Wu C, Wang Z Y, Lin G Z, Yu T, Liu B, Si Y, Zhang Y B, Li Y C
Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China.
School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Aug 18;51(4):728-732. doi: 10.19723/j.issn.1671-167X.2019.04.023.
To establish animal models and investigate the impact of unilateral hemilaminectomy (ULHL) and different degrees of facetectomy (FT) on the cervical spinal biomechanics.
Twenty sheep were randomly and evenly divided into 4 groups. No operation was performed for group A, right C4-C6 ULHL was performed for group B, right C4-C6 ULHL and 50% ipsilateral C4-C5 FT was performed for group C, right C4-C6 ULHL and 100% ipsilateral C4-C5 FT was performed for group D. Animals of group A, B, C and D were sacrificed 24 weeks after operating and fresh cervical spine specimens were acquired, biomechanically tested and these data were compared to determine whether ULHL and different degrees of FT led to long-term differences in range of motion.
(1) Changes of the total range of motion of cervical spine 24 weeks after surgery: the total range of motion of group D (60.2°±8.6°) was significantly greater than group A (40.7°±6.4°) and group B (41.2°±13.1°) under flexion-extension station, the total range of motion of group D (81.5°±15.7°) was significantly greater than that of group A (56.7°±12.2°) and group B (57.7°±12.8°) under lateral bending station, and the total range of motion of group D (38.5°±17.5°) had no obvious increase compared with group A (26.4°±9.9°) and group B (27.1°±10.9°) under axial rotation station. The total range of motion of group C had no obvious increase compared with group A and group B under flexion-extension station (44.1°±11.7°), lateral bending station (73.6°±11.4°) and axial rotation station (31.3°±11.5°). (2) Changes of the intersegmental motion 24 weeks after surgery: the intersegmental motion of group D (20.3°±4.6°) at C4-C5 was significantly greater than that of group A (11.7°±3.4°) and group B (11.9°±2.1°) under flexion-extension station, the intersegmental motion of group D (26.8°±3.5°) at C4-C5 was significantly greater than that of group A (15.2°±3.1°) and group B (16.2°±3.2°) under lateral bending station, the intersegmental motion of group D (15.2°±3.5°) at C4-C5 was significantly greater than that of group A (6.6°±2.3°) and group B (7.1°±1.9°) under axial rotation station. The intersegmental motion of group C (21.2°±4.1°) at C4-C5 was significantly greater than that of group A and group B under lateral bending station, the intersegmental motion of group C at C4-C5 had no obvious increase compared with group A and group B under flexion-extension station (15.7°±3.7°) and axial rotation station (10.3°±3.1°).
ULHL does not affect cervical stability, ULHL and 50% ipsilateral FT does not affect the long-term cervical stability, ULHL and 100% ipsilateral FT can lead to long-term instability under lateral bending and flexion-extension station.
建立动物模型,研究单侧半椎板切除术(ULHL)及不同程度关节突切除术(FT)对颈椎生物力学的影响。
将20只绵羊随机均分为4组。A组不进行手术;B组行右侧C4 - C6 ULHL;C组行右侧C4 - C6 ULHL及同侧C4 - C5 50% FT;D组行右侧C4 - C6 ULHL及同侧C4 - C5 100% FT。A、B、C、D组动物于术后24周处死,获取新鲜颈椎标本,进行生物力学测试,并比较这些数据,以确定ULHL及不同程度的FT是否会导致长期的活动度差异。
(1)术后24周颈椎总活动度变化:在屈伸位时,D组的总活动度(60.2°±8.6°)显著大于A组(40.7°±6.4°)和B组(41.2°±13.1°);在侧屈位时,D组的总活动度(81.5°±15.7°)显著大于A组(56.7°±12.2°)和B组(57.7°±12.8°);在轴向旋转位时D组的总活动度(38.5°±17.5°)与A组(26.4°±9.9°)和B组(27.1°±10.9°)相比无明显增加。在屈伸位(44.1°±11.7°)、侧屈位(73.6°±11.4°)和轴向旋转位(31.3°±11.5°)时,C组的总活动度与A组和B组相比无明显增加。(2)术后24周节段间活动度变化:在屈伸位时,D组C4 - C5节段间活动度(20.3°±4.6°)显著大于A组(11.7°±3.4°)和B组(11.9°±2.1°);在侧屈位时,D组C4 - C5节段间活动度(26.8°±3.5°)显著大于A组(15.2°±3.1°)和B组(16.2°±3.2°);在轴向旋转位时,D组C4 - C5节段间活动度(15.2°±3.5°)显著大于A组(6.6°±2.3°)和B组(7.1°±1.9°)。在侧屈位时,C组C4 - C5节段间活动度(21.2°±4.1°)显著大于A组和B组;在屈伸位(15.7°±3.7°)和轴向旋转位(10.3°±3.1°)时,C组C4 - C5节段间活动度与A组和B组相比无明显增加。
ULHL不影响颈椎稳定性,ULHL及同侧50% FT不影响颈椎长期稳定性,ULHL及同侧100% FT可导致侧屈位和屈伸位长期不稳定。