钢板切迹对颈椎前路融合术后邻近节段退变的影响：单节段和双节段融合比较

目的 采用计算机仿真技术研究单节段和双节段颈椎前路椎间盘切除融合术(anterior cervical discectomy and fusion, ACDF)后钢板切迹对邻近节段退变(adjacent segment degeneration, ASD)的影响。方法 构建完整的C₂-T₁节段的三维有限元模型,并验证其有效性。在正常模型基础上分别建立使用零切迹或传统钢板融合系统的四种ACDF手术模型。记录并比较融合节段上方邻近节段的生物力学参数变化,包括活动度、终板和椎间盘内的应力、关节突关节的负荷等。结果 单节段融合术后,传统钢板模型的相邻节段生物力学参数比零切迹融合系统模型略增加;双节段融合固定后,两种模型的生物力学参数差值改变明显。在屈伸运动中,邻近节段两种模型的生物力学参数差异性最大。结论 钢板切迹会影响ACDF术后ASD发生,双节段的影响较单节段更明显,零切迹融合系统可能有助于预防ASD发生。     

颈前路融合术后相邻节段退变120例

目的：探讨颈椎前路减压融合术后相邻节段退变的因果关系。方法：对237例患者行前路椎间节段减压植骨融合术（87例）,椎体次全切除减压植骨融合术（109例）,椎间节段减压、椎体次全切除减压植骨融合术（41例）。通过影像学检查,观察不同手术方法术后相邻节段退变发生情况。结果：术后随访时间2.6~13年,平均6.8年;发生相邻节段明显退变的120例（50.6%）,头侧相邻节段退变发生率明显高于尾侧邻近节段（P＜0.05）,其中27例（22.2%）需2次翻修手术。结论：颈椎前路融合术后可导致颈椎相邻节段的退变。     

分节段减压与椎体次全切治疗多节段颈椎病的疗效比较

目的比较分节段减压融合术与传统椎体次全切除融合术在治疗多节段脊髓型颈椎病的中远期临床疗效,并评估其相关影响因素。方法回顾性总结2006年6月至2011年6月行分节段减压融合术(A组)与前路椎体次全切除减压融合术(B组)联合髂骨取骨植骨治疗多节段颈椎病52例。比较两组手术时间、术中出血量、住院天数;术后随访并通过影像学测量融合节段前凸角度、全颈椎生理曲度和颈椎矢状面的活动度(range of motion,ROM),同时评估植骨融合程度、融合节段高度的变化以及相邻节段退变情况;采用日本矫形外科学会(Japanese orthopaedic association,JOA)评分系统评估其神经功能恢复情况。结果术中B组的出血量明显大于A组,但手术时间少于A组,差异有统计学意义(P0.05)。52例患者均获得有效随访,平均随访时间为3.2年(1.2~5年)。术后6个月内JOA评分及改善率两组间无明显差异;12个月后B组明显降低。两组术后融合节段高度较术前明显增高(P0.05),其中B组平均增加值最明显,术后12个月B组高度丢失明显。术后两组ROM都明显下降,而融合节段Cobb角及全颈椎曲度与术前比较增加明显(P0.05)。术后两组脊髓减压程度相仿。结论分节段减压融合术与传统椎体次全切除融合术两种手术方式在治疗多节段颈椎病的早期均可获得满意的临床效果,但选择性椎体次全切除分节段减压植骨融合合并颈椎前路长节段钛板固定的手术方式中远期效果更可靠。     

颈椎前路融合后相邻节段的即刻运动范围

目的：观察中下颈椎前路单椎体次全切除减压植骨和应用颈椎前路钢板固定对相邻节段即刻三维运动范围的影响。方法：采用6具新鲜成人尸体颈椎标本，测量完整状态、C5椎体次全切除减压植骨、C5椎体次全切除减压植骨颈前路钢板固定3种状态上下相邻节段的三维六自由度运动范围。结果：3种状态下相邻节段的即刻三维运动范围无显著差异。结论：中下颈椎前路单椎体次全切除减压植骨和应用钢板内固定对相邻节段即刻运动范围没有显著影响，颈椎前路融合后相邻节段退变加快的原因需要进一步探讨。     

颈椎前路融合后相邻节段的即刻运动范围

目的观察中下颈椎前路单椎体次全切除减压植骨和应用颈椎前路钢板固定对相邻节段即刻三维运动范围的影响.方法采用6具新鲜成人尸体颈椎标本,测量完整状态、C5椎体次全切除减压植骨、C5椎体次全切除减压植骨颈前路钢板固定3种状态上下相邻节段的三维六自由度运动范围.结果3种状态下相邻节段的即刻三维运动范围无显著差异.结论中下颈椎前路单椎体次全切除减压植骨和应用钢板内固定对相邻节段即刻运动范围没有显著影响,颈椎前路融合后相邻节段退变加快的原因需要进一步探讨.     

