保留单侧椎旁肌的颈椎后路单开门椎管扩大椎板成形术缓解术后即刻椎间盘生物力学环境恶化的有限元分析

关键词：颈椎  椎间盘  减压术，外科  生物力学现象  有限元分析

Keywords:Cervical vertebrae  Intervertebral disc  Decompression,surgical  Biomechanical phenomena  Finite element analysis

摘要：

      目的 探究保留单侧椎旁肌的颈椎后路单开门椎管扩大椎板成形术对缓解椎间盘生物力学环境恶化的生物力学效应。方法 选择1例因非特异性颈痛于海军军医大学长征医院骨科门诊就诊的43岁女性志愿者，进行CT扫描。采集数据构建颈椎有限元模型，在三维CAD软件环境中，对C_3~7节段颈椎后路单开门椎管扩大椎板成形术进行数字化模拟，建立2种术后模型：对照组模拟椎旁肌全部切除状态；研究组模拟保留铰链侧（右侧）椎旁肌。采集各节段椎间盘内压力和纤维环峰值应力，以及模型总位移量评估术后早期椎间盘退行性变和后凸畸形加剧的潜在风险。结果 与对照组相比，研究组在相同扭矩下的模型总位移均明显降低，在前屈、后伸工况下2组总位移差异较小，在左右侧曲和左右扭转工况下2组总位移差异较大。与对照组相比，研究组椎间盘的应力集中明显降低，在左右侧曲和左右扭转工况下更明显。结论 保留单侧椎旁肌的颈椎后路单开门椎管扩大椎板成形术能缓解术后即刻肌肉剥离导致的生物力学环境恶化，有降低术后椎间盘退行性变的可能。

Abstract:

      Objective To investigate the biomechanical effects of cervical posterior single-door laminoplasty with preservation of unilateral paraspinal muscle on alleviating the deterioration of intervertebral disc biomechanical environment. Methods A 43 year old female who visited the Changzheng Hospital of Naval Medical University due to non-specific neck pain was selected as a volunteer to undergo CT scanning. The data were collected to construct a finite element model of the cervical spine. In the 3D CAD software environment，digital simulation was performed on the C₃-₇ cervical posterior single-door laminoplasty，and 2 postoperative models were established：the control group simulated the complete resection of paraspinal muscles，and the research group simulated the preservation of the paraspinal muscle on the hinge side（right side）. The stress distribution and peak stress of the annulus fibrosus within each segment of the intervertebral disc，as well as the total displacement of the model was collected，to evaluate the potential risk of early postoperative intervertebral disc degeneration and exacerbation of kyphosis. Results Compared with the control group，the total displacement of the model in the research group was significantly reduced under the same torque. The difference in total displacement between the 2 groups was small under flexion and extension conditions，and large under left and right bending and rotation conditions. Compared with the control group，the stress concentration of the intervertebral disc in the research group was significantly reduced，and was more pronounced under left and right bending and rotation conditions. Conclusion cervical posterior single-door laminoplasty with preservation of unilateral paraspinal muscle can mitigate the immediate postoperative deterioration of the biomechanical environment caused by muscle detachment，potentially reduce the risk of postoperative intervertebral disc degeneration.