摘要
目的:探讨颈椎前路融合对相邻节段有无影响。方法:采用6具成人新鲜颈椎标本(C2￣T1),在MTS脊柱三维运动系统上先后测量C5/6融合前后其上下相邻节段在前屈、后伸、侧弯及旋转时的椎间运动范围(ROM)。临床随访2000年3月￣2004年12月连续诊治的58例行颈椎前路减压植骨融合内固定的患者(其中脊髓型颈椎病45例,颈椎间盘突出症6例,颈椎创伤7例),对比分析融合前后上下相邻节段椎间高度的变化及临床疗效(JOA)。相同节段融合前后比较采用配对t检验。结果:在载荷控制的屈伸、侧弯条件下,融合后上下相邻节段椎间ROM与融合前比较无显著变化(P>0.05);在位移控制模式下的旋转运动中,融合后上下相邻节段椎间ROM与融合前比较显著性增大(P<0.05)。临床平均随访28个月,随访时X线测量融合上下相邻节段椎间高度与融合前比较均无显著性差异(P>0.05);术后JOA评分较术前显著性提高(P<0.05)。结论:在载荷控制的条件下颈椎前路融合不会直接导致相邻节段出现运动范围的增加,临床上如患者术后试图保持术前的运动范围(如同生物力学试验条件下的位移控制模式)则可能会加速相邻节段的退变过程。
Objeetlve：To identify whether cervical anterior fusion has effect on the adjacent segment. Method：6 fresh adult cadavers （C2-T1） were applied in a special designed spinal three-dimension system combined with MTS machine,and the adjacent segment＇s range of motion （ROM） of C5/6 were tested before and after fusion.A retrospective study of 58 patients （including 45 cases for cervical spondylotic myelopathy,6 cases for cervical disc herniation,7 cases for cervical trauma） who underwent anterior cervical decompression and fusion between March 2000 and December 2004 was taken to compare the intervertebral height of adja- cent segment and JOA score.Pared t-test was used for statistical analysis.Result：In the load-control mode of flexion,extension and lateral bending motion,there was no obviously difference on the ROM of adjacent segment（P〉0.05）.In the displacement-control mode of rotation ,there was an obviouse ROM raise after fusion（P〈 0.05）.The mean follow-up period was 28 months,during the followed-up time there was no obviouse X-rays change on the adjacent segment intervertebral height （P〉0.05）.There was significant difference of postoperative JOA scores compared with pre-operation （P〈0.05）.Conclusion：Under the mode of load-control,the anterior cervical fusion doesn＇t increase the ROM of the adjacent segment direcdy.The patient＇s motives of trying to maintain the motion of preoperation（just like the mode of displacement-control for biomechanics） may accelerate the process of adjacent segment＇s degeneration.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2008年第1期28-31,共4页
Chinese Journal of Spine and Spinal Cord
关键词
颈椎
相邻节段
生物力学
融合
退变
Cervical
Adjacent segment
Biomechanics
Fusion
Degeneration
