后路固定术治疗胸腰椎爆裂骨折的生物力学研究

发布时间：2019-01-21 20:44

【摘要】：为了给胸腰椎爆裂性骨折病人手术方式的选择提供理论支持和临床依据,建立T10-L2节段正常脊柱模型、爆裂性骨折模型,经伤椎单节段固定模型、经伤椎双节段固定模型和跨伤椎短节段固定钉模型。在T10上表面施加400 N的压缩载荷和7.5 N·m的力矩,模拟人体前屈、后伸、左/右侧弯和左/右侧旋转6种生理活动,利用有限元方法分析3种手术固定方式的生物力学特性。结果表明,与完整的正常脊柱模型相比,3种固定模型在所有运动状态下的活动度(ROM)均有所减少。相比经伤椎双节段内固定模型,经伤椎单节段内固定模型在前屈、后伸、左弯、右弯、左旋和右旋6种受力状态下,椎弓根螺钉上的应力分别增加了78.1%、87.8%、90.5%、81.3%、51.3%,72.3%。经伤椎单节段固定术系统的活动度和正常脊柱最为相似,其在恢复脊柱稳定性的同时可最大可能地保护脊柱原有的力学属性,但其钉棒的最大应力远高于经伤椎双节段固定术。对于失稳严重的损伤,经伤椎双节段固定术可明显降低螺钉应力,同时提高脊柱的稳定性。
[Abstract]:In order to provide theoretical support and clinical basis for the choice of surgical methods in patients with thoracolumbar burst fracture, T10-L2 model of normal spinal column, burst fracture model and single segment fixation model of injured vertebrae were established. The two-segment fixation model of injured vertebra and the short-segment fixation model of trans-injured vertebra. Applying a compression load of 400 N and a torque of 7.5 N m on the upper surface of T10, we simulated the physiological activities of human body flexion, extension, left / right bending and left / right rotation. The biomechanical characteristics of three kinds of surgical fixation methods were analyzed by finite element method. The results showed that the (ROM) of the three fixed models decreased in all motion states compared with the complete normal spinal model. Compared with the two-segment internal fixation model of injured vertebrae, the stress on pedicle screw increased by 78.1% and 87.8% respectively in flexion, extension, left bending, right bend, left rotation and right bending, respectively, in the single segment internal fixation model of injured vertebra, and the stress on pedicle screw was increased by 78.1% and 87.8%, respectively. 90.5 / 81.3 / 51.3 / 72.3. The range of motion of the single segment fixation system is most similar to that of the normal spinal column. It can protect the original mechanical properties of the spine as well as restore the stability of the spine, but the maximum stress of the screw rod is much higher than that of the double segment fixation of the injured vertebrae. For severe unsteady injuries, double segment fixation of injured vertebrae can significantly reduce screw stress and improve spinal stability.
【作者单位】：北京航空航天大学生物与医学工程学院;北京航空航天大学生物医学工程高精尖创新中心;首都医科大学附属北京宣武医院骨科;
【基金】：国家自然科学基金(11372029,81672201)
【分类号】：R318.01;R687

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