Development of intraoperative monitoring system for spinal function

虽然计算机辅助导航系统被广泛应用于脊柱疾病的治疗，以尽量减少手术对周围组织的损伤，但包括退行性组织在内的脊柱关节运动的生物力学却知之甚少。腰椎运动节段（椎-盘-椎）的不稳定被认为是脊柱疾病的一个重要因素。放射学或基础生物力学研究对节段不稳定性的定义已经有了很好的记录。然而，一些有争议的定义一直被证明。在本项目研究中，为了定量评估脊柱活动度并证明木材融合或稳定的合理性，我们开发了一种术中特殊设计的测量系统。用于测量脊柱节段活动度的系统由三个节段、棘突支架、运动发生器和计算机控制器组成。棘突支架可以在不侵犯棘上韧带和棘间韧带的情况下处理脊柱突。由运动发生器的执行器以2.0 mm/s的速度产生的连续位移给予棘突支架的尖端。对23例退行性腰椎疾病患者的24个脊柱运动节段进行了人体脊柱活动度测量。其中：椎间盘突出8节段，脊柱炎畸形11节段，腰椎管狭窄5节段。患者年龄从21岁到83岁不等（平均57岁）。每次测量平均只需要大约10分钟。记录了脊柱节段性运动时的负荷-位移曲线，重现性好。在临床实验和结论中，该系统是测量术中脊柱功能的准确工具。它可以用来充分评价脊柱节段的退行性特征，并进行前后的测量。

Although computer assisted navigation system are widely used in the treatment of spinal disease in order to minimize the operational damage to the surrounding tissue, the biomechanically spinal joint motion including the degenerative tissue has been insignificantly understood. Instability in the lumbar spinal motion segment (vertebra-disc-vertebra) is noted to be an important factor of spinal disorders. Radiographic or basic biomechanical research for definition of the segmental instability has been well documented. However, some contraversial definitions have been consistently demonstrated.In this project research, to evaluate quantitative spinal mobility and to justify lumber fusion or stabilization, an intraoperative and special designed measurement system has been developed. The system used for measuring spinal segmental mobility is consisted of three segments, spinous process holders, motion generator, and computerized controller. The spinous holders make it possible to handle spinal process without invasiveness for the supra- and inter-spinous ligaments. A continuous displacement that generated from actuator of motion generator at speed of 2.0 mm/s is given to the tip of the spinous processes holders. Measurements of human spinal mobility were made on 24 spinal motion segments in 23 patients with degenerative lumbar disease. (12 men and 11 women) including : 8 segments discopathy, 11 segments spondylitis deformans, 5 segments lumbar spinal canal stenosis. Patient ages ranged from 21 to 83 years (average, 57 years).Each measurement took only about ten minutes on average. Load-displacement curves during spinal segmental motion were recorded with excellent reproducibility. In clinical experiment and conclusion, this system is a accurate tool for measuring intraoperative spinal function. It can be used to evaluate sufficiently the degenerative charasiteristics of spinal segment, and to make pre and post disorder measurements.