Beauséjour Marie-Hélène, Petit Yvan, Hagen Jeremy, Arnoux Pierre-Jean, Thiong Jean-Marc Mac, Wagnac Eric
Department of Mechanical Engineering, Ecole de technologie superieure, Montreal, Canada.
Department of traumatology and acute care, Research Center, Hopital du Sacre-Coeur de Montreal, Montreal, Canada.
Comput Methods Biomech Biomed Engin. 2020 Sep;23(12):832-843. doi: 10.1080/10255842.2020.1767776. Epub 2020 May 28.
Posterior ligamentous complex (PLC) and intervertebral disc (IVD) injuries are common cervical spine flexion-distraction injuries, but the residual stability following their disruption is misknown. The objective of this study was to evaluate the effect of PLC and IVD disruption on post-traumatic cervical spine stability under low flexion moment (2 Nm) using a finite element (FE) model of C2-T1. The PLC was removed first and a progressive disc rupture (one third, two thirds and complete rupture) was modeled to simulate IVD disruption at C2-C3, C4-C5 and C6-C7. At each step, a non-traumatic flexion moment was applied and the change in stability was evaluated. PLC removal had little impact at C2-C3 but increased local range of motion (ROM) at the injured level by 77.2% and 190.7% at C4-C5 and C6-C7, respectively. Complete IVD rupture had the largest impact on C2-C3, increasing C2-C3 ROM by 181% and creating a large antero-posterior displacement of the C2-C3 segment. The FE analysis showed PLC and disc injuries create spinal instability. However, the PLC played a bigger role in the stability of the middle and lower cervical spine while the IVD was more important at the upper cervical spine. Stabilization appears important when managing patients with soft tissue injuries.
后韧带复合体（PLC）和椎间盘（IVD）损伤是常见的颈椎屈伸分离损伤，但其断裂后的残余稳定性尚不明确。本研究的目的是使用C2-T1有限元（FE）模型，评估在低屈曲力矩（2 Nm）下PLC和IVD断裂对创伤后颈椎稳定性的影响。首先去除PLC，并模拟C2-C3、C4-C5和C6-C7处的椎间盘逐渐破裂（三分之一、三分之二和完全破裂）以模拟IVD损伤。在每个步骤中，施加非创伤性屈曲力矩并评估稳定性变化。去除PLC对C2-C3影响较小，但分别使C4-C5和C6-C7损伤节段的局部活动范围（ROM）增加77.2%和190.7%。IVD完全破裂对C2-C3影响最大，使C2-C3的ROM增加181%，并导致C2-C3节段出现较大的前后移位。有限元分析表明，PLC和椎间盘损伤会导致脊柱不稳定。然而，PLC在中下颈椎稳定性中起更大作用，而IVD在上颈椎更重要。在处理软组织损伤患者时，稳定化似乎很重要。