颈椎人工椎间盘的研究与应用现状

颈椎前路减压植骨融合术已广泛应用于颈椎病、颈椎间盘突出症患者的手术治疗。近年来，由于颈椎融合，特别是多节段颈椎融合，导致邻近融合节段椎间盘过早退行性变并出现临床症状的病例逐渐增多为解决异常应力作用于融合邻近节段的问题。颈椎人工椎间盘置换技术应运而生，并已在临床取得一定的效果，笔者对日前颈椎人工椎间盘的现状做一综述。     

颈椎前路融合节段相邻椎间盘压力与轴性症状关系初探

[摘要]目的：分析在生理前凸获得有效重建的颈椎前路减压融合术中,融合节段相邻椎间盘压力变化与颈椎术后轴性症状发生的关系。方法：行前路单椎体次全切除减压内固定手术治疗颈椎伤病42例,术中测量融合节段相邻椎间盘内压力,计算颈椎融合前后压力差。     

双节段颈前路椎间盘切除融合术应用零切迹系统或钢板联合融合器固定后颈椎生物力学变化的三维有限元研究

目的：通过三维有限元分析法比较双节段颈椎前路椎间盘切除融合术（anterior cervical discectomy and fusion,ACDF）应用零切迹（zero-profile,ZP）系统与钢板联合融合器（cage-and-plate,CP）固定后颈椎的生物力学变化。方法：采集1例正常成年女性志愿者颈椎C3～C7节段CT扫描数据,建立C3～C7颈椎有限元模型并通过对比前期研究验证模型有效性。ZP固定模型与CP固定模型的手术节段均设定为C4/5与C5/6节段。在C3椎体上方施加轴向压缩负荷73.6N的模拟重力,并逐步施加1.8N·m的转矩,进而模拟屈伸、侧屈及轴向旋转等颈椎运动。测定并比较手术模型融合节段活动度（range of motion,ROM）、邻近节段椎间盘内应力、C5椎体及融合器装置应力。结果：CP固定模型融合节段的ROM在屈伸、侧屈、旋转位均明显小于ZP固定模型;CP固定模型相邻节段（C3/4、C6/7）的椎间盘内应力均远远高于ZP固定模型,两种模型融合节段上方的椎间盘内应力均高于融合节段下方;各工况下,ZP固定模型的C5椎体应力均明显高于CP固定模型,在前屈位...     

保留椎体后壁的颈椎前路减压融合术治疗多节段颈椎间盘突出症

目的 探讨保留椎体后壁的颈椎前路减压融合术治疗多节段颈椎间盘突出症的临床疗效.方法 回顾分析13例多节段颈椎间盘突出症行保留椎体后壁的颈椎前路减压融合术治疗,评价其疗效.结果 平均手术时间90min,出血量200ml,本组病例均获得随访,平均随访时间1.3年,植骨全部获得骨性愈合,参照日本骨科学会(JOA)评分16.7分,改善率92%.结论 保留椎体后壁的颈椎前路减压融合术具有手术时间短、手术风险小、减压彻底、术后并发症少、植骨愈合率高等优点,是治疗多节段颈椎间盘突出症可选择的手术方法 .     

保留椎体后壁的前路减压术治疗多节段颈椎病

目的探讨保留椎体后壁的颈前路减压融合术对多节段脊髓型颈椎病的疗效,并与传统的椎体次全切除术比较。方法2006年3月~2007年4月,收治多节段脊髓型颈椎病患者36例,其中男22例,女14例,年龄为38~72岁,平均55.61岁。以上病例随机分成2组,每组18例,分别行传统的椎体次全切除术和保留椎体后壁的颈前路椎体次全切除植骨融合术。比较两组手术时间、出血量、并发症、术后JOA评分、植骨融合率等各项指标。结果两种术式术后3个月植骨融合率均为100%,JOA评分改善无明显差异。保留椎体后壁组手术时间短,出血少。结论保留椎体后壁的颈前路减压融合术具有手术时间短、出血少、手术风险小、减压彻底等优点,对颈椎椎体结构干扰破坏小,植骨融合率高,术后并发症少,是一种比传统的椎体次全切除植骨融合术更理想的术式。     

