小关节接触力明显小于融合组。完整组C2/3(P<0.001)、C4/5(P<0.001)、C6/7(P<0.001)小关节接触力明显小于融合组。

CONCLUSIONS

非连续CDA可保持相邻节段和中间节段的IDP和小关节面关节力,使颈椎运动学保持在术前水平附近。然而,不连续的ACDF会增加相邻和中间水平的退行性变风险。此外,Prodisc-C在非连续CAD中的应用可能比Prestige-LP具有更多的优势。


BACKGROUND

Biomechanical characteristics of noncontinuous ACDF and noncontinuous CDA in the treatment of noncontinuous cervical degenerative disc disease were still unclear. The aim of this research is to compare the differences between these two kinds of treatment methods and to verify the effectiveness of Prodisc-C in noncontinuous CDA.

METHODS

Eight FEMs of the cervical spine (C2-C7) were built based on CT images of 8 mild CDDD volunteers. In the arthroplasty group, we inserted Prodisc-C at C3/4 and C5/6. In the fusion group, CoRoent® Contour and NuVasive® Helix ACP were implanted at C3/4 and C5/6. Initial loads of 75 N were used to simulate the head weight and muscle forces. The application of 1.0 N m moment on the top on the C2 vertebra was used to create motion in all directions. Statistical analyses were performed using STATA version 14.0 (Stata Corp LP, College Station, Texas, USA). Statistical significance was set at P < 0.05.

RESULTS

The IDPs in C2/3 (P < 0.001, P = 0.005, P < 0.001, P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) of the intact group were significantly less than that in the fusion group in flexion, extension, lateral bending, and axial rotation, respectively. In addition, the IDPs in C2/3 (P < 0.001, P = 0.001, P < 0.001, P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) of the arthroplasty group were significantly less than that in the fusion group in flexion, extension, lateral bending, and axial rotation, respectively. Contact forces of facet joints in C2/3 (P = 0.010) in the arthroplasty group was significantly less than that in the intact group. Contact forces of facet joints in C2/3 (P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) in the arthroplasty group was significantly less than that in the fusion group. Contact forces of facet joints in C2/3 (P < 0.001), C4/5 (P < 0.001), and C6/7 (P < 0.001) in the intact group were significantly less than that in the fusion group.

CONCLUSIONS

Noncontinuous CDA could preserve IDP and facet joint forces at the adjacent and intermediate levels to maintain the kinematics of cervical spine near preoperative values. However, noncontinuous ACDF would increase degenerative risks at adjacent and intermediate levels. In addition, the application of Prodisc-C in noncontinuous CAD may have more advantages than that of Prestige LP.


获取全文 10.1186/s13018-020-1549-3