PUMCⅡd_2型青少年特发性脊柱侧凸选择性融合治疗:以有限元法分析最佳融合节段(英文)  

Choice fusion therapy of PUMC Ⅱd_2 adolescent idiopathic scoliosis A finite element analysis of optimal fusion segment

作　　者：汪学松[1] 吴志宏[1] 邢泽军[1] 王储[1] 闫家智[1] 邱贵兴[1] 

机构地区：[1]中国医学科学院,中国协和医科大学,北京协和医院骨科,北京市100730

出　　处：《中国组织工程研究与临床康复》2009年第52期10382-10386,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：the National Natural Science Foundation of China,No.30772191;the Post-doctoral Science Foundation of China,No.20060400567~~

摘　　要：背景：目前国内外尚未成功建立双足直立的灵长类的特发性脊柱侧凸实验动物模型。随着计算机和影像学的飞速发展,现在可以做到通过计算机软件来虚拟人类特发性脊柱侧凸模型,并进行相关的生物力学分析,为临床手术操作提供指导。目的：利用有限元模型验证PUMCⅡd2型特发性脊柱侧凸脊柱融合治疗的最佳融合节段。设计、时间及地点：对比观察,于2007-05/2008-05在北京协和医院骨科完成。对象：PUMCⅡd2脊柱侧凸女性患者1例,为双弯畸形。方法：利用PUMCⅡd2型特发性脊柱侧凸有限元模型（T5-S）,分别模拟上胸弯融合、下腰弯融合和双弯融合方式,在侧弯凹侧端椎椎弓根内分别赋予50,100,150N载荷,比较上弯端椎T5和下弯端椎T11在矢状面向上的位移（Z轴正值为矢状面向上的位移,负值为矢状面向下的位移）以及二者之间的差值,以T5位移代表双弯矫形效果,以T11位移代表下腰弯矫形效果,二者差值（T5-T11）代表上胸弯矫形效果。主要观察指标：不同融合节段、不同矫形力下的T5和T11位移。结果：对于PUMCⅡd2型侧弯,T5在Z轴的位移：双弯矫型较单纯上弯或者下弯矫形融合位移大（P〈0.01）。T5~T11位移差：双弯矫形﹥单纯上胸弯矫形﹥单纯下腰弯矫形（P〈0.01）。T11在Z轴的位移：双弯矫形﹥单纯下腰弯矫形﹥单纯上胸弯矫形（P〈0.01）。结论：对于PUMCⅡd2型侧弯,双弯矫型内固定较单纯上弯或者下弯矫形融合内固定效果好;3种载荷对于上胸弯的矫正效果：双弯矫形〉单纯上胸弯矫形﹥单纯下腰弯矫形;3种载荷对于下腰弯的矫正效果：双弯矫形〉单纯下腰弯矫形〉单纯上胸弯矫形。三维有限元分析法可以作为一种有效的方法应用于脊柱侧弯畸形矫正的生物力学分析,为临床开创了一种虚拟、无创的验证方式,可以优化手术方案。BACKGROUND： At present, experimental animal models of primate idiopathic scoliosis with erect feet have not been established. With rapid development of computer and imaging, we can use computer software to simulate models of human idiopathic scoliosis, and do relevant biomechanical analysis and provide instructions for clinical surgery operation. OBJECTIVE： To research the best surgical fusion level for the adolescent idiopathic scoliosis （AIS） of PUMC Ⅱd2 with the finite element model （FEM）. DESIGN, TIME AND SETTING： The comparison observation was performed at the Department of Orthopedics, Beijing Union Hospital from May 2007 to May 2008. PARTICIPANTS： One female patient with PUMC Ⅱd2 scoliosis （double curve malformation） was included. METHODS： FEM （T5-S） of PUMC Ⅱd2 idiopathic scoliosis was used to simulate upper thoracic curve, lower lumbar curve and double curve fusion manners. Hollow lateral curvature pedicle of vertebral arch received 50, 100, 150 N load. Displacement of T5 and T11 on upper sagittal plane （displacement of Z axis positive value on upper sagittal plane, displacement of negative value on lower sagittal plane） and their difference value were compared. T5 displacement represented outcomes of double curve orthopaedics. T11 displacement represented outcomes of lower lumbar curve orthopaedics. Their difference value （T5-T11） represented outcomes of upper thoracic curve orthopaedics. MAIN OUTCOME MEASURES： Different fusion segments and displacement of T5 and T11 under different orthopedic forces were measured. RESULTS： In PUMCⅡd2 lateral curvature, T5 displacement on Z axis： fusion displacement of double curves was greater compared with upper curve alone or lower curve alone （P〈 0.01）. Difference of T5-T11 displacement： double curves orthopaedics upper thoracic curve orthopaedics alone lower lumbar curve orthopaedics alone （P〈 0.01）. Displacement of T11 on Z axis： double curves orthopaedics〉 lower lumbar curve orthopaedics alone〉 u

关 键 词：特发性脊柱侧凸 三维有限元分析 生物力学 数字化医学 

分 类 号：R318[医药卫生—生物医学工程]