有限元法分析强直性脊柱后凸去松质骨截骨与全脊椎截骨矫形的生物力学特点  

Finite element analysis of the biomechanical characteristics of ankylosing kyphosis osteotomy using the vertebral column decancellation and the vertebral column resection

作　　者：段延辑 马俊毅[1] 李辉[1] 李栎[1] 马原[1] 

机构地区：[1]新疆医科大学第六附属医院脊柱外科研究所,新疆维吾尔自治区乌鲁木齐市830002

出　　处：《中国组织工程研究》2017年第31期5019-5025,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81360280)~~

摘　　要：背景:严重的强直性脊柱后凸畸形常采用矫形截骨术对患者进行治疗,但脊柱截骨矫形手术风险高,具体治疗方案较为个体化,畸形脊柱的生物形态与力学特性错综复杂。但有限元分析法对不规则物体的生物力学分析有其独特的优势性。目前国内通过有限元建模分析强直性脊柱后凸截骨治疗的生物应力特点鲜有报道。目的:建立强直性脊柱后凸三维有限元模型,探讨截骨方式选择与全脊柱变形位移趋势及截骨接触面、钛棒、椎弓根螺钉等应力分布的关系。方法:采用三维医学图形软件构建强直性脊柱后凸全脊柱模型,导入ANASYS有限元分析软件,分别模拟在T_(12)和L_1椎体节段行2种截骨方式(全脊椎截骨术与去松质骨截骨术)的4个截骨模型。对椎体及螺钉分别施加相应的载荷,得到4种工况下的一系列变形和应力云图。结果与结论:(1)T_(12)椎体截骨加载后各方向轴的全脊柱位移趋势大于L_1椎体截骨模型;(2)去松质骨截骨模型的应力集中部位于后方的内固定装置,全脊椎截骨的生物应力主要集中在钛笼及截骨接触面;(3)个体化的强直性脊柱后凸畸形手术治疗会影响截骨节段及截骨方式的选择,截骨节段的选择将主要影响全脊柱的变形稳定性,内固定节段的应力分布可能与截骨方式及内固定装置方式相关;(4)该结论可为强直性脊柱后凸的生物力学分析提供一定的理论参考依据。BACKGROUND： Patients with severe ankylosing kyphosis are often treated with orthopedic osteotomy, but with highsurgical risk, treatment schemes are individualized, and the biological morphology and mechanical properties of thedeformed spine are complex. Meanwhile, the finite element model is more adaptable for biomechanical analysis of thespinal deformity. However, its application in the treatment of ankylosing kyphosis in China was little reported.OBJECTIVE： To establish an ankylosing kyphosis finite element model so as to investigate the relationship betweendifferent osteotomy methods and the deformation and stress distribution of the spine.METHODS： A three-dimensional finite element model of ankylosing kyphosis was established, and then imported intoANASYS software, to simulate vertebral column decancellation and vertebral column resection at T12 and L1 levels,respectively. The vertebrae and screw were loaded with the same load, and deformation and stress nephograms wereobtained.RESULTS AND CONCLUSION： （1） The deformation of the osteotomy at T12 level was significantly larger than that at L1level. （2） The stress distribution of the decancellation osteotomy concentrated on the pedicle screw and titanium bar; thestress concentration of vertebral column resection was the intervertebral cage. （3） Individualized surgical treatment ofankylosing kyphosis may influence the selection of the osteotomy segment and osteotomy operation. The osteotomysegment may affect the stability of the spine, and stress distribution of internal fixation is likely related to the method ofinternal fixation. （4） This conclusion may provide theoretical reference for the biomechanical study of analysingankylosing kyphosis.

关 键 词：骨科植入物 脊柱植入物 脊柱后凸 强直性脊柱炎 有限元分析 生物力学 应力分析 全脊椎截骨 去松质骨截骨 截骨接触面 截骨节段 截骨方式 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]