de Vicente F, Bernard F, FitzPatrick D, Moissonnier P
University College Dublin, School of Veterinary Medicine, Clinical Studies, Small Animal Surgery, Dublin, Ireland.
Vet Comp Orthop Traumatol. 2013;26(1):19-26. doi: 10.3415/VCOT-12-02-0016. Epub 2012 Nov 21.
The purpose of this study was to assess the effect of three surgical procedures (left lateral corpectomy [LC], LC plus mini-hemilaminectomy [LC-MH], and LC plus hemilaminectomy [LC-H]) on the biomechanics and intervertebral collapse of a lumbar vertebral motor unit (VMU).
Six canine cadaveric first and second lumbar vertebrae (L1-L2) VMU were retrieved. Range-of-motion (ROM) was measured while a custom-built mechanical simulator applied 3 Nm torque in lateral bending, flexion and extension to the intact VMU and following the three surgical procedures (LC, LC-MH, LC-H) performed sequentially. Radiographs were taken with and without 3 kg axial compression at each step.
Left lateral corpectomy and LC-MH significantly increased the ROM in left lateral bending and total lateral bending. A LC-H significantly increased the ventral, left, right, total lateral, and total dorsoventral ROM. Significant intervertebral collapse was observed after LC-H with and without axial compression, and after LC and LC-MH, but only with axial compression.
A LC induces significantly increased ROM in lateral bending to the side of the surgery and in total lateral ROM. Extending the LC to a LC-MH does not change the spinal column stability compared to LC alone, while it provides better access to the spinal canal. The LC-H further destabilizes the VMU. The finding of intervertebral collapse following these surgical procedures confirms the importance of the intervertebral disc and articular facet in the maintenance of spatial integrity.
本研究旨在评估三种手术操作(左侧椎体次全切除术[LC]、LC联合微型半椎板切除术[LC-MH]以及LC联合全椎板切除术[LC-H])对腰椎运动单元(VMU)生物力学及椎间塌陷的影响。
获取6具犬类尸体的第1和第2腰椎(L1-L2)VMU。使用定制的机械模拟器对完整的VMU以及依次进行三种手术操作(LC、LC-MH、LC-H)后,在侧弯、前屈和后伸时施加3 Nm扭矩,测量活动范围(ROM)。在每个步骤中,分别在有无3 kg轴向压缩的情况下拍摄X线片。
左侧椎体次全切除术和LC-MH显著增加了左侧侧弯和总侧弯的ROM。LC-H显著增加了腹侧、左侧、右侧、总侧弯以及总背腹侧ROM。在LC-H术后,无论有无轴向压缩均观察到显著的椎间塌陷,在LC和LC-MH术后也观察到椎间塌陷,但仅在有轴向压缩时出现。
LC可显著增加手术侧侧弯及总侧弯ROM。与单独的LC相比,将LC扩展为LC-MH并不会改变脊柱稳定性,同时能更好地进入椎管。LC-H会进一步破坏VMU的稳定性。这些手术操作后出现椎间塌陷这一发现证实了椎间盘和关节突在维持空间完整性方面的重要性。