颈前路植骨高度对相邻节段影响的三维有限元分析  

The finite element analysis of the effect of height of bone graft on adjacent segment after anterior cervical decompression and fusion

作　　者：张玉华 蔡宗熙[1] 熊五一 雪原[2] 刘浩飞 

机构地区：[1]天津大学机械工程学院力学系,300350 [2]天津医科大学总医院骨科,300070

出　　处：《中华骨科杂志》2017年第24期1540-1548,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81471403,30973024,11672202）

摘　　要：目的 应用三维有限元分析法探讨颈椎前路减压融合术中植骨高度不同对邻近节段椎间盘的力学影响。方法 应用CT扫描图像进行三维重建建立几何准确、较为详细的人体颈椎模型，并模拟前屈、后伸、轴向旋转和侧弯四种生理过程。将建立的模型与文献中的相关数据和应用山羊颈椎标本进行的生物力学测试结果进行对比验证。在此基础上将C4-5椎间盘材料改为松质骨以模拟术中植骨，并安装相应的固定装置；改变C4，5椎间隙高度建立植骨高度为术前椎间隙高度90%、150%、175%、200%四组有限元模型；模拟前屈、后伸、轴向旋转和侧弯四种生理过程，分析手术植入物和上、下邻近节段椎间盘的应力分布情况。结果 不同植骨高度之间对比，在前屈、后伸、轴向旋转和侧弯四种生理过程中C3-4椎间盘von Mises应力最大值分别为0.99 MPa、0.85 MPa、0.91 MPa和0.89 MPa，均出现在植骨高度为术前椎间隙高度200%的情况下；而植骨高度为术前椎间隙高度150%时应力值最小，分别为最大值的81%、73%、80%和87%。对于C5-6椎间盘von Mises应力最大值则分别是0.77 MPa、0.83 MPa、0.91 MPa和0.81 MPa，除后伸过程在植骨高度为术前椎间隙高度200%时最大外，余最大值均出现在植骨高度为术前椎间隙高度175%的情况下；植骨高度为术前椎间隙高度150%时C5-6椎间盘各应力值最小，分别为最大值的76%、93%、86%和78%。植骨部位von Mises应力在植骨高度为术前椎间隙高度200%时最大，分别为1.25 MPa、1.77 MPa、1.75 MPa、1.81 MPa；当植骨高度为术前椎间隙高度150%时，其应力值分别为最大值的63%、63%、75%和52%。植骨高度为术前椎间隙高度150%时植入物和上、下节段椎间盘的应力最小。结论 颈前路减压融合术中椎间植骨高度对邻近节段应力