Effect of heterotopic ossification after bryan-cervical disc arthroplasty on adjacent level range of motion: A finite element study

BackgroundQuantitative bone re-modelling theories suggest that bones adapt to mechanical loading conditions. Follow-up studies have shown that total disc replacement (TDR) modifies stress patterns in the bones, leading to heterotopic ossification (HO). Although there are a few studies on HO using finite element models (FEM), its effect on the adjacent levels and change in range of motion (ROM) have not been adequately investigated. This study interfaces the HO using bone re-modelling algorithm with a finite element solution and investigates the subsequent changes in segmental ROM.MethodsA FEM of the human cervical spine (C3–C7) was developed for this study, with material properties obtained from literature. The motion of the segments in the sagittal, frontal and transverse planes under combined loading conditions of 1 Nm moment and 73.6 N compression were validated against experimental corridors. The natural disc between the C5–C6 segment was replaced with the Bryan artificial cervical disc, and changes in sagittal ROM were compared before and after HO. The process of HO was simulated using a bone remodelling algorithm using strain energy density (SED) as the mechanical stimuli.Results and conclusionOur study demonstrates the feasibility of using SED calculations from the flexion-extension loading conditions for prediction of HO after ADR. The current findings suggest that the nature of trabecular stresses, and the subsequent rate and location of HO formation could differ based on the geometric design and nature of constraint for different artificial discs. The Bryan disc significantly reduced ROM at the implanted level in flexion. However, in extension, ROM increased at the implanted level and decreased slightly at the adjacent levels. After HO, ROM drastically reduced at the implanted level in both extension and flexion, and showed a minor increase in the adjacent levels, indicating that biomechanical behavior of high-grade HO is similar to a fused segment, thereby reducing the intended and initial motion preservation.     

The factors that influence the postoperative segmental range of motion after cervical artificial disc replacement

Background contextAdvantages of cervical artificial disc replacement (ADR) are to preserve segmental range of motion (ROM) and avoid adjacent segmental disease. To achieve successful outcome after cervical ADR, ROM maintenance is important, but few authors have investigated the factors that influence the postoperative segmental ROM.PurposeTo evaluate the factors that influence the postoperative segmental ROM after cervical ADR.Study design/settingA retrospective clinical study.Patient sampleForty-one consecutive cervical ADR cases were analyzed.Outcome measuresDisc height, segmental and overall ROM, and clinical parameters checked with Neck Disability Index (NDI) and visual analog scale (VAS) in neck and arm pain were assessed.MethodsThere were 21 men and 20 women with a mean age of 45 years (range, 27–61 years). All cases were followed up for more than 2 years (range, 24–54 months; average, 31 months). Angles of the inserted implant on the immediate postoperative lateral radiographs, segmental and overall ROM (full flexion angle?full extension angle), disc height increment (immediate postoperative disc height?preoperative disc height), and adjacent segment changes at cephalad and caudal disc space were measured. Correlations between the factors and segmental ROM at last follow-up were analyzed.ResultsMean preoperative NDI was improved from 61.0 preoperatively to 11.5 at last follow-up, and mean VAS in the neck pain decreased from 56.8 preoperatively to 11.8 postoperatively and arm pain decreased from 68.1 to 18.0. The mean preoperative segmental ROM changed from 7.4±3.2° preoperatively to 10.4±5.9° at last follow-up, and mean preoperative disc height increased from 6.4±1.0 (4.1–8.4) mm preoperatively to 7.9±1.0 (6.3–9.9) mm postoperatively. The segmental ROM at last follow-up was not significantly correlated with preoperative segmental and overall ROM, angle of inserted implant, VAS, or age (p>.05). However, the segmental ROM at last follow-up was significantly correlated with the disc height increment (p=.046, r=0.374) and preoperative NDI (p=.026, r=0.412). The patient group with the postoperative segmental ROM greater than 10° had a significantly lower mean preoperative disc height than the group with the segmental ROM less than 10° (p=.050).ConclusionsAt a minimum of 2 years after cervical ADR, clinical outcomes were satisfactory in terms of function and pain scores. Within our results, the segmental ROM was not affected by preoperative ROM but postoperative disc height increment positively and preoperative disc height negatively.     

