内镜下单侧小关节分级切除对颈椎节段稳定性影响
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1.华南理工大学医学院 2.解放军总医院第六医学中心中医医学部骨伤科;2.解放军总医院第六医学中心中医医学部骨伤科

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The Effect of Segmental Stability After Endoscopic Graded Facetectomy of The Cervical Spine
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    摘要:

    目的 探究颈椎内镜下不同范围小关节切除对颈椎节段稳定性的影响,为临床手术提供生物力学理论基础。方法 基于CT数据建立颈椎C5-6正常有限元模型,并模拟颈椎内镜手术操作获得不同范围(0、25%、50%、75%、100%)单侧小关节切除椎板开窗模型,分析比较各组模型节段ROM及椎间盘von Mises应力情况。结果 除前屈工况外,M1、M2较M0各方向下ROM及椎间盘von Mises应力改变不明显,M3较M0各方向下ROM及椎间盘von Mises应力出现较为明显增加,ROM分别增加27%、4%、3%、13%、5%、16%,von Mises应力分别增加32%、4%、2%、5%、9%、5%。M4、M5较M0各方向下ROM及椎间盘von Mises应力增加显著, M4模型 ROM分别增加27%、14%、6%、24%、7%、167%,von Mises应力分别增加33%、13%、3%、32%、10%、130%;M5模型ROM分别增加27%、17%、6%、25%、7%、167%,von Mises应力分别增加33%、29%、8%、33%、12%、138%。。结论 随着单侧小关节切除范围的增加,颈椎节段ROM和椎间盘von Mises应力极值逐渐增加。当单侧小关节切除超过1/2时,颈椎出现较大的活动度增加及应力改变,临床手术中应尽量保留1/2以上颈椎小关节,避免医源性失稳。

    Abstract:

    Objective To investigate the effect of different ranges of facet joint resection on the stability of cervical spine, and to provide a biomechanical theoretical basis for clinical surgery. Methods A normal finite element model of the cervical spine C5-6 was established based on the CT data, and different ranges (0, 25%, 50%, 75%, 100%) of unilateral facetectomy and laminectomy models were obtained by simulating cervical endoscopic surgical operations. Comparing the ROM of C5-6 and von Mises stresses of the discs in each group. Results Except for flexion, M1 and M2 show insignificant changes in ROM and disc von Mises stresses in each direction compared with M0. M3 shows an obvious increase in ROM and disc von Mises stresses in each direction compared with M0, the ROM increases by 27%, 4%, 3%, 13%, 5%, 16%, and von Mises stress increases by 32%, 4%, 2%, 5%, 9%, 5%, respectively. M4 and M5 show a significant increase in ROM and disc von Mises stresses in each direction compared with M0. For the M4 model, ROM increases by 27%, 14%, 6%, 24%, 7%, 167%, and von Mises stress increases by 33%, 13%, 3%, 32%, 10%, 130%. As for the M5 model, ROM increases by 27%, 17%, 6%, 25%, 7%, 167%, and von Mises stress increases by 33%, 29%, 8%, 33%, 12%, 138%. Conclusions As the range of unilateral facetectomy increased, the ROM and extreme values of disc von Mises stresses in cervical segments gradually increased. the cervical spine shows significant changes in ROM and disc von Mises stresses when the facet joint resection on one side exceeded 1/2. More than 1/2 of the facet joint should be preserved in surgery to avoid medical instability.

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  • 收稿日期:2023-10-17
  • 最后修改日期:2023-11-20
  • 录用日期:2023-11-22
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