颈椎后纵韧带骨化症：影响后路减压效果的因素
Cervical ossification of the posterior longitudinal ligament: factors affecting the effect of posterior decompression.
作者信息
Nishida Norihiro, Kanchiku Tsukasa, Kato Yoshihiko, Imajo Yasuaki, Suzuki Hidenori, Yoshida Yuichiro, Ohgi Junji, Chen Xian, Taguchi Toshihiko
机构信息
a Department of Orthopaedic Surgery , Yamaguchi University Graduate School of Medicine , Yamaguchi , Japan.
b Department of Applied Medical Engineering Science , Yamaguchi University , Yamaguchi , Japan.
出版信息
J Spinal Cord Med. 2017 Jan;40(1):93-99. doi: 10.1080/10790268.2016.1140392. Epub 2016 Jan 20.
OBJECTIVE
Decompression procedures for cervical myelopathy of ossification of the posterior longitudinal ligament (OPLL) are anterior decompression with fusion, laminoplasty, and posterior decompression with fusion. Preoperative and postoperative stress analyses were performed for compression from hill-shaped cervical OPLL using 3-dimensional finite element method (FEM) spinal cord models.
METHODS
Three FEM models of vertebral arch, OPLL, and spinal cord were used to develop preoperative compression models of the spinal cord to which 10%, 20%, and 30% compression was applied; a posterior compression with fusion model of the posteriorly shifted vertebral arch; an advanced kyphosis model following posterior decompression with the spinal cord stretched in the kyphotic direction; and a combined model of advanced kyphosis following posterior decompression and intervertebral mobility. The combined model had discontinuity in the middle of OPLL, assuming the presence of residual intervertebral mobility at the level of maximum cord compression, and the spinal cord was mobile according to flexion of vertebral bodies by 5°, 10°, and 15°.
RESULTS
In the preoperative compression model, intraspinal stress increased as compression increased. In the posterior decompression with fusion model, intraspinal stress decreased, but partially persisted under 30% compression. In the advanced kyphosis model, intraspinal stress increased again. As anterior compression was higher, the stress increased more. In the advanced kyphosis + intervertebral mobility model, intraspinal stress increased more than in the only advanced kyphosis model following decompression. Intraspinal stress increased more as intervertebral mobility increased.
CONCLUSION
In high residual compression or instability after posterior decompression, anterior decompression with fusion or posterior decompression with instrumented fusion should be considered.
目的
对于后纵韧带骨化症（OPLL）所致的颈椎脊髓病，减压手术包括前路减压融合术、椎板成形术以及后路减压融合术。使用三维有限元法（FEM）脊髓模型，对山形颈椎OPLL压迫进行术前和术后应力分析。
方法
使用三个分别包含椎弓、OPLL和脊髓的有限元模型，构建术前脊髓压迫模型，分别施加10%、20%和30%的压迫；构建后移椎弓的后路减压融合模型；构建后路减压后脊柱后凸加重且脊髓在脊柱后凸方向被拉伸的模型；构建后路减压后脊柱后凸加重与椎间活动度增加的联合模型。联合模型中OPLL中部存在连续性中断，假定在脊髓最大压迫水平存在残余椎间活动度，并且脊髓可随椎体屈曲5°、10°和15°而活动。
结果
在术前压迫模型中，椎管内应力随压迫增加而升高。在后路减压融合模型中，椎管内应力降低，但在30%压迫下仍部分持续存在。在脊柱后凸加重模型中，椎管内应力再次升高。前路压迫越高，应力升高越明显。在脊柱后凸加重+椎间活动度增加模型中，减压后椎管内应力比仅脊柱后凸加重模型升高得更多。椎管内应力随椎间活动度增加而升高更明显。
结论
对于后路减压后存在高残余压迫或不稳定的情况，应考虑前路减压融合术或后路器械辅助融合减压术。
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