腰椎融合术三种内固定方式生物力学特点的有限元分析
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中南大学湘雅三医院 骨科

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Finite element analysis of biomechanical characteristics of three internal fixation methods for lumbar fusion
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Department of Orthopedics,the Third Xiangya Hospital,Central South University

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    摘要:

    摘要:目的 利用三维有限元方法分析腰椎融合术中3种不同内固定方式的生物力学特点。方法 建立L4/5关节突全切及半切除的L4/5三维有限元腰椎融合模型,在L4/5未固定模型(UM)上分别加载椎板关节突螺钉内固定装置(TLFS)、椎板关节突螺钉并椎弓根螺钉内固定装置(LPS+TLFS)、双侧椎弓根螺钉内固定装置(BPS)。比较未固定模型及3种内固定模型在脊柱屈曲、后伸、左/右侧弯、左/右旋转6种运动状态下L4椎体及内植物的生物力学特点。结果 UM、TLFS、LPS+TLFS、BPS模型L4椎体6种运动状态下的平均最大位移分别为1.4108mm,0.6298mm,0.3369mm,0.2528mm(关节突关节全切模型);1.2967mm,0.8449mm,0.3409mm,0.2738mm(关节突关节半切模型);cage平均最大位移分别为0.4799mm,0.3195mm,0.1676mm,0.1264mm(关节突关节全切模型);0.3787mm,0.3484mm,0.1835mm,0.1372mm(关节突关节半切模型);TLFS、LPS+TLFS、BPS模型6种运动状态下钉、棒的平均最大等效应力分别为178.34MPa,79.55MPa,56.33MPa(关节突关节全切模型);142.29MPa,103.02MPa,59.69MPa(关节突关节半切模型)。结论 在经皮椎间孔镜下腰椎融合术中,BPS模型与LPS+TLFS模型固定效果相当,BPS可以取得最好的脊柱稳定性,而LPS+TLFS模型也为一个效果优良的固定方式选择。单独TLFS模型稳定性相对较差,但仍优于cage植骨而不行内固定的脊柱模型。在不行内固定时关节突的保留显著增加了脊柱稳定性。

    Abstract:

    Abstract: Objective To analyze the biomechanical characteristics of three different internal fixation methods for lumbar fusion by three-dimensional finite element (FE) methods. Methods The FE fixation models of physiological L4/5, unfixed fusion L4/5, TLFS, TLFS+LPS, BPS with facet joint complete osteotomy or partial osteotomy were established, respectively. The biomechanical characteristics of L4 centrum and implants under six kinds of motion states (spinal flexion, extension, lateral?bending?and?axial?rotation) in L4/5 fusion model and three fixation models were compared by FE analysis.Results L4 centrum average maximal displacement in L4/5 unfixed fusion model, TLFS model, TLFS+LPS model, BPS model were 1.4108mm, 0.6298mm, 0.3369mm, 0.2528mm( facet joint complete osteotomy);1.2967mm, 0.8449mm, 0.3409mm, 0.2738mm( facet joint partial osteotomy); Cage average maximal displacement were 0.4799mm, 0.3195mm, 0.1676mm, 0.1264mm(facet joint complete osteotomy);0.3787mm, 0.3484mm, 0.1835mm, 0.1372mm(facet joint partial osteotomy);Average maximal stress of screws and rods in 6 motions of TLFS、TLFS+LPS、BPS models were 178.34MPa, 79.55MPa, 56.33MPa(facet joint complete osteotomy);142.29MPa,103.02MPa,59.69MPa(facet joint partial osteotomy).Conclusion In Percutaneous Transforaminal Lumbar Interbody Fusion, the fixation effect of BPS model is similar to that of LPS+TLFS model. BPS can achieve the best spinal stability, and LPS+TLFS model is also a good fixation method. The stability of TLFS model alone was relatively poor, but it was still better than that of cage bone graft without internal fixation. In the absence of internal fixation, the preservation of the articular process significantly increased the stability of the spine.

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  • 收稿日期:2019-09-27
  • 最后修改日期:2019-11-22
  • 录用日期:2019-12-03
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