双头螺钉对三柱截骨术后多棒结构稳定性的影响
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1.西南交通大学 摩擦学研究所;2.钒钛资源综合利用国家重点实验室

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Influence of double-headed screws on the stability of multi-rod structure in posterior three-column spinal osteotomies
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    摘要:

    目的 本研究通过有限元分析比较了双头螺钉多棒结构与传统连接器多棒结构在脊柱后路三柱截骨术后矫形固定的稳定特性。方法 基于重度脊柱角状后凸患者术后CT数据建立T3~L4胸腰椎有限元模型。在患者标准双棒模型(2R)基础上,分别建立双头螺钉多棒结构模型(double-head screws,4R-DHS)和传统连接器多棒结构模型(traditional connectors,4R-TC)。在300N的随动载荷和7.5N·m的力矩载荷下对模型进行评估,分析两种多棒结构的稳定性、主棒上的最大Von Mises应力及应力分布。结果 两种多棒结构的稳定性差异不大。相比于4R-TC,4R-DHS 除了后伸时主棒上的最大Von Mises应力略有增加外,其余运动中主棒上的最大Von Mises均有所下降(屈曲7.2%,左侧弯8.8%,右侧弯8.7%,左轴向旋转18.5%,右轴向旋转16.9%),并且应力分布更加均匀。结论 双头螺钉多棒结构相比于传统连接器多棒结构可以降低主棒上的最大应力,且不存在连接器附近主棒应力集中的问题,可以更有效降低内固定失效风险。

    Abstract:

    Objective The stability of multi-rod structure with double-headed screws and multi-rod structure with conventional connectors in posterior three-column osteotomy of the spine were compared by means of finite element analysis. Methods A finite element model of T3~L4 thoracolumbar spine was constructed based on the postoperative CT data of patients with severe kyphotic kyphosis. On the basis of the patient's standard two-rod model (2R), the double-headed screw multi-rod structure model (4R-DHS) and the traditional connector multi-rod structure model (4R-TC) are constructed. The two models were evaluated under a 300N follower load and a 7.5N·m moment load to analyze the stability, maximum Von Mises stresses on the main rods, and stress distributions of the two multi-rod structures. Results There was little difference in the stability between the two multi-rod structures. Compared with 4R-TC, 4R-DHS shows decreases in the maximum Von Mises stresses on the main rods during all motions (7.2% in flexion, 8.8% in left lateral bending, 8.7% in right lateral bending, 18.5% in left-axial rotation, and 16.9% in right-axial rotation) and a more uniform distribution of stresses, except for a slight increase in maximum Von Mises stresses on the main rods during post-extension. Conclusions The double-headed screw multi-rod structure can reduce the maximum stress on the main rod compared with the traditional connector multi-rod structure, and there is no problem of stress concentration on the main rod near the connector, which can more effectively reduce the risk of internal fixation failure.

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  • 收稿日期:2023-10-07
  • 最后修改日期:2023-11-16
  • 录用日期:2023-11-22
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