Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
J Orthop Surg Res. 2023 Jan 20;18(1):57. doi: 10.1186/s13018-023-03537-7.
Hybrid construction (HC) may be an ideal surgical strategy than noncontinuous total disc replacement (TDR) and noncontinuous anterior cervical discectomy and fusion (ACDF) in the treatment of noncontinuous cervical spondylopathy. However, there is still no consensus on the segmental selection for ACDF or TDR in HC. The study aims to analyse the effects of different segment selection of TDR and ACDF on cervical biomechanical characteristics after HC surgery.
Twelve FEMs of C2-C7 were constructed based on CT images of 12 mild cervical spondylopathy volunteers. Two kinds of HC were introduced in our study: Fusion-arthroplasty group (Group 1), upper-level (C3/4) ACDF, and lower-level TDR (C5/6); Arthroplasty-fusion group (Group 2), upper-level (C3/4) TDR and lower-level ACDF (C5/6). The follow-load technique was simulated by applying an axial initial load of 73.6 N through the motion centre of FEM. A bending moment of 1.0 Nm was applied to the centre of C2 in all FEMs. Statistical analysis was carried out by SPSS 26.0. The significance threshold was 5% (P < 0.05).
In the comparison of ROMs between Group 1 and Group 2, the ROM in extension (P = 0.016), and lateral bending (P = 0.038) of C4/5 were significantly higher in Group 1 group. The average intervertebral disc pressures at C2/3 in all directions were significantly higher in Group 1 than those in Group 2 (P < 0.005). The average contact forces in facet joints of C2/3 (P = 0.007) were significantly more than that in Group 2; however, the average contact forces in facet joints of C6/7 (P < 0.001) in Group 1 group were significantly less than that in Group 2.
Arthroplasty-fusion is preferred for intervertebral disc degeneration in adjacent upper segments. Fusion-arthroplasty is preferred for patients with lower intervertebral disc degeneration or lower posterior column degeneration.
This research was registered in Chinese Clinical Trial Registry (ChiCTR1900020513).
在治疗非连续性颈椎病方面，杂交手术（HC）可能是一种优于非连续性全椎间盘置换术（TDR）和非连续性前路颈椎间盘切除融合术（ACDF）的理想手术策略。然而，对于 HC 中 ACDF 或 TDR 的节段选择仍没有共识。本研究旨在分析 TDR 和 ACDF 的不同节段选择对 HC 手术后颈椎生物力学特性的影响。
根据 12 名轻度颈椎病志愿者的 CT 图像，构建了 12 个 C2-C7 的 FEM。本研究引入了两种 HC：融合-关节成形术组（第 1 组），上水平（C3/4）ACDF 和下水平 TDR（C5/6）；关节成形术-融合组（第 2 组），上水平（C3/4）TDR 和下水平 ACDF（C5/6）。通过在 FEM 的运动中心施加 73.6N 的轴向初始载荷，模拟后续加载技术。在所有 FEM 中，在 C2 的中心施加 1.0Nm 的弯矩。采用 SPSS26.0 进行统计分析。显著性阈值为 5%（P<0.05）。
在第 1 组和第 2 组的 ROM 比较中，C4/5 伸展（P=0.016）和侧屈（P=0.038）的 ROM 明显高于第 1 组。在各个方向上，C2/3 的椎间盘压力平均在第 1 组显著高于第 2 组（P<0.005）。C2/3 关节突关节的平均接触力（P=0.007）显著大于第 2 组；然而，第 1 组 C6/7 关节突关节的平均接触力（P<0.001）显著小于第 2 组。
对于相邻上节段的椎间盘退变，首选关节成形-融合术；对于下位椎间盘退变或下位后柱退变的患者，首选融合-关节成形术。
本研究在中国临床试验注册中心（ChiCTR1900020513）注册。
