斜外侧椎间融合结合不同内固定方式治疗退变性腰椎侧凸的有限元分析
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2020 年宁夏重点研发计划项目(2020BEG03034)


Biomechanical Evaluation of Oblique Lateral Interbody Fusion Combined with Different Internal Fixation Methods for Treating Degenerative Lumbar Scoliosis:A Finite Element Analysis
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    摘要:

    目的 运用三维有限元分析法验证斜外侧椎间融合(oblique lateral interbody fusion,OLIF)辅助不同内固定方式治疗退变性腰椎侧凸( degenerative lumbar scoliosis,DLS)的生物力学稳定性。 方法 建立 L1 ~ S1 三维有限元DLS 模型(模型 1),模拟 L2~ 5 连续三节段 OLIF 手术及其结合不同内固定方式,分别建立单纯 OLIF( stand-alone OLIF)模型(模型 2)、椎体钉棒固定模型(模型 3)、单边椎弓根螺钉固定模型(模型 4)和双边椎弓根螺钉固定模型(模型 5)。 在直立、前屈、后伸、左右侧弯、左右旋转工况下,记录并分析各模型融合节段活动度( range of motion,ROM)、融合器及内固定的应力及其分布情况。 结果 6 种运动工况下,模型 2 ~ 5 融合节段整体 ROM 均小于模型 1;与模型 1 相比,模型 3、4 的 ROM 降幅大于模型 2、小于模型 5;前屈和后伸工况下,模型 4 与模型 5 的 ROM 降幅相仿;左右侧弯工况下,模型 3 与模型 5 的 ROM 降幅相仿。 在所有运动工况下,模型 3、4 融合器应力峰值大于模型 5、小于模型 2;其中,模型 3 的 L2~ 3、L3~ 4、L4~ 5 融合器应力峰值在左侧弯工况下较模型 5 增幅分别为 5. 52% 、10. 96% 、7. 99% ,而模型 4 的 L2~ 3、L3~ 4、L4~ 5 融合器应力峰值在前屈工况下增幅分别为 8. 70% 、7. 00% 、6. 99% 。在所有运动工况下,模型 5 的钉棒应力峰值均小于模型 3、4,且在直立状态下模型 3~ 5 钉棒应力峰值最小。 结论 OLIF 附加单边椎弓根钉棒固定以及侧方椎体钉棒固定的两种辅助固定方式均能够提供手术节段的生物力学稳定。研究结果为临床应用 OLIF 技术治疗 DLS 提供一定参考。

    Abstract:

    Objective To verify the biomechanical stability of oblique lateral interbody fusion ( OLIF) combinedwith different fixation methods for treating degenerative lumbar scoliosis (DLS) by three-dimensional (3D) finite element analysis. Methods The L1-S1 3D finite element DLS model ( Model 1) was established, and then the OLIF (L2-5) at 3 contiguous levels of fusion and its combination with different internal fixation methods were simulated, namely, stand-alone OLIF model ( Model 2), vertebral screw fixation model ( Model 3), unilateral pedicle screw fixation model (Model 4) and bilateral pedicle screw fixation model (Model 5) were established,respectively. Under upright, flexion, extension, lateral bending and axial rotation states, range of motion (ROM) of fusion segments, as well as cage stress, internal fixation stress, and stress distribution were recorded and analyzed. Results Under six motion states, the overall ROM of fusion segments in Models 2-5 was smaller than that of Model 1. Compared with Model 1, the overall ROM reduction of Model 3 and Model 4 was larger than that of Model 2 and smaller than that of Model 5. Under flexion and extension, the overall ROM reduction of Model 4 and Model 5 was basically equal. Under left and right lateral bending, the overall ROM reduction of Model 3 and Model 5 was basically equal. Under all motion states, the peak stress of Model 3 and Model 4 fusion cage was larger than that of Model 5 and smaller than that of Model 2. The peak stresses of L2-3, L3-4 and L4-5 fusion cages in Model 3 increased by 5. 52% , 10. 96% and 7. 99% respectively compared with Model 5 under left lateral bending, and the peak stresses of L2-3, L3-4 and L4-5 fusion cages in Model 4 increased by 8. 70% , 7. 00% and 6. 99% respectively under flexion. Under all motion states, the peak stress of screw rod in Model 5 was smaller than that of Model 3 and Model 4, and the peak stresses of screw rod in Models 3-5 were the smallest in upright state. Conclusions The OLIF with unilateral pedicle screw fixation or vertebral screw fixation can provide favorable biomechanical stability of the fusion segment. The results provide some references for clinical application of OLIF technology in the treatment of DLS.

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杨树龙,马 荣,王志强,梁思敏,陈 振,刘晓印,张建群,戈朝晖.斜外侧椎间融合结合不同内固定方式治疗退变性腰椎侧凸的有限元分析[J].医用生物力学,2023,38(1):52-58

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  • 收稿日期:2022-01-03
  • 最后修改日期:2022-03-06
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  • 在线发布日期: 2023-02-28
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