Department of Spine Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, People's Republic of China.
Department of Spine Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, People's Republic of China.
World Neurosurg. 2020 Oct;142:e364-e371. doi: 10.1016/j.wneu.2020.06.234. Epub 2020 Jul 13.
We sought to clarify the safety and unlocking mechanism of the Z-shape elevating-pulling closed reduction (ZR) technique and to analyze the differences in facet contact force and intraspinal pressure during subaxial facet dislocation reduction using the ZR technique and traditional skull traction closed reduction (SR).
In 15 human cadaveric skull-neck-thorax specimens, reproducible unilateral and bilateral facet dislocations (UFDs/BFDs) were created at the C5-C6 level and then reduced by applying the ZR and SR techniques, respectively. Tekscan FlexiForce A-201 pressure sensors were used to measure the anterior and posterior intraspinal pressure and injured facet contact force under physiological conditions and before and after reduction. The maximum pressures during the reduction process were recorded.
After creation of the facet dislocation, the anterior and posterior intraspinal pressure and facet contact force were significantly increased relative to normal (P < 0.001). The UFDs and BFDs of all specimens were successfully reduced by both ZR and SR, and the intraspinal pressure and facet contact force were significantly reduced compared with before reduction (P < 0.001). Compared with SR, the maximum posterior intraspinal pressure during BFD reduction (P = 0.027) and the maximum facet contact force during UFD reduction (P < 0.001) were lower when ZR was used for closed reduction.
Our findings suggest that ZR and SR can both be used to reduce subaxial facet dislocation and decompress the spinal cord. However, the ZR technique appears to safer and more effective than the SR technique for closed reduction of subaxial facet dislocations.
我们旨在阐明 Z 形提拉闭合复位（ZR）技术的安全性和解锁机制，并分析使用 ZR 技术和传统颅骨牵引闭合复位（SR）对下颈椎小关节脱位复位时小关节面接触力和椎管内压力的差异。
在 15 个人体头颅-颈-胸标本中，在 C5-C6 水平处制造可复制的单侧和双侧小关节脱位（UFDs/BFDs），分别使用 ZR 和 SR 技术进行复位。使用 Tekscan FlexiForce A-201 压力传感器在生理条件下以及复位前后测量前、后椎管内压力和受伤小关节面接触力。记录复位过程中的最大压力。
在小关节脱位形成后，前、后椎管内压力和小关节面接触力与正常情况相比显著增加（P < 0.001）。所有标本的 UFDs 和 BFDs 均通过 ZR 和 SR 成功复位，与复位前相比，椎管内压力和小关节面接触力均显著降低（P < 0.001）。与 SR 相比，ZR 用于闭合复位时 BFD 复位时的最大后椎管内压力（P = 0.027）和 UFD 复位时的最大小关节面接触力（P < 0.001）更低。
我们的研究结果表明，ZR 和 SR 均可用于下颈椎小关节脱位复位和脊髓减压。然而，与 SR 技术相比，ZR 技术在闭合复位下颈椎小关节脱位方面似乎更安全、更有效。
