两种齿状突切除术对颅颈交界区稳定性影响的有限元分析

发布时间：2018-02-04 07:20

本文关键词： 颅颈交界区齿状突切除术有限元稳定性　出处：《中国耳鼻咽喉颅底外科杂志》2016年06期 　论文类型：期刊论文

【摘要】：目的通过构建上颈椎有限元模型研究两种齿状突切除术对颅颈交界区(craniocervical junction,CCJ)稳定性影响的生物力学差异。方法采用有限元软件构建Oc-C2的正常上颈椎实体模型,然后在正常模型的基础上构建常规齿状突切除模型及保留C1前弓的微创齿状突切除模型,进而在有限元软件ABAQUS v6.9.1.中分析各种模型的生物力学差异,从而得出齿状突切除术中保留C1前弓的生物力学优势。结果常规齿状突切除术对C1-C2的活动度影响较Oc-C1显著,各向活动度增加分别为前屈23%、后伸97%、侧弯231%、轴向旋转349%;对Oc-C1的稳定性同样有明显影响,其中Oc-C1后伸活动度影响最大,增加达196%。保留C1前弓的齿状突切除术可明显缩减C1-C2轴向旋转活动度的增加,实验中仅出现轻度代偿性的活动度减少;而其他方向活动度仍有异常的增加(Oc-C1后伸活动度增加167%、C1-C2侧弯活动度增加181%)。结论齿状突切除术对C1-C2的活动度影响显著,但对Oc-C1的活动度同样有明显影响。保留C1前弓的齿状突切除术可保护脊柱轴向旋转的活动度,但仍存在脊柱不稳定因素。
[Abstract]:Objective to construct the finite element model of the upper cervical spine of two odontoid resection of craniocervical junction (craniocervical junction, CCJ). Cervical biomechanical differences affect the stability of solid model construction method Oc-C2 using finite element software to normal, and then construct the odontoid process of conventional minimally invasive resection of odontoid process model and retention of C1 anterior arch resection model on the basis of the normal model, and biomechanical analysis of differences between the various models in finite element software ABAQUS v6.9.1., so that odontoidectomy retains the biomechanical advantages of anterior arch of C1 during operation. The results of conventional odontoid resection of effect of surgery on the C1-C2 than the Oc-C1 activity increased significantly, anisotropy respectively reach 23%, extension 97%, 231% and 349% lateral bending, axial rotation; stability of Oc-C1 have the same effect, the Oc-C1 extension activity increased to the greatest impact, 196%. keep C1 anterior arch The odontoid resection can significantly reduce the increase of C1-C2 axial rotation degree, only mild compensatory activity decreased in the other direction and experiment; activity is abnormal increase (Oc-C1 extension activity increased 167% C1-C2, lateral bending activity increased 181%). Conclusion odontoid resection surgery on the effect of activity C1-C2 is significantly, but the Oc-C1 activity also had obvious effects. Keep C1 anterior arch of odontoid resection can protect the activity of spinal rotation axis, but there are still some spinal instability.

【作者单位】：中国人民解放军武汉总医院神经外科;第二军医大学附属上海长征医院神经外科;
【基金】：湖北省自然科学基金项目青年基金(2015CFB382) 武汉市中青年医学骨干人才培养工程
【分类号】：R687.3
【正文快照】： 前路齿状突切除术是解决颈延髓腹侧压迫的有效手术入路,但其对颅颈交界区(craniocervical junc-tion,CCJ)的稳定性有着非常严重的影响,临床中超过2/3的患者在齿状突切除术后表现出明显的脊柱不稳[1-3]。先前的in vitro研究分析了该手术对C1-C2的生物力学影响[4],但其并未分析

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