腰椎融合术3种内固定方式的生物力学特点
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Biomechanical Characteristics of Lumbar Fusion by Three Internal Fixation Methods
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    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L4~5三维有限元腰椎融合模型,在L4~5未固定模型(unfixed model,UM)上分别加载椎板关节突螺钉(translaminar facet screw,TLFS)、椎板关节突螺钉并椎弓根螺钉(lumbar pedical screw+translaminar facet screw,LPS+TLFS)、双侧椎弓根螺钉(bilateral pedical screw,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 未固定、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1.4108、0.629 8、0.336 9、0.2 528 mm(关节突关节全切模型)和1.296 7、0.844 9、0.340 9、0.273 8 mm(关节突关节半切模型);融合器平均最大位移分别为0.479 9、0.319 5、0.167 6、0.126 4 mm(关节突关节全切模型)和0.378 7、0.348 4、0.183 5、0.137 2 mm(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178.34、79.55、56.33 MPa(关节突关节全切模型)和142.29、103.02、59.69 MPa(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模型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,但仍优于融合器植骨而不行内固定的脊柱模型。在不进行内固定时,关节突的保留显著增加脊柱稳定性。

    Abstract:

    Objective To analyze the biomechanical characteristics of lumbar fusion by 3 internal fixation methods using three-dimensional (3D) finite element (FE) method. Methods The FE fixation models of physiological L4-5, unfixed fusion L4-5, translaminar facet screw (TLFS), lumbar pedical screw+translaminar facet screw (LPS+TLFS), bilateral pedical screw (BPS) with complete osteotomy or partial osteotomy of facet joint were established, respectively. The biomechanical characteristics of L4 centrum and implants under six 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 The average maximal displacements of L4 centrum in L4-5 unfixed fusion model, TLFS model, TLFS+LPS model, BPS model were 1.410 8, 0.629 8, 0.336 9, 0.252 8 mm (complete osteotomy of facet joint) and 1.296 7, 0.844 9, 0.340 9, 0.273 8 mm (partial osteotomy of facet joint); the average maximal displacements of cage were 0.479 9, 0.319 5, 0.167 6, 0.126 4 mm (complete osteotomy of facet joint) and 0.378 7, 0.348 4, 0.183 5, 0.137 2 mm (partial osteotomy of facet joint);the average maximum stresses of screws and rods during 6 motions in TLFS model, TLFS+LPS model, BPS model were 178.34, 79.55, 56.33 MPa (complete osteotomy of facet joint) and 142.29, 103.02, 59.69 MPa (partial osteotomy of facet joint). Conclusions In percutaneous transforaminal lumbar interbody fusion, the fixation effect of BPS model was similar to that of LPS+TLFS model. BPS model could achieve the best spinal stability, and LPS+TLFS model was 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, preservation of the articular process significantly increased stability of the spine.

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叶建东,程哲,王剑龙.腰椎融合术3种内固定方式的生物力学特点[J].医用生物力学,2021,36(2):208-215

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  • 收稿日期:2019-09-27
  • 最后修改日期:2019-11-22
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  • 在线发布日期: 2021-04-25
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