Relationship between the laminectomy extension and spinal cord injury caused by acute spinal shortening: goat in vivo experiment
Relationship between the laminectomy extension and spinal cord injury caused by acute spinal shortening: goat in vivo experiment
复制标题
椎板切除延长与急性脊柱短缩引起的脊髓损伤的关系：山羊体内实验
DOI：
10.1007/s00586-020-06369-9
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发表时间：
2020-03-24
影响因子：
2.8
通讯作者：
Ma, Xiang-Yang
中科院分区：
文献类型：
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作者：
Yang, Hao-Zhi;Wang, Bin-Bin;Ma, Xiang-Yang
目的探讨活体山羊模型中不同类型的椎板切除延长与三柱截骨术后急性脊髓短缩后脊髓损伤的关系。方法选取健康山羊18只，完成双椎板切除和T13、L1全椎板切除手术，并在体感诱发电位（SSEP）监测下进行不同的椎板切除延长。根据随后的椎板切除术扩展类型将样本分为三组。在第一组（上椎板扩大切除组）中，在T12尾部10毫米处进行椎板切除延伸；第二组（上下椎板等距扩大切除组），同时进行尾侧5mm至T12、颅侧至L25mm的椎板切除扩展；在第三组（下椎板扩大切除组）中，对颅骨进行 10 毫米的椎板切除术延伸至 L2。将椎体切除后测量的SSEP设为基线，将SSEP较基线振幅下降50%和/或相对基线峰值潜伏期延迟10%设为阳性结果，表明脊髓损伤。脊柱逐渐缩短，直到SSEP监测没有显示阳性结果。测量各组的缩短距离（ΔH）和脊髓屈曲的变化角度（Δα）。术后第2天通过Tarlov评分记录神经功能。结果三组的安全缩短距离分别为38.6±1.2 mm、41.5±0.7 mm、43.7±0.8 mm。相应的脊髓屈曲变化角度为62.8±6.9°、82.8±7.5°、98.5±7.0°。 LSD多重比较检验发现三组间ΔHandΔα差异有显着性（P< 0.05）。 Pearson相关性检验显示各组之间ΔH和Δα之间存在较强的相关性。结论三柱截骨术后不同的椎板切除延长对预防急性脊柱短缩引起的SCI有不同的效果。下椎板扩大切除优于上下椎板等距扩大切除，在预防 SCI 方面优于上椎板扩大切除。图文摘要这些幻灯片可在电子补充材料下检索。
ObjectiveTo investigate the relationship between different types of laminectomy extension and spinal cord injury subsequent to acute spinal shorting after 3-column osteotomy in living goat model.MethodsA total of 18 healthy goats were selected, and a procedure of bivertebral column resections and total laminectomy of T13 and L1 was completed followed by different laminectomy extensions under the somatosensory evoked potential (SSEP) monitoring. The samples were divided into three groups according to types of subsequent laminectomy extension. In the first group (enlarged resection of upper lamina group), laminectomy extension was performed on 10 mm caudal to T12; in the second group (equidistant enlarged resection of upper and lower lamina group), laminectomy extension was performed on 5 mm caudal to T12 and 5 mm cranial to L2 simultaneously; and in the third group (enlarged resection of lower lamina group), laminectomy extension was performed on 10 mm cranial to L2. The SSEP measured after vertebral resection was set as the baseline, and the SSEP decreased by 50% from the baseline amplitude and/or delayed by 10% relative to the baseline peak latency was set as positive results, which indicated spinal cord injury. Spinal column was gradually shortened until the SSEP monitoring just did not show a positive result. The shortened distance (ΔH) and the changed angle of the spinal cord buckling (Δα) were measured in each group. Neurologic function was recorded by the Tarlov scores at 2 days after the surgery.ResultsThe safe shortening distances of three groups were 38.6 ± 1.2 mm, 41.5 ± 0.7 mm, 43.7 ± 0.8 mm, respectively; the corresponding changed angles of the spinal cord buckling were 62.8 ± 6.9°, 82.8 ± 7.5°, and 98.5 ± 7.0°. Significant differences of ΔHand Δαwere found among the three groups by LSD multiple comparison test (P< 0.05). Strong correlation between ΔHand Δαwas shown in each group by Pearson’s correlation test.ConclusionsDifferent laminectomy extensions after 3-column osteotomy have different effects on the prevention of SCI caused by acute spinal shortening. The enlarged resection of lower lamina is superior to equidistant enlarged resection of upper and lower laminas which is superior to enlarged resection of upper lamina in preventing SCI.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.