背景：通过前期的临床随访研究发现，前路颈椎融合后邻近节段椎间盘退变速度要快于人工颈椎间盘置换，人工颈椎间盘置换相较于前路颈椎融合可以保持良好的置换节段活动度，是否置换后邻近椎间盘的应力情况与融合之间存在着差异需要进一步研究。目的：对比人工颈椎间盘置换与前路颈椎间盘切除融合后邻近节段椎间盘的应力分布情况。方法：选择1名30岁健康男性志愿者，人工颈椎间盘和颈椎前路钢板实物进行薄层CT扫描，通过Mimics 10.01及Geomagic Studio.v11软件重建出三维图像，将以上三维数据导入Abaqus 6.9有限元分析软件中进行网格划分、赋值、应力分析。利用有限元方法分析模拟人工颈椎间盘置换及前路颈椎间盘切除融合后邻近节段椎间盘的应力变化。结果与结论：①在相同的预载荷条件下，前屈、后伸、侧屈等运动状态时前路颈椎间盘切除融合后邻近节段椎间盘的应力明显大于正常人相应节段椎间盘应力；而人工椎间盘植入后与正常人相比，在前屈、后伸、侧屈等运动状态时邻近节段椎间盘的应力差异无显著性意义；②前路颈椎间盘切除融合组与人工颈椎间盘置换组相比较，融合组术后邻近节段椎间盘的应力较置换组增大10.3%-51.6%；③有限元分析方法发现，前路颈椎间盘切除融合后邻近节段椎间盘应力大于人工颈椎间盘置换组，随着随访时间的延长，相较于传统前路减压融合，人工颈椎间盘置换可能将更好地发挥其对邻近节段椎间盘的保护作用。%BACKGROUND:Previous clinical fol ow-up study showed that disc degeneration of adjacent segment after anterior cervical discectomy and fusion was faster than that of artificial cervical disc replacement. Compared with the anterior cervical discectomy and fusion, artificial cervical disc replacement can maintain a good range of motion of replacement segment. Further investigation should be taken to compare the difference between stress and fusion after replacement. OBJECTIVE:To compare the adjacent level discs loads between artificial cervical disc replacement and anterior cervical discectomy and fusion. METHODS:A healthy 30-year-old male volunteer was scanned with CT at the artificial cervical intervertebral disc and anterior cervical plate. Three-dimensional images were reconstructed with Mimics 10.01 and Geomagic Studio.v11 software. Above three-dimensional data were input into the Abaqus6.9 finite element analysis software for meshing, assignment, and stress analysis. Finite element method was used to simulate the stress changes of the adjacent segments after artificial cervical disc replacement and anterior cervical discectomy and fusion. RESULTS AND CONCLUSION:(1) Under the same preload, during anteflexion, posterior extension, and lateroflexion, the disc stress at adjacent segment was significantly larger after anterior cervical discectomy and fusion than normal disc. Compared with normal persons, no significant difference was detected in stress of adjacent segment at anteflexion, posterior extension, and lateroflexion after artificial cervical disc replacement. (2) Compared with artificial cervical disc replacement group, the stress of adjacent segment increased 10.3%-51.6%in the anterior cervical discectomy and fusion group. (3) Finite element analysis showed that the stress was larger in the anterior cervical discectomy and fusion group than in the artificial cervical disc replacement group. With prolonged fol ow-up, compared with the conventional anterior decompression and fusion, artificial cervical disc replacement can better play its protective effect on the adjacent intervertebral disc.
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