严重胸腰椎爆裂性骨折手术入路的有限元研究  

Finite element analysis of three surgical treatments of severe thoracolumbar burst fractures

作　　者：陈昊[1] 王根林[1] 林俊[1] 吴贵忠[1] 朱海[1] 杨惠林[1] 

机构地区：[1]苏州大学附属第一医院骨科,215006

出　　处：《中华创伤骨科杂志》2014年第9期798-802,共5页Chinese Journal of Orthopaedic Trauma

基　　金：江苏省普通高校研究生科研创新计划项目（CXLX12_0845）

摘　　要：目的 通过有限元法比较前、后路不同手术方式治疗载荷分享评分≥6分的严重胸腰椎爆裂性骨折的优缺点,以期为临床治疗提供参考.方法 选取1名30岁男性健康志愿者的胸腰段脊柱CT扫描图像和有限元软件建立T12至L2脊柱三维有限元模型.验证有效后,模拟L1爆裂性骨折,建立前路内固定治疗模型、后路椎弓根螺钉内固定加间接减压治疗模型及后路椎弓根螺钉内固定加直接减压治疗模型.比较术后即刻及术后2个月时每种模型在不同工况下内固定最大位移及最大承载应力分布. 结果 最大位移：术后即刻及术后2个月时,前路手术模型最小,其次为后路间接减压模型及后路直接减压模型;最大承载应力分布：术后即刻,前路手术模型最小,其次为后路直接减压模型及后路间接减压模型,术后2个月时,3种模型最大承载应力分布相当. 结论 术后即刻前路手术在3种手术方案中稳定性最好,最不容易发生内固定治疗失败,但会丢失部分脊柱活动度.术后2个月时后路两种手术模型稳定性已达到正常生理状态,3种手术模型内固定应力分布相当,后路手术亦为治疗严重胸腰椎爆裂性骨折的有效方法之一.Objective To characterize anterior internal fixation,posterior pedicle screwing ＋ indirect decompression,and posterior pedicle screwing ＋ direct decompression in treatment of severe thoracolumbar burst fractures （load-sharing classification ≥ 6 points） through finite element analysis.Methods Helical CT scan images of the thoracolumbar spine from a 30 year-old male volunteer were obtained for establishment of three dimensional finite element models of T12-L2 spine.Mter authentication,severe burst fracture of L1 and corresponding 3 treatments （anterior internal fixation,posterior pedicle screwing ＋ indirect decompression,and posterior pedicle screwing ＋ direct decompression） were simulated in the finite element models.The maximum displacements of and stress distributions on the internal fixation were compared under axial load 500 N and 15 N ＆#183; m torque between the 3 different working conditions at immediate and 2 months postoperation respectively.Results At immediate and 2 months postoperation,the anterior approach model exhibited the least maximum displacement,followed by the posterior indirect decompression model and the posterior direct decompression model.At immediate postoperation,the anterior approach model presented the least stress distribution,followed by the posterior direct decompression model and the posterior indirect decompression model.At 2 months postoperation,the stress distribution was similar between the 3 models.Conclusions At immediate postoperation,the anterior approach yields the best stability and the least probability of internal fixation failure,but may cost partial loss of the mobility of the treated segment.At 2 months postoperation when the stability of the 2 posterior treatments has reached a normal physiological status,the stress distribution shows no significant difference between the 3 treatments,indicating the posterior pedicle screwing is also an efficient treatment of severe thoracolumbar burst fractures.

关 键 词：脊柱 骨折 生物力学 有限元分析 

分 类 号：R687.3[医药卫生—骨科学]