颈前路融合手术对相邻节段影响的有限元分析  

Impact of anterior cervical fusion surgeries on adjacent segments:a finite element analysis

作　　者：卢腾 张廷[1] 董军[1] 臧全金[1] 杨宝辉[1] 王栋[1] 李浩鹏[1] 贺西京[1] 

机构地区：[1]西安交通大学第二附属医院脊柱外科,西安陕西710004

出　　处：《南方医科大学学报》2017年第1期49-55,74,共8页Journal of Southern Medical University

基　　金：国家自然科学基金(81571209);教育部博士点基金项目(20120201130009)~~

摘　　要：目的通过有限元分析比较正常人体下颈椎、颈前路椎间盘切除植骨融合术(ACDF)后及颈前路椎体次全切植骨融合术(ACCF)后活动度(ROM)和相邻节段椎间盘及关节突关节的应力变化。方法建立正常人体下颈椎三维有限元模型。通过与已发表的关于颈椎ROM的文献相对比,验证该模型的有效性。模型验证成功后,建立下颈椎ACDF、ACCF模型,并对比正常颈椎、ACDF及ACCF术后ROM和相邻节段椎间盘及关节突关节的应力变化。结果所建立的下颈椎三维有限元模型在各个方向上的ROM与已发表研究所测得的ROM数值基本吻合,验证了模型的有效性。ACDF和ACCF术后总体ROM和融合节段ROM显著低于正常下颈椎。ACDF及ACCF术后相邻节段各个方向的ROM显著高于正常下颈椎。ACDF、ACCF术后相邻节段椎间盘及关节突关节应力峰值在各个运动方向上高于正常下颈椎组。结论颈椎融合术后总体ROM减少、相邻节段ROM增加,并且相邻节段椎间盘及关节突关节应力峰值升高,显著改变了颈椎的正常生理特性。Objective To investigate the changes in the range of motion （ROM） and stress of the intervertebral disc and facet joint of the adjacent segments following anterior cervical corpectomy and fusion （ACCF） and anterior cervical discectomy and fusion （ACDF） using finite element analysis. Methods A three-dimensional finite element model of the lower cervical vertebrae was constructed and validated by comparing the ROM of the finite element model against the published data. After the validation of successful modeling, finite element models of ACDF and ACCF were constructed. The ROM and the stress of the intervertebral disc and facet joint of the adjacent segments were compared between the intact lower cervical vertebrae and the cervical vertebrae after ACDF and ACCF. Results The ROM of the finite element model was consistent with the published data. The total ROM and the ROM of the fusion segments with ACDF and ACCF were significantly decreased compared with the intact cervical vertebrae. In the adjacent segments following ACDF and ACCF, the ROM the adjacent segments and the stress peak of the intervertebral disc and facet joint all increased obviously compared with those of intact cervical vertebrae. Conclusion After fusion surgeries, the total ROM of the cervical vertebrae decreases and the ROM of the adjacent segment increases. The stress peak of the intervertebral disc and facet joint of the adjacent segments also increases to significantly alter the physiological characteristics of the intact cervical vertebrae.

关 键 词：有限元分析 颈椎融合 相邻节段退变 活动度 应力峰值 

分 类 号：R687.3[医药卫生—骨科学]