背景 临床上颈椎钩突关节增生经常是多节段存在,由于多间隙病变复杂,手术方案的制定需要考虑多种因素.临床医生发现,即使是采用微创前路椎间孔减压术治疗两节段的神经根型颈椎病,减压充分后也不一定都需要行椎间融合术.目的 本文对两个节段的钩突进行部分切除后,研究对颈椎稳定性的影响.方法 依据健康志愿者的影像学资料,采用Mimicsl3.1、SolidWorks2012软件建立三维几何模型,ANSYS15.0软件进行网格划分和网格优化,赋值各类组织的材料属性,建立颈椎(C2-C7)三维有限元模型,通过有限元分析技术研究部分切除单侧两个钩突后对颈椎稳定性和邻近节段椎体应力的影响.结果 采用文中所述切除方法进行左侧钩突部分切除后,当切除双节段(60+60模型)时,各个工况下的最大位移相对于前3种切除方式均有明显的增大,而且各个工况下的最大应力相对于前3种切除方式均有显著增大.结论 随着切除节段的增多和切除范围的增大,节段之间的活动度增大,局部应力增大,给颈椎带来一定的影响,导致颈椎不稳,加速颈椎的退变.因此在制定手术方案时,要严格掌握手术适应证,除非有明确的神经根、脊髓受压的指征,否则不可盲目扩大切除范围.%Backgrounds Hyperplasia of cervical uncinate joint usually exists in multi-level cervical segments,the surgical planning needs to consider a variety of factors because of the disease complexity.Clinicians find that two-level cervical segments' unilateral microsurgical anterior cervical foraminotomy for radiculopathy after anterior decompression does not necessarily require interbody fusion.Objective To investigate biomechanical stability of cervical spine after two-level cervical segments' unilateral microsurgical anterior cervical foraminotomy for radiculopathy.Methods Based on the CT scan images of an adult male volunteer,a three-dimensional geometric model of the cervical spine (C2-C7) was established by using Mimics13.1,SolidWorks2012 and ANSYS15.0 softwares.And then the mechanical parameters were assigned according to the material characteristic of tissues.Threedimensional finite element model of the cervical spine was eventually created by using tetrahedral mesh method.The stability of cervical spine and the stress change of adjacent vertebral segment were analyzed by using the finite element analysis technique after two-level cervical segments' unilateral microsurgical anterior cervieal foraminotomy.Results The results showed that the maximum total deformation of each condition relative to the other three resections definitely increased after the removal of two-level cervical segment (60+60 model) by using the method described in this paper.Moreover,the various conditions of maximum equivalent stress signifieantly increased relative to the other three resections.Conclusions With the increase of the removed segments and the removal scope,the activity between the segments increases and the overall stability of the cervical spine are weakened.Increase in local cervical stress leads to cervical instability and accelerates the degeneration of the cervical spine.Therefore,we should strictly control surgical indications in surgical planning.The scope of resection cannot be blindly expanded unless there are certain clear indications,such as compression of nerve roots and spinal cord.
展开▼
