早发性脊柱侧凸不同生长棒固定方式对邻近节段生物力学的影响  

Biomechanical effects on adjacent segments of different growing-rod fixation in early onset scoliosis

作　　者：海涌[1] 潘爱星 李永刚[2] 藏磊[1] 袁硕[1] 

机构地区：[1]首都医科大学附属北京朝阳医院骨科,100020 [2]首都医科大学附属复兴医院骨科

出　　处：《中华医学杂志》2017年第48期3768-3773,共6页National Medical Journal of China

基　　金：国家自然科学基金（81372008）;首都临床特色应用研究专项（Z131107002213008）;北京市自然科学基金（7142063）

摘　　要：目的探讨早发性脊柱侧凸（EOS）不同生长棒固定方式对邻近节段生物力学的影响。方法选择一例重度EOS患者，采集患者术前及生长棒术（上固定区：T4、T5，下固定区：L3、L4）后全脊柱三维重建CT数据，应用有限元方法建立不同生长棒固定模型并比较不同模型对邻近节段生物力学的影响。结果生长棒术后邻近节段椎体、椎间盘与椎间韧带的应力普遍低于术前。与单生长棒相比，在双生长棒内固定模型中：L椎体应力减少6．2％，T3/4椎间盘应力减少6．7％，T3/4椎间韧带）应力减少27．7％；L椎体应力减少16．9％，T5／6椎间盘应力减少1．2％，T5/6椎间韧带应力减少40．4％；L2椎体应力减少32．6％，L2/3椎间盘应力减少30％，k。椎间韧带应力减少15．6％；L5椎体应力减少1．2％，L4/5椎间盘应力减少15．7％，L4/5椎间韧带应力减少100．0％。在近端应用椎板钩能轻度减少锚定点上方T3椎体、T3/4椎间盘和T3/4椎间韧带的应力。其中，在单棒模型中L椎体应力减少2．8％，T3/4椎间盘应力减少2．4％，T3/4椎间韧带应力减少3．6％；在双棒模型中L椎体应力减少2．2％，T3/4椎间盘应力减少1．5％，T3/4椎间韧带应力减少5．7％。同时，相比于双生长棒，单生长棒术后模型邻近节段应力更加集中。结论在生长棒手术治疗EOS患者中，双生长棒结构和头侧应用椎板钩固定能更有效地减少邻近节段的应力。Objective To analyse the biomechanical effects on adjacent segments of different growing-rod （GR） fixation in early onset seoliosis through a finite element analysis method. Methods A severe early-onset scoliosis patient was se｜eeted and the pre-operation and post-GR-operation （Upper instrumented levels ： T4, T5. Lower instrumented levels ： L3 , L4 ） whole spine 3-dimentional CT scan data were collected to build the finite models. Based on the different models, biomechanical differences on adjacent segments were analysed. Results The stress on the adjacent structures decreased after the GR surgery compared with the pre-operation. Compared with the single GR, stress on T3 vertebrae decreased by 6. 2%, stress on T3/4 disc decreased by 6.7%, stress on T3/4 ligament decreased by 27. 7%, stress on T6 vertebrae decreased by 16. 9%, stress on Ts/6 disc decreased by 1.2%, stress on Ts/6 ligament decreased by 40. 4% , stress on L2 vertebrae decreased by 32. 6% , stress on L2/3 disc decreased by 30% , stress on L2/3 ligament decreased by 15.6% , stress on L5 vertebrae decreased by 1.2% , stress on L4/5 disc decreased by 15.7% , stress on Lg/5 ligament decreased by 100.0% in dual GR structure. The application of hook （s） on the upper instrumented vertebrae （s） decreased the stress on the cranial adjacent segment. Stress on T3 vertebrae decreased by 2. 8% and 2. 2% , stress on T3/4 disc decreased by 2. 4% and 1.5% , stress on T3/4 ligament decreased by 3. 6% and 5. 7% in single GR and dual GR models separately when the hook （s） were utilized. In the meanwhile, the stress on the adjacent segment was more concentrated in the single GR model. Conclusion Dual-rod growing-rod and the application of hook （s） on the upper instrumented vertebrae could reduce the stress on the adjacent segments more effectively in patients with early onset scoliosis.

关 键 词：脊柱侧凸 内固定器 生物力学 有限元分析 

分 类 号：R318.01[医药卫生—生物医学工程] R687.3[医药卫生—基础医学]