| Part Ⅰ Imaging measurement of uncinate process and foramen intervertebrale of cervical spondylotic radiculopathy and their correlation analysisObjective:The purpose of this study was to measure the volume of the uncinate process,the area of the corresponding foramen and the degree of degeneration of the nucleus pulposus in patients with cervical spondylotic radiculopathy,and to explore the relationship between the volume of the uncinate process,the volume of the uncinate process and the size of the foramen.Methods:From January 2018 to June 2019,Thirty-eight patients with cervical spondylotic radiculopathy diagnosed by the First Affiliated Hospital of Guangxi Medical University and the first people’s Hospital of Changde City were selected in this study.The general data and MRI imaging data of the patients were collected.The degenerated discs were divided into four groups by using the Videman Grading criteria:group 1,score 0,relatively normal disc group without degeneration 2,score 1-3,mild degeneration group;group 3,score 4-6,moderate degeneration group;group 4,score 7-9,severe degeneration group.The volume of uncinate process and the area of intervertebral foramen were measured by computer software,and the relationship among the volume of uncinate process,the corresponding area of intervertebral foramen and the level of nucleus pulposus degeneration was analyzed.Results:From the upper segment of the cervical spine to the lower segment,the higher the score of nucleus pulposus,the larger the volume of uncinate process and the smaller the area of intervertebral foramen were found(P<0.05).The volume of right uncinate process was larger than left uncinate process in the C6 vertebral body(P<0.05).Comparing the volume of uncinate process and the area of intervertebral foramen in each group,we found that there were significant differences in the size of uncinate process and the area of intervertebral foramen between the groups corresponding to C2/3 and C5/6,P<0.05;there were no significant differences in the size of uncinate process between the groups corresponding to C3/4 and C6/7,P>0.05,but there were significant differences in the size of intervertebral foramen between the groups corresponding to C3/4 and C6/7,P<0.05;There was no significant difference in the size of uncinate process and the area of intervertebral foramen between the groups corresponding to C4/5(P>0.05).In the correlation analysis,C4/5,C5/6 and C6/7 foramen area were negatively correlated with the corresponding disc nucleus pulposus score(r=-0.264,r=-0.627,r=-0.573,P<0.05).There was a negative correlation between the volume of C5,C6 and C7 uncinate process and the corresponding foramen area(r=-0.256,r=-0.465,r=-0.292,P<0.05);there was a positive correlation between the uncinate process of C6 and C7 and the corresponding disc nucleus pulposus score(r=0.399,r=0.369,P<0.05).Conclusion:The volume of uncinate process increases with the degree of degeneration of nucleus pulposus,while the area of intervertebral foramen decreases with the degree of degeneration of nucleus pulposus in the cervical spondylotic radiculopathy.The volume of the right uncinate process is larger than that of the left,which may be related to the habitual right hand labor.The volume of the uncinate process in the lower cervical spine was positively correlated with the score of the nucleus pulposus;the area of the foramen was negatively correlated with the score of the nucleus pulposus;and the volume of the uncinate process was negatively correlated with the area of the corresponding foramen.Part Ⅱ Biomechanical study on the effect of ACDF combined with different degrees of uncinate process resection on the stability of cervical spineObjective:The purpose of this study is to evaluate the effect of different degrees of uncinate process resection on the stability of cervical spine by measuring the three-dimensional motion range of cervical spine specimens after ACDF combined with different degrees of uncinate process resection,so as to provide theoretical basis for the range of clinical partial uncinate process resection.Methods:Seven fresh cadaver specimens of C3-C7 were selected from the Department of anatomy,Southern Medical University.No obvious bone destruction and deformity were found after careful observation and examination with naked eyes.The pathological specimens of fracture,dislocation,tuberculosis and tumor were excluded by X-ray.After the preparation of the specimens,the control group with complete structurc was named as group A,the specimens treated by ACDF were named as group B,the specimens treated by ACDF combined with unilateral partial uncinate process resection were named as group C,the specimens treated by ACDF combined with bilateral partial uncinate process resection were named as group D,and the specimens treated by ACDF combined with bilateral total uncinate process resection were named as group E.CT scanning and three-dimensional reconstruction were performed on each specimen after operation.The volume of uncinate process,the area of intervertebral foramen and the corresponding area of uncinate joint surface were measured.Load tests were carried out in six directions:forward flexion,backward extension,left flexion,right flexion,left rotation and right rotation.The stability of each group was evaluated by comparing the movement range of six movement states.Results:The ROM of group B,C,D was smaller than that of group A and E in flexion state,and there was significant difference between group B and D(P<0.05);there was significant difference between group E and group B,C,D(P<0.05).In the state of extension,ROM of group B and C was smaller than that of group A and E(P<0.05);ROM of group D was smaller than that of group E(P<0.05);there was no significant difference between group D and that of group A,B and C(P>0.05).In the left flexion state,ROM of group A and group B was smaller than that of group E(P<0.05);there was no significant difference between group C and group D and that of group A,group B and group E(P>0.05).In the right flexion state,compared with the left flexion state,the ROM of group C was smaller than that of group E P<0.05;there was no statistical significance between groups A,B,C,D and between group D and group E,P>0.05.In left rotation state,ROM of group B and C was smaller than that of group A and E,P<0.05;there was significant difference between group D and group E,P<0.05;there was no statistical significance between group D and group A,B and C,P>0.05.The statistical data of each group in the right rotation state is less different from that in the left rotation state,and the statistical analysis significance is the same as that in the left rotation state.Conclusion:Anterior cervical fixation system can significantly enhance the stability of the corresponding segments of the cervical spine in all directions.When the volume of uncinate process was reduced by 25.9%and the corresponding area of articular surface of uncinate vertebrae was reduced by 35.6%,ACDF combined with unilateral partial uncinate process resection had no significant effect on the stability of cervical spine in all directions.When the volume of uncinate process was reduced by 45.9%and the corresponding area of articular surface of uncinate vertebrae was reduced by 79.2%,ACDF combined with bilateral partial uncinate process resection had a certain impact on the stability of cervical spine,especially in the flexion movement.The stability of ACDF combined with bilateral total uncinate process resection was poor in all directions.Part Ⅲ Application of anterior cervical decompression and fusion combined with partial uncinate process resection in cervical spondylotic radiculopathyObjective:The purpose of this study is to compare the C2-C7 Cobb angle,T1S angle,VAS and NDI at different time points between anterior cervical decompression and fusion combined with partial uncinate process resection and anterior cervical decompression and fusion,to evaluate the clinical effect of anterior cervical decompression and fusion combined with partial uncinate process resection in the treatment of cervical spondylotic radiculopathy,and to provide theoretical basis for the clinical application of partial uncinate process resection.Methods:From July 2015 to July 2019,53 cases(27 male,26 female)of cervical spondylotic radiculopathy with aged from 30 to 81 years(52.6±9.64 years)were analyzed retrospectively.Among them,5 cases of ACDF and 17 cases of ACCF were included in the simple group,7 cases of ACDF combined with uncinate process partial resection and 24 cases of ACCF combined with uncinate process partial resection were included in the resection group.The operation time,intraoperative blood loss,C2-C7 Cobb’s angle,VAS and NDI before and after operation were analyzed.Results:Fifty-three cases were followed up for 6-36 months,with an average of 22 months.The average operative time in the ACDF/ACCF+UR group and ACDF/ACCF group were(116.29±14.50)min and(107.59±15.59)min respectively,and the average blood loss during operation were(330.97±84.28)ml,(288.45±71.53)ml respectively.The C2-C7 Cobb angle and T1S angle of all patients increased significantly after operation,and there was no significant loss was found at the last follow-up(P<0.05).There was no significant difference between the two groups in C2-C7 Cobb angle and T1S angle at each time point(P>0.05).The VAS and cervical NDI in both groups at postoperative,3 months after operation and at the last follow-up were significantly improved compared with that those before operation.There was significant difference among three time points at preoperative,postoperative and 3 months after operation(P<0.05).At the last follow-up,VAS and cervical NDI of the two groups were slightly improved compared with 3 months after operation,but there was no significant difference(P>0.05).There was no significant difference between the two groups in VAS and cervical NDI at each time point(P>0.05).However,the VAS and NDI of the resection group were better than that of the simple group at postoperative.At the last follow-up,all patients were confirmed to have bone graft fusion by X-ray or CT examination.Conclusion:ACDF/ACCF and ACDF/ACCF+UR can improve C2-C7 Cobb angle and T1S angle.In the early postoperative period,ACDF/ACCF+UR is better than ACDF/ACCF in the improvement of pain and cervical function,and its clinical effect may be better. |
PDF Full Text Request