连续两节段颈椎hybrid手术的有限元法生物力学对比分析  

Finite element analysis of biomechanical comparison of cervical hybrid surgery in continuous two-level segments

作　　者：唐北川[1] 任先军[1] 邹喜红[2] 

机构地区：[1]第三军医大学新桥医院骨科,重庆400037 [2]重庆理工大学车辆工程学院,重庆400054

出　　处：《第三军医大学学报》2015年第8期809-815,共7页Journal of Third Military Medical University

摘　　要：目的利用有限元法对比分析连续两节段颈椎人工椎间盘置换联合节段融合手术（hybrid手术）后颈椎的生物力学特性。方法建立C2-T1有限元模型。应用Prestige-LP假体模拟置换,以前路钢板系统加松质骨融合模拟节段融合,构建C3-C5、C4-C6、C5-C7共6组hybrid手术（C3-C4置换联合C4-C5融合、C3-C4融合联合C4-C5置换,C4-C5置换联合C5-C6融合、C4-C5融合联合C5-C6置换,C5-C6置换联合C6-C7融合、C5-C6融合联合C6-C7置换）。对应的组间比较置换节段的椎间活动度（range of motion,ROM）、小关节应力（Mises应力）的差异和变化趋势。结果1C3-C5 hybrid手术：前屈、后伸、轴转、侧弯时置换节段的ROM增加,C3-C4置换分别增加119%、186%、208%、173%;C4-C5置换分别增加142%、262%、251%、164%。后伸、轴转、侧弯时置换节段小关节Mises应力增加,C3-C4置换分别增加256%、187%、185%;C4-C5置换分别增加50%、54%、124%。2C4-C6 hybrid手术：在前屈、后伸、轴转、侧弯时置换节段的ROM增加,C4-C5置换分别增加107%、200%、238%、145%;C5-C6置换分别增加65%、130%、147%、111%。C4-C5置换小关节Mises应力在后伸、轴转、侧弯时分别增加20%、53%、111%;C5-C6置换小关节Mises应力在后伸时降低8%,轴转、侧弯时分别增加297%、60%。3C5-C7 hybrid手术：在前屈、后伸、轴转、侧弯时置换节段的ROM增加,C5-C6置换分别增加77%、167%、179%、122%;C6-C7置换分别增加84%、268%、324%、230%。C5-C6置换节段小关节Mises应力在轴转、侧弯时分别增加267%、63%;C6-C7置换节段小关节Mises应力在前屈、后伸、轴转、侧弯时分别增加202%、155%、204%、145%。结论hybrid手术中置换节段的ROM和小关节Mises应力均有增加。选择生理活动度较大的节段予以置换,而相对较小的节段予以融合,这种hybrid组合方式对颈椎生物力学的影响较小。Objective To comparatively analyze biomechanical characteristics of cervical hybrid surgery（ artificial cervical disc replacement combined with segmental fusion） in continuous two-level with finite element method. Methods C2 - T1 finite element model was established to simulate arthroplasty by Prestige-LP prosthesis,and arthrodesis by anterior plate / screw / allograft in C3 - C5,C4 - C6 and C5 - C7 segments. The difference and change trend of range of motion（ ROM） and stress of facet joint（ Von Mises stress,Mises stress） of corresponding hybrid surgery were compared. Results（ 1） With C3 - C5 hybrid surgery,the ROM of C3 - C4 segments was increased by 119%,186%,208%,and 173% in flexion,extension,axial rotation,and lateral bending,respectively,while that of C4 - C5 segments was increased by142%,262%,251%,and 164%,respectively. The facet Mises stress of C3 - C4 segments was increased by256%,187%,and 185% in extension,axial rotation,and lateral bending,respectively,while that of C4 -C5 segments was increased by 50%,54%,and 124%,respectively.（ 2） With C4 - C6 hybrid surgery,the ROM of C4 - C5 segments was increased by 107%,200%,238%,and 145% in flexion,extension,axial rotation,and lateral bending,respectively,while that of C5 - C6 segments was increased by 65%,130%,147%,and 111%,respectively. The facet Mises stress of C4 - C5 segments was increased by 20%,53%,and 111% in extension,axial rotation,and lateral bending,respectively,while that of C5 - C6 segments was reduced by 8% in extension,and increased by 297% and 60% in rotation and later bending,respectively.（ 3） With C5 - C7 hybrid surgery,the ROM of C5 - C6 segments was increased by 77%,167%,179%,and122% in flexion,extension,axial rotation,and lateral bending,respectively,and that of C6 - C7 segments was increased by 84%,268%,324%,and 230%,respectively. The facet Mises stress of C5 - C6 segments was increased by 267% and 63% in axial rotation and lateral bending,respectively; while that of C6 - C7 segments was increased by 202%,155%,204%,a

关 键 词：颈椎间盘置换 生物力学 有限元 hybrid手术 

分 类 号：R318.01[医药卫生—生物医学工程] R681.53[医药卫生—基础医学]