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非连续颈椎间盘置换与非连续颈椎间盘切除融合术治疗非连续性颈椎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.

机构信息

Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.

National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.

出版信息

J Orthop Surg Res. 2020 Jan 31;15(1):36. doi: 10.1186/s13018-020-1549-3.

DOI:10.1186/s13018-020-1549-3
PMID:32005193
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6995191/
Abstract

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.

摘要

背景：非连续前路颈椎间盘切除融合术（ACDF）和非连续颈椎间盘置换术（CDA）的生物力学特征仍不清楚。本研究旨在比较这两种治疗方法的差异，并验证 Prodisc-C 在非连续 CDA 中的疗效。

方法：根据 8 名轻度 CDDD 志愿者的颈椎 CT 图像，建立了 8 个颈椎（C2-C7）的有限元模型。在关节置换组，我们在 C3/4 和 C5/6 植入了 Prodisc-C。在融合组，在 C3/4 和 C5/6 植入了 CoRoent®Contour 和 NuVasive®Helix ACP。使用 75N 的初始载荷模拟头部重量和肌肉力。在 C2 椎体顶部施加 1.0N·m 的力矩以在各个方向上产生运动。使用 STATA 版本 14.0（StataCorp LP，德克萨斯州 College Station）进行统计分析。P<0.05 为差异有统计学意义。

结果：在完整组中，C2/3（P<0.001、P=0.005、P<0.001、P<0.001）、C4/5（P<0.001）和 C6/7（P<0.001）节段的椎间盘内压力明显小于融合组的屈伸、侧屈和轴向旋转。此外，在关节置换组中，C2/3（P<0.001、P=0.001、P<0.001、P<0.001）、C4/5（P<0.001）和 C6/7（P<0.001）节段的椎间盘内压力明显小于融合组的屈伸、侧屈和轴向旋转。在关节置换组中，C2/3 节段的关节突关节接触力（P=0.010）明显小于完整组。在关节置换组中，C2/3（P<0.001）、C4/5（P<0.001）和 C6/7（P<0.001）节段的关节突关节接触力明显小于融合组。在完整组中，C2/3（P<0.001）、C4/5（P<0.001）和 C6/7（P<0.001）节段的关节突关节接触力明显小于融合组。

结论：非连续 CDA 可保持邻近和中间节段的椎间盘内压和关节突关节力，维持颈椎运动学接近术前值。然而，非连续 ACDF 会增加邻近和中间节段的退行性变风险。此外，Prodisc-C 在非连续 CAD 中的应用可能比 Prestige LP 更有优势。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c75/6995191/779dbf3798c7/13018_2020_1549_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c75/6995191/308b32562af7/13018_2020_1549_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c75/6995191/8966c1c42f70/13018_2020_1549_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c75/6995191/1d3c3d623571/13018_2020_1549_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c75/6995191/cbca8387911e/13018_2020_1549_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c75/6995191/779dbf3798c7/13018_2020_1549_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c75/6995191/308b32562af7/13018_2020_1549_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c75/6995191/8966c1c42f70/13018_2020_1549_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c75/6995191/1d3c3d623571/13018_2020_1549_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c75/6995191/cbca8387911e/13018_2020_1549_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8c75/6995191/779dbf3798c7/13018_2020_1549_Fig5_HTML.jpg

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本文引用的文献

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Biomechanics following skip-level cervical disc arthroplasty versus skip-level cervical discectomy and fusion: a finite element-based study.

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