前路椎体次全切除减压融合术治疗下颈椎的有限元分析

发布时间：2018-03-16 22:14

本文选题：前路椎体次全切除减压融合术　切入点：钛网植骨　出处：《医用生物力学》2017年03期 　论文类型：期刊论文

【摘要】：目的建立人体下颈椎C3~7节段前路椎体次全切除钛网植骨融合术的三维有限元模型,分析术后椎体稳定性及内固定器械的应力分布。方法建立前路椎体C5节段次全切除钛网植骨钢板螺钉内固定颈椎C3~7节段有限元模型,同时建立C3~7节段下颈椎原始模型。对术后模型分别施加0.5、1.0、1.5、2.0 N·m扭矩,分析前屈、后伸、侧弯及轴向旋转时关节活动度(range of motion,ROM)、关节突关节最大应力与内固定器械整体应力分布情况。结果前路椎体次全切除减压融合术(cervical corpectomy and fusion,ACCF)后,C5重建节段ROM随扭矩的增大而增加,与无损模型在1.0 N·m、预载荷50 N工况下相比,C5重建节段、C3~4,C6~7和C3~7节段ROM分别下降81%、62%、58%和80%;C5重建节段后方关节突关节最大应力减小,临近节段关节突关节应力显著升高;钛网应力主要分布于运动受压侧,螺钉根部承受较大载荷。结论 ACCF术式会较大提升颈椎稳定性,降低手术节段后方关节突关节应力,对于减缓因脊髓型颈椎病引起的脊髓压迫有较好疗效。研究结果可为ACCF手术的临床应用研究提供理论依据。
[Abstract]:Objective to establish a three-dimensional finite element model of human cervical spine C3~7 segment of anterior corpectomy with titanium mesh and bone graft, the analysis of stress distribution of vertebral stability and internal fixation. Methods anterior segment C5 subtotal titanium mesh bone plate and screw fixation of cervical spine C3 segment ~7 finite element model at the same time, the establishment of the original model of cervical segment C3~7. The postoperative 0.5,1.0,1.5,2.0 N M model was applied to analysis of torque, flexion, extension, lateral bending and axial rotation ROM (range of, motion, ROM), facet joint maximum stress and internal fixation devices overall stress distribution results. Anterior cervical corpectomy and fusion (cervical corpectomy and fusion, ACCF) after C5 reconstruction segment ROM increased with the increase of torque, and the lossless model in 1 N - m, compared to pre load 50 N under the condition of C5 reconstruction segment, C3~ 4, C6~7 and C3~7 ROM fell 81%, 62%, 58% and 80%; C5 reconstruction of segmental rear facet joint maximum stress decreases near the facet joints stress significantly increased; titanium mesh stress is mainly distributed in the movement of the compression side, the root of the screw under high load. Conclusions the ACCF surgery will greatly enhance the stability of the cervical spine, reduce surgical segment rear facet joint stress, to slow due to cervical spondylotic myelopathy, spinal cord compression has a good effect. Provide a theoretical basis for the clinical application of the results can be used for the ACCF operation.

【作者单位】：上海理工大学医疗器械与食品学院;上海理工大学能源与动力工程学院;上海市杨浦区中心医院骨科;
【基金】：国家自然科学基金项目(11502146) 上海市自然科学基金项目(15ZR1429600) 上海市科委科研计划项目(13DZ2260900)
【分类号】：R318.01;R687.3

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