Biomechanical analysis of the disc adjacent to posterolateral fusion with laminectomy in lumbar spine

OBJECTIVES: After posterolateral fusion with laminectomy for the degenerative lumbar spine, accelerated degeneration of the disc adjacent to the fusion mass has been clinically observed. Previous studies used a finite element model (FEM) to calculate the stress of the adjacent disc in the fused lumbar spine with spinal fixator and bone graft. However, little emphasis was placed on the simultaneous spinal fusion and decompression procedure. To investigate if the spinal decompression procedure in posterolateral fusion would increase stress significantly, the FEM was employed to estimate the stress concentration of the disc above the fusion mass in posterolateral fusion with laminectomy and hemilaminectomy. METHODS: Three FEMs of the lumbar spine were established: intact spine, posterolateral fusion with total laminectomy, and posterolateral fusion with hemilaminectomy (preserved partial lamina, spinous process, and supraspinous and interspinous ligaments). The posterolateral fusion added spinal fixator and bone graft between the transverse process. The L1 vertebral body was subjected to 10-Nm flexion, extension, torsion, and lateral bending. The bottom of the L5 vertebral body was fixed. RESULTS: In flexion, the stress on the adjacent disc in posterolateral fusion with laminectomy and hemilaminectomy respectively increased 90% and 21% over that of the intact spine. In posterolateral fusion with hemilaminectomy, the supraspinous and interspinous ligaments shared some external forces to alleviate the stress concentration of the adjacent disc. However, in extension, torsion, and lateral bending, these two fusion models had almost no change in range of motion and stress of adjacent disc. CONCLUSION: Posterolateral fusion with hemilaminectomy (preserved partial lamina, spinous process, and supraspinous and interspinous ligaments) was able to alleviate the stress concentration of the disc above the fusion mass in flexion.     

Effect of cervical dynamics on adjacent segment degeneration after anterior cervical fusion with cages

The objective of this study is to evaluate the effect of anterior cervical discectomy and fusion (ACDF) on the motion of the cervical spine and dynamic stress (tendency to kyphosis) on adjacent segments and on the overall spinal alignment which may predispose to symptomatic disc diseases at other levels. Twenty consecutive patients underwent ACDF with a mean follow-up of 28 months (range 13-38). Preoperative and postoperative clinical assessments were done by using the neck disability index (NDI) and the Japanese Orthopedic Association (JOA) score. In all cases, at the last follow-up control, a neuro-radiographic assessment [cervical spine static and dynamic X-ray and magnetic resonance imaging (MRI)] was done. The angle of the operated disc space, the disc space angle of contiguous segments, and their range of motion (ROM) and the kyphotic Cobb angle (C2-7) were measured by computer software. The study was done at Sant'Andrea Hospital, Rome, Italy in the period from November 2003 to November 2005. We observed that: the mean Cobb angle improved significantly (p < 0.001) from 3.4 degrees (kyphosis) to postoperative 14.5 degrees . This normalization of angle showed a direct effect on improvement of myelopathic patients, but it had a statistically nonsignificant effect on adjacent segments degeneration (ASD). The mean segmental ROM of adjacent segments did not show significant instability. The mean was 11.1 degrees at upper and 10.2 degrees at lower levels (close to normal). In six cases, the ROM was higher than normal: five of these patients demonstrated symptomatic adjacent segment pathology. Postoperative improvement of mean JOA and NDI scores was statistically significant (p < 0.001). Anyway, symptomatic ASD was observed in five patients (20%): in four of them, the higher disc spaces and in one, the lower disc spaces were involved. In four cases, the preoperative MRI showed slight and asymptomatic disc degeneration at the same levels involved subsequently. This ASD was significantly related to the increased ROM at the segments involved. Follow-up X-rays showed solid fusion with absence of movement in all but one case (at 13-month follow-up), who showed slight movement in the operated level in spite of clinical improvement. The follow-up MRI showed, in all cases, good decompression in the treated levels. Compensatory increase in ROM of the contiguous motion segments in patients subjected to ACDF may lead to ASD especially in those cases with asymptomatic adjacent subclinical degenerative disease. If these preliminary results will be confirmed by larger series, it could be reasonable in young selected patients with soft disc herniation to adopt total disc arthroplasty instead of fusion after cervical micro-discectomy.     

Anschlusssegmentbeweglichkeit nach monosegmentaler Bandscheibenprothesenimplantation und monosegmentaler Fusion Segment L4/5

Background

Preservation of movement at the treated segment and possible reduction of adjacent segment effects is assumed to be an advantage of non-fusion technologies over fusion. The aim of this study was to compare the segmental range of motion (ROM) at the operative level, the cranial and caudal adjacent levels and the global lumbar spine ROM (L2-S1) after monosegmental fusion and total disc replacement (TDR).

Patients and methods

Radiographic data was collected from 27 patients with level 1 degenerative disc disease operated at level L4/5. The ROM was assessed at the index level (L4/5), the cranial and caudal adjacent level and for the lumbar spine (L2-S1).

Results

In the TDR group no significant changes of lumbar spine ROM (L2–S1) and segmental ROM (index level, cranial and caudal adjacent level) were noticed. In the fusion group there was a significant reduction of lumbar ROM (L2-S1) and index level ROM. Additionally the relative ROM in the adjacent caudal segment significantly increased while no changes were seen in the cranial segment.

Conclusion

The relative ROM was significantly increased in monosegmental fusion at level L4/5 compared to TDR. To what extent this fact may result in early adjacent segment degeneration in cases of fusion compared to TDR is still unknown.     

Long-term flexion-extension range of motion of the prodisc total disc replacement

The rationale for total disc replacement is avoidance of the junctional degeneration seen after arthrodesis by preservation of segmental motion. To justify the use of disc prostheses, it is essential to document maintained range of motion (ROM) and sagittal alignment at long-term follow-up. This is a retrospective radiographic study of 42 patients who had placement of 58 first-generation Prodisc prostheses at a mean follow-up of 8.7 years. Flexion-extension ROM was measured by Cobb's method. Junctional levels were evaluated for junctional degeneration. Pre- and postoperative global and segmental lordosis were measured. Prognostic patient factors predicting ROM of <2 degrees were evaluated. We observed ROM of at least 2 degrees in 66% of Prodisc prostheses at 8.7-year follow-up, although ROM was less than that reported in asymptomatic normal individuals. Mean ROM for disc prostheses with motion was 7.5 degrees at L3-L4, 6.2 degrees at L4-L5, and 4.1 degrees at L5-S1. Mean ROM for all prostheses was 3.8 degrees. The incidence of radiographic junctional degeneration was 24%, although no patients required surgery for symptomatic junctional degeneration. Mean ROM of prostheses below a degenerated junctional disc was 1.6 degrees compared with 4.7 degrees below a normal junctional disc (P < 0.035). Females were 3.5 times more likely to have ROM of <2 degrees. This is the longest published follow-up study of a lumbar disc replacement. The data show that ROM is preserved at long-term follow-up in the majority of patients. Global and segmental sagittal alignment improve after surgery. Furthermore, there is an association between ROM of disc prostheses and the development of junctional degeneration.     

单节段Bryan人工椎间盘置换术后异位骨化形成对置换节段活动度的影响

目的探讨单节段Bryan人工椎间盘置换术后异位骨化（heterotopic ossification,HO）形成及其对置换节段活动度（range of motion,ROM）的影响。方法回顾分析2003年12月～2009年8月期间接受单节段前路减压及Bryan人工椎间盘置换术的患者40例。患者平均随访38.8个月。应用医学影像存储与传输系统观察随访时的HO形成情况并测量手术前后置换节段ROM。利用独立样本t检验分析HO形成与否以及不同HO分级与置换节段ROM间的关系。结果本组研究中单节段Bryan人工椎间盘置换术后HO的发生率为37.5%,对发生HO的患者采用McAfee分级：Ⅰ级2例,Ⅱ级3例,Ⅲ级8例,Ⅳ级2例。所有患者术前颈椎ROM平均为8.82°,随访时为8.52°。其中未发生HO的患者随访时ROM平均为9.77°,发生HO的患者随访时ROM平均为6.43°,差异有统计学意义（P〈0.05）。Ⅰ级和Ⅱ级的HO患者随访时ROM平均为8.76°,Ⅲ级和Ⅳ级的患者为5.26°,差异有统计学意义（P〈0.05）。结论 Bryan人工椎间盘置换术后形成HO会导致置换节段ROM的减少,McAfee分级Ⅲ、Ⅳ级的HO患者较之Ⅰ、Ⅱ级更加明显。     

Long-term kinematic analysis of cervical spine after single-level implantation of Bryan cervical disc prosthesis

Background contextCervical arthroplasty theoretically reduces the risk of adjacent level disc degeneration and segmental instability that may be seen after a cervical fusion. An essential argument in confirming the utility of cervical arthroplasty is long-term confirmation that cervical disc replacements can maintain physiological kinematics at the index and adjacent levels.PurposeThe purpose of this in vivo prospective study was to characterize the long-term segmental kinematic outcomes after cervical arthroplasty.Study design/settingProspective cohort study.Patient sampleTwenty patients with a 5-year clinical follow-up who underwent anterior cervical discectomy with insertion of the Bryan cervical disc.Outcome measuresPhysiological measures (kinematic analysis of lateral neutral, flexion, and extension radiographic imaging).MethodsTwenty consecutive patients with degenerative disc disease were followed with regular radiographic imaging after implantation of the Bryan cervical disc prosthesis. Lateral neutral, flexion, and extension radiographs (n=240) were analyzed using Quantitative Motion Analysis software (Medical Metrics, Inc., Houston, TX, USA) to measure the biomechanical profile at the index level and adjacent levels up to 5 years after surgery. Parameters collected included range of motion (ROM), functional spinal unit (FSU) angle, anterior and posterior disc heights, sagittal translation, and center of rotation (COR).ResultsBiomechanics of the implanted artificial cervical disc was maintained up to 5 years with no significant changes in ROM, FSU angle, disc height, sagittal translation, and COR values when compared with early postoperative performance. Artificial discs were able to adequately restore and maintain preoperative kinematics. Early differences seen in disc height and FSU angle did not change during the duration of follow-up. No significant kyphotic changes or decrease in ROM were seen at the adjacent spinal levels.ConclusionsThe Bryan cervical disc prosthesis provides for a durable solution for functional spinal motion at the operated level and maintained the preoperative kinematics at adjacent levels at the 5-year follow-up.     

The change of whole lumbar segmental motion according to the mobility of degenerated disc in the lower lumbar spine: a kinetic MRI study

Purpose

To analyze the effects of mobility of degenerated disc in the lower lumbar discs (L4–5 and L5–S1) on both whole lumbar motion and adjacent segment ROM.

Methods

The kMRIs with disc degeneration at L4–5 or L5–S1 were classified into three groups: the normal group, the motion-preserved (MP) group and the motion-lost (ML) group based on range of motion (ROM) of 5° in the degenerated segment. Each segmental ROM, whole lumbar motion, and the contribution % of the upper lumbar spine (ULS: L1–2–3) and the lower lumbar spine (LLS: L4–5–S1) motion to whole lumbar motion were measured and compared with each of the other groups.

Results

There were 94, 99 and 66 patients in the normal group, MP group and ML group, respectively. The normal group showed no significant difference compared to the MP group in all ROM parameters. The ML group showed significantly less whole lumbar motion, more contribution % in the ULS and less in the LLS than the normal and the MP groups. The ROM in the superior adjacent segment in the ML group was not significantly different between that in the normal and MP group.

Conclusions

Degenerated lumbar discs did not show hypermobility within functional ROM. Loss of segmental ROM from advanced disc degeneration did not cause an increase in the ROM of the superior adjacent segment in vivo. When the LLS had motion-lost, advanced disc degeneration, whole lumbar motion was significantly decreased and compensatory increase in ROM was accomplished by the ULS.

     

颈前路单椎间减压植骨融合与加用钛板内固定的比较研究

目的通过生物力学研究和临床随访研究,探讨对无明显后凸畸形和节段不稳的单节段颈椎间盘突出症或颈椎病患者行前路单椎间减压植骨融合后是否有必要加用钛板内固定。方法采用16具新鲜尸体颈椎标本,测量单纯植骨组和加用钛板内固定组在2.0Nm纯力矩载荷下的运动范围;应用有限元力学分析计算出各时相两组的骨痂强度及与融合节段相邻部分的平均应力水平。临床随访同时期施行单纯植骨融合的27例与加用钛板内固定的18例患者,比较3年以上疗效;同时随访行单纯植骨融合的33例患者,评价10年以上疗效。结果尸体标本生物力学试验结果显示术后即刻加用钛板内固定组的稳定性高于单纯植骨融合组(P<0.05)。有限元力学分析显示:术后0.5年起单纯植骨融合组的骨痂强度和融合节段相邻的C5椎体平均应力水平与加用钛板内固定组基本相当;颈椎前部结构总体应力水平随植骨融合而增加,后部结构总体应力水平随植骨融合而减小。单纯植骨融合组与加用钛板内固定组术后3年以上随访疗效相当;单纯植骨融合术后10年以上随访总体疗效满意。结论对不伴明显后凸畸形和节段不稳的单节段颈椎间盘突出症或颈椎病,前路单椎间减压植骨融合与加用钛板内固定的疗效相当。