2013-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/656799摘要：頸椎脊髓神經病變是常見的頸椎疾病，形成的原因包含：椎間盤突出(HIVD) 或後縱韌帶鈣化(OPLL)導致神經腔狹窄等。通常病變椎節在三節以內，以實施 前路減壓融合手術為主。手術可減緩病人的症狀，但長期而言，鄰近節活動度的 代償性上升，會引發鄰近節椎間盤提早退化。對於有四節以上的脊神經病變病 人，通常選擇後方椎弓板整形術或椎弓板移除術，術後併發症則有；病人頸椎自 然屈度的喪失，頸椎活動度降低與劇烈的頸痛與旋轉障礙等。目前對於頸椎脊髓 神經病變，前路減壓手術及後路椎板整形術已有良好的臨床效果，但是其鄰近節 退化及頸椎活動度降低的後遺症仍然困擾著醫事人員。對於實施融合手術的節數 選擇、是否保留韌帶及術後物理治療的策略，目前並沒有明確的指導原則或是評 估方法。本計畫擬使用動物體外屍骨模型及人體屍骨模型進行三年期研究，目標為提 供脊椎經各式手術後的穩定度分析給總計劃，以便讓總計劃發展一套適用於頸椎 脊髓神經病變之手術規劃與術後物理治療方式的評估方法。本計劃第一年將建立 體外動物的OPLL和HIVD生物力學測試模型，以用於研究對於頸椎脊髓神經病 變的頸椎生物力學反應之影響。第二年將研究不同術式、手術的節數及是否保留 韌帶等因子對於頸椎穩定度的影響，並討論載荷方式影響。第三年將研究肌肉訓 練對於病患術後頸椎穩定度及物理治療計畫的影響，並針對前述實驗結果提出更 合適的治療方式。本實驗的結果有助於對頸椎脊髓神經病變性質的深入了解，不 僅能讓我們改善頸椎脊髓神經病變手術後遺症，亦能提供病人術後的物理治療策略。<br> Abstract: Radiculomyelopathy is a leading disease of spinal cord dysfunction in the elderly population. Radiculomyelopathy is usually the result of ossification of posterior longitudinal ligament (OPLL), herniation of intervertebral disc (HIVD) or other spinal disorders. Anterior decompression with fusion and posterior laminoplasty are frequently used surgical procedures to treatment cervical radiculomyelopathy. The cervical surgeries usually provide good clinical outcomes. However, long term follow-up reveals that complications such as the early degeneration change at the adjacent segment, abnormal kyphotic cervical alignment and severely neck pain are frequently observed. Till now, there is no clear evaluation tool for surgical surgeon and physical therapist to decide the surgery method or rehabilitation strategies.The purpose of this study is to develop a biomechanical model to analyze the spinal stability after varies of surgery methods. The results of this project will be send to the main project; which is to develop a guide line for surgery and rehabilitation strategies of cervical radiculomyelopathy. The in vitro human cadaveric and porcine biomechanical model will be used for this study. The first year of this project is to develop an in-vitro experimental spine model with core muscle function to simulate pathological OPLL and HIVD change. The second of this project is to realize the biomechanical effect of different surgery approach, surgery level, and the muscle function for better surgical strategies. The third year is to study the effect of core muscle training for the stability of cervical spine post surgery. The results of this study will provides the theoretical basis of the surgical and rehabilitation strategies for cervical radiculomyelopathy.頸椎脊髓神經病變減壓手術椎弓板整形術物理治療radiculomyelopathydecompressionlaminoplastybiomechanicsphysical therapy