不同方式颈椎融合手术对上颈椎Jefferson骨折稳定效果的有限元分析
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1.上海理工大学;2.上海理工大学 医疗器械与食品学院;3.复旦大学附属肿瘤医院 放射治疗中心;4.上海市第一人民医院 骨科

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国家自然科学(11502146);上海市自然科学(15ZR1429600);


Finite Element Analysis of Different Methods of Cervical Fusion Surgery on the Stability in Jefferson Fracture of the Upper Cervical Spine
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1.School of Medical Instrument and Food Engineering,University of Shanghai for Science and Technology;2.China;3.Department of Radiation Oncology,Fudan University Shanghai Cancer Center;4.Department of Orthopedics,Shanghai Ceneral Hospital

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    摘要:

    目的 建立人体上颈椎C0-3节段Jefferson骨折的有限元模型(Finite Element Model , FEM),分析后路寰枢椎融合(Posterior Atlantoaxial Fusion, PSF)和枕颈融合(Occipitocervical Fusion, OCF:OCF1、OCF2)术中三种不同内固定方式对颈椎椎体生物力学特性和钉棒系统力传导特性的影响。 方法 基于CT图像建立人体上颈椎C0-3节段Jefferson骨折模型,依据临床手术方案实施PSF、OCF1和OCF2内固定术,施加50N集中力和1.5N·m力矩于枕骨底部,研究上颈椎C0-3节段发生前屈、后伸、侧屈和旋转运动时,颈椎椎体的应力分布和关节活动度(Range of Motion, ROM)、钉棒系统最大应力值以及椎间盘的应力分布情况。 结果 上颈椎在PSF、OCF1、OCF2三种术式下,前屈、后伸、侧屈和旋转运动时椎体整体ROM分别为2.0°、2.0°、1.0°、2.1°,2.5°、1.5°、1.5°、1.9°和2.0°、1.5°、1.8°、1.7°,等效应力值分别为56.8、41.9、35.2、57.9MPa,29.8、17.7、25.7、51.4MPa和31.2、17.5、23.3、44.7MPa。PSF、OCF1、OCF2三种术式中钉棒和椎间盘的等效应力最大值分别为213.9、168.1、150.0MPa,14.9、9.8、8.5 MPa,应力分别集中分布于上下软骨终板和螺钉根部,结合临床表明OCF2具有较好的固定效果。 结论 PSF、OCF1、OCF2三种固定术式均可减少上颈椎的ROM,重建上颈椎的稳定性,其中PSF和OCF术式使椎体和椎间盘的应力分布趋向正常水平,研究结果可为临床手术方案提供理论依据。

    Abstract:

    Abstract Objective: To establish a finite element model (FEM) for upper cervical vertebrae at C0-3 with Jefferson fracture, and to analyze the influence of atl0061ntoaxial fusion (posterior atlantoaxial fusion, PSF) and occipitocervical fusion (OCF1, OCF2) on the mechanical properties of vertebral body biomechanics and mechanical conduction of screw-rod system. Methods A model of upper cervical vertebrae C0-3 segment Jefferson fracture was established based on CT images. The stress distribution and joint activity of cervical vertebrae, the maximum stress of screw-rod system and the stress distribution of intervertebral disc were studied by using PSF, OCF1 and OCF2 internal fixation based on clinical operation. Results: The total ROM of the upper cervical spine was 2.0°, 2.0°, 1.0°, 2.1°,2.5°, 1.5°, 1.5°, 1.9° and 2.0°, 1.5°, 1.8°, 1.7°, and the equivalent force values were 56.8, 41.9, 35.2, 57.9MPa, 29.8, 17.7, 25.7, 51.4MPa and 31.2, 17.5, 23.3, 44.7MPa, respectively. The maximum equivalent stress of PSF, OCF1 and OCF2 were 213.9, 168.1, 150.0MPa, 14.9, 9.8, 8.5MPa respectively. The stress was concentrated on the upper and lower cartilage endplate and screw root respectively. Combined with clinical results, OCF2 showed a better fixation effect. Conclusion: PSF, OCF1 and OCF2 can reduce the ROM of the upper cervical vertebrae and reconstruct the stability of the upper cervical vertebrae.

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  • 收稿日期:2020-02-13
  • 最后修改日期:2020-04-27
  • 录用日期:2020-04-28
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