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首页> 外文期刊>Spine >Kinematics of progressive circumferential ligament resection (decompression) in conjunction with cervical disc arthroplasty in a spondylotic spine model.
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Kinematics of progressive circumferential ligament resection (decompression) in conjunction with cervical disc arthroplasty in a spondylotic spine model.

机译：在脊椎模型中，进行渐进性圆周韧带切除（减压）与颈椎间盘置换的运动学。

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STUDY DESIGN.: Benchtop biomechanics study examining kinematic effects of progressive resection in a human cadaveric spine model. OBJECTIVE.: To determine the effects of posterior longitudinal ligament (PLL) resection, unilateral and bilateral foraminotomy, and laminectomy on cervical intervertebral rotation and translation after cervical disc arthroplasty (CDA). SUMMARY OF BACKGROUND DATA.: Although the clinical results after CDA have been studied, there remain unanswered questions regarding the surgical techniques used at the time of device insertion. For example, it is unclear whether a surgeon should retain or resect the PLL and uncinate processes at the time of primary surgical intervention. Further, the effect of a subsequent posterior decompression (foraminotomy or laminectomy) on the stability of a motion segment containing a disc arthroplasty is unknown. METHODS.: Three-dimensional intervertebral motion was measured by biplanar videography in human cadaveric spines at C4-C5 or at C5-C6 subjected to a 1.5-Nm moment applied to induce motion in the sagittal plane. Coupled motions were not constrained. After measuring intact spine motion, disc arthroplasty with bilateral ventral foraminotomy was performed without PLL resection. Sequentially, rotations and translations were measured after PLL resection, unilateral foraminotomy, bilateral foraminotomy, and laminectomy. RESULTS.: CDA with bilateral ventral foraminotomy increased sagittal rotation by 0.4 degrees (16%) compared with the intact spine. The addition of PLL resection increased rotation by 0.5 degrees (14% increase). Unilateral and bilateral foraminotomy had negligible effects on sagittal rotation or anteroposterior (AP) translation. Laminectomy resulted in an additional sagittal plane rotation of 2 degrees . The sagittal-plane interverterbal rotation resultant after all interventions was 6 degrees , with 1.5 mm of AP translation occurring only. CONCLUSION.: Given that a greater degree of motion was seen with PLL resection combined with ventral foraminotomy, we recommend that PLL resection be performed when performing CDA. In our benchtop model, unilateral and bilateral posterior foraminotomies were not associated with the creation of significant sagittal rotational or AP translational instability.
机译：研究设计：台式生物力学研究在人体尸体脊柱模型中进行性切除的运动学效果。目的：确定后纵韧带（PLL）切除，单侧和双侧椎间孔切开术以及椎板切除术对颈椎间盘置换术（CDA）后颈椎间旋转和翻译的影响。背景数据概述：尽管已经研究了CDA术后的临床结果，但是关于在设备插入时使用的外科技术仍存在未解决的问题。例如，尚不清楚外科医生在初次外科手术时是否应保留或切除PLL并清除过程。此外，随后的后减压（开孔术或椎板切除术）对包含椎间盘置换术的运动节段的稳定性的影响尚不清楚。方法：通过双平面摄像，在人尸体的C4-C5或C5-C6脊椎上，通过施加1.5-Nm力矩在矢状面中诱发运动来测量三维椎间运动。联动不受限。在测量完整的脊柱运动后，进行椎间盘置换术并进行双侧腹侧截骨术，而无需进行PLL切除。依次地，在PLL切除，单侧椎间孔切开术，双侧椎间孔切开术和椎板切除术后测量旋转和平移。结果：与完整脊柱相比，双侧腹侧开孔术的CDA使矢状旋转增加了0.4度（16％）。 PLL切除术的增加使旋转增加了0.5度（增加了14％）。单侧和双侧椎间孔切开术对矢状旋转或前后（AP）平移的影响可忽略不计。椎板切除术导致矢状面旋转了2度。所有干预后的矢状面椎间旋转为6度，仅发生1.5 mm的AP平移。结论：鉴于PLL切除结合腹侧开孔术可以看到更大程度的运动，因此我们建议在进行CDA时进行PLL切除。在我们的台式模型中，单侧和双侧后路开孔术与明显的矢状旋转或AP平移不稳定性无关。

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