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颈椎后路与前后路联合固定的生物力学稳定性比较

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颈椎后路与前后路联合固定的生物力学稳定性比较

  1. 1. Biomechanical rigidity of cadaveric cervical spine with posterior versus combined posterior and anterior instrumentation 人尸体颈椎后路与前后路联合固定的生物力学刚度比较 JNS : spine February 2009
  2. 2. Object 目的 <ul><li>In patients with cervical stenosis with myelopathy, posterior instrumentation following cervical laminectomy has been shown to reduce the incidence of postoperative instability and kyphosis. However, the indications for posterior plus anterior instrumentation are not always obvious, and using both posterior and anterior instrumentation routinely is unnecessary and excessive. This study examines the rigidity of the intact isolated cadaveric cervical spine, after C4–6 laminectomy, with posterior lateral mass instrumentation, and following posterior plus anterior instrumentation. </li></ul>颈椎脊髓病致椎管狭窄的患者,椎板切除后路固定可以减少术后不稳及后凸畸形发生。而前后联合入路的适应症并不明显,通常来说是不必要的或有些过分。本研究是比较完整颈椎、 C4–6 椎板切除后后路侧块固定与前后路固定的生物力学稳定性。
  3. 3. Methods 方法 <ul><li>Ten fresh-frozen human cadaveric cervical spines from C-1 to T-2 were potted in the neutral position, and retroreflective markers were placed on C-3 and C-7. Specimens were mounted on a biomechanical testing frame, and angular rotations of C-3 relative to C-7 were measured. Pure moments of 0, 0.3, 0.6, 0.9, and 1.2 Nm were applied at C-2 in all 3 planes. Each specimen was load tested as follows: 1) in the intact state; 2) after C4–6 laminectomy; 3) with C3–7 lateral mass instrumentation; and 4) with C3–7 posterior plus anterior instrumentation. </li></ul>10 具新鲜冰冻人尸体颈椎( C1-T2) 放置在中立位,反光性标志物放置在 C3 与 C7 。标本置于一个生物力学测度架上,记录 C3 与 C7 的相对角位移。单纯施加 0 、 0.3 、 0.6 、 0.9 及 1.2 的扭矩。每个标本测试四种状态: 1 )完整、 2 ) C4-6 椎板切除后、 3 ) C3-7 侧块固定、 4 ) C3-7 前后联合固定。
  4. 4. Results 结果 <ul><li>Laminectomy was not associated with a significant increase in motion compared with the intact state with any load or in any direction. Instrumentation was associated with reduction in motion in all directions, and there was no significant difference in posterior versus combined posterior and anterior instrumentation </li></ul>椎板切除与完整脊椎比较,在所有负荷的各个方向下的角位移均无明显增加。内固定后较完整脊柱在所有状态下都稳定,而后路与前后联合固定无统计学差异。
  5. 5. Conclusions 结论 <ul><li>Rigidity imparted to the cervical spine by a 5-level posterior lateral mass fixation is not augmented by anterior instrumentation. </li></ul>颈椎后路 5 个节段的侧块固定加用前路固定并没有增加其稳定性。
  6. 6. 运动分析系统及 3 个摄像机
  7. 7. C3-C7 后路侧块固定及前路钢板固定 颈椎前后路固定的侧位 X 线片

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