新型后路寰枢椎限制性非融合内固定系统的有限元分析

发布时间：2018-04-19 17:52

  本文选题：枢椎 + 颈椎　； 参考：《中国组织工程研究》2017年03期

【摘要】：背景:寰枢椎融合是目前治疗寰枢椎脱位的主要修复方式,但是其前提是牺牲寰枢椎活动为代价,特别是旋转功能。限制性非融合内固定是一种既可以维持寰枢椎稳定性,又可保留寰枢椎活动功能的方法,其生物力学特点与传统融合术之间的差异有待进一步研究。目的:通过建立寰枢椎不稳的三维有限元模型并模拟后路寰枢椎限制性非融合内固定系统和后路寰枢椎钉棒内固定系统,验证该新型内固定系统的生物力学特性。方法:选择1名31岁成年健康男性志愿者,采集从枕骨底到第3颈椎(C0-C3)的CT数据,应用Simpleware3.0、Geomagic 8.0、Hypermesh 10.0、Abaqus 6.9、Rhino 4.0软件构建有限元模型。施加1.5 N·m的纯力偶矩,使模型在屈伸、侧弯、旋转方向上运动,将模型的椎间活动度与文献报道的体外生物力学实验数据相比进行验证。建立后路寰枢椎限制性非融合内固定系统模型和后路寰枢椎钉棒内固定系统模型,对比两种模型在前屈、后伸、侧弯、旋转等工况下的椎间活动度,记录下限制性非融合内固定系统模型的SMise应力云图。结果与结论:(1)实验建立了健康人的上颈椎(C0-C3)三维非线性有限元模型,模型包括206 747单元,72 500个节点,其外形逼真,椎间活动度与文献报道的体外生物力学实验结果吻合;(2)限制性非融合内固定系统模型C1-C2节段前屈、后伸工况的活动度与传统钉棒内固定系统模型相似;(3)在左右侧屈工况下,传统钉棒内固定系统模型C1-2间的侧屈活动度明显受限,而限制性非融合内固定系统模型的活动度比寰枢椎脱位模型有所增加,与正常寰枢椎模型基本相同;(4)在左右旋转工况下,传统钉棒内固定系统模型寰枢椎之间的旋转活动度基本消失,而限制性非融合内固定系统模型其活动度虽有所减少,但仍保留大部分旋转活动度;(5)限制性非融合内固定系统模型在螺钉与连接棒、连接杆接触部位出现应力集中;(6)结果表明,后路寰枢椎限制性非融合内固定系统是一种实用、有效的寰枢椎内固定方式,该限制性非融合内固定装置具有限制屈伸活动,并且有效保留寰枢椎轴向旋转和侧弯活动功能的特点。
[Abstract]:Background: atlantoaxial fusion is the main repair method for atlantoaxial dislocation at present, but its premise is to sacrifice atlantoaxial activity, especially rotational function.Restrictive non-fusion internal fixation is a method which can maintain the stability of atlantoaxial vertebra and preserve the function of atlantoaxial movement. The difference between its biomechanical characteristics and traditional fusion needs to be further studied.Objective: to verify the biomechanical characteristics of the new internal fixation system by establishing a three-dimensional finite element model of atlantoaxial instability and simulating the posterior atlantoaxial limited non-fusion internal fixation system and the posterior atlantoaxial screw rod internal fixation system.Methods: Ct data from occipital floor to C0-C3 of the third cervical vertebra were collected from a 31-year-old adult male volunteer. The finite element model was constructed with Simpleware 3.0 Geomagic 8.0 HyperMesh 10.0 Abaqus 6.9 Rhino 4.0 software.The pure force couple moment of 1.5 N m was applied to make the model move in the direction of flexion, extension, lateral bending and rotation. The intervertebral activity of the model was compared with the biomechanical data reported in the literature in vitro.The posterior atlantoaxial limited non-fusion internal fixation system model and the posterior atlantoaxial screw rod internal fixation system model were established to compare the intervertebral mobility of the two models under the conditions of anterior flexion, extension, lateral bending and rotation.The SMise stress cloud of the restricted nonfused internal fixation system model was recorded.Results and conclusion\\\The results of in vitro biomechanical experiments were in agreement with the results of in vitro biomechanical experiments reported in the literature. (2) the model of C1-C2 segment anterior flexion and extension were similar to those of the traditional screw rod internal fixation system model under the condition of left and right flexion.The lateral flexion activity of the traditional screw rod internal fixation system model C1-2 is obviously limited, while that of the restricted non-fusion internal fixation system model is higher than that of the atlantoaxial dislocation model, which is basically the same as that of the normal atlantoaxial system model.The rotation activity between atlantoaxial vertebrae of the traditional screw rod internal fixation system model was basically disappeared, but the limited non-fusion internal fixation system model had a decrease in the range of motion.The results showed that the posterior atlantoaxial limited non-fusion internal fixation system was practical.Effective atlantoaxial internal fixation, the limited non-fusion internal fixation device has the characteristics of limiting flexion and extension activities, and effectively preserving the atlantoaxial rotation and lateral bending functions.
【作者单位】： 解放军第二军医大学附属长征医院骨科;解放军第451医院创伤显微外科;上海交通大学附属瑞金医院伤骨科研究所;解放军福州军区总医院骨科;
【分类号】：R318
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