Distractive Force Relative to Initial Graft Compression in an In Vivo Anterior Cervical Discectomy and Fusion Model
Distractive Force Relative to Initial Graft Compression in an In Vivo Anterior Cervical Discectomy and Fusion Model
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DOI：
10.1097/brs.0b013e3181bb0e6e
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发表时间：
2010-03-01
期刊：
影响因子：
3
通讯作者：
Herkowitz, Harry N.
中科院分区：
文献类型：
--
作者：
Francke, Eric I.;Demetropoulos, Constantine K.;Herkowitz, Harry N.
研究设计.一种体内生物力学颈椎前路椎间盘切除术和内固定融合（ACDFI）模型，采用经校准的牵引器和超小型测力传感器，用于术中测量椎间盘切除部位的牵引力和牵引器取出后椎间测力传感器的后续压缩力。在体内ACDFI模型中确定牵拉力和最终的初始移植物压缩之间的关系。尚未在体内ACDFI模型中研究牵引力与取出牵引器后移植物压缩之间的关系。牵引过度或牵引不足的后果及其对移植物压缩的后续影响，包括轴向颈痛、终板失效伴移植物下沉和融合率，是ACDFI的一个具有临床意义的领域。从12例接受单节段和两节段ACDFI的患者的17个椎间盘切除部位获得术中测量值。手术前获得所有受试者的知情同意书。使用经校准的Caspar牵开器测量椎间盘切除术部位的牵开，将超小型椎间体测力传感器放入椎间盘切除术部位，并用于测量牵开器取出后的合成初始压缩力。通过Pearson相关系数分析椎间盘切除部位的牵拉力与随后的压力传感器压力之间的相关性和统计学意义。取出牵引器后，椎间盘切除部位的平均牵引力为33.5 +/- 11.6 lbs，椎间测力传感器的后续压缩力为16.9 +/- 5.9 lbs。Pearson相关系数r = 0.912（P < 0.0005）。数据显示在所研究的牵引范围内，牵引力和随后的压缩力之间存在统计学显著的线性相关性。本研究证明，在体内ACDFI模型中，在取出牵开器后，施加在椎间盘切除部位的牵开力与随后放置在椎间间隙中的测力传感器上的压缩力之间存在统计学显著的线性相关性。
Study Design. An in vivo biomechanical anterior cervical discectomy and instrumented fusion (ACDFI) model employing a calibrated distractor and a subminiature load cell used to intraoperatively measure distractive force across the discectomy site and subsequent compressive force across the interbody load cell following distractor removal.Objective. To determine the relationship between the distractive force and resultant initial graft compression in an in vivo ACDFI model.Summary of Background Data. The relationship between the distractive force and subsequent graft compression following distractor removal has not been studied in an in vivo ACDFI model. The consequences of over or under distraction and its subsequent effect on graft compression with regards to axial neck pain, endplate failure with graft subsidence, and fusion rates is an area of clinical significance for ACDFI.Methods. Intraoperative measurements were obtained from 17 discectomy sites in 12 patients undergoing one and two level ACDFI. Informed consent was obtained from all subjects before surgery. A calibrated Caspar distractor was used to measure the distraction across the discectomy site and a subminiature interbody load cell was placed into the discectomy site and used to measure the resultant initial compressive force following distractor removal. The statistical significance and correlation between the distractive force across the discectomy site and the subsequent compressive force across the load cell were investigated with the Pearson correlation coefficient.Results. The average distractive force across the discectomy site was 33.5 +/- 11.6 lbs and the subsequent compressive force across the interbody load cell was 16.9 +/- 5.9 lbs following distractor removal. The Pearson correlation coefficient was r = 0.912 (P < 0.0005). The data showed a statistically significant linear correlation between the distractive force and the subsequent compressive force across the range of distraction investigated.Conclusion. This study demonstrated a statistically significant linear correlation between the distractive force applied across the discectomy site and the subsequent compressive force across a load cell placed in the interbody space following distractor removal in an in vivo ACDFI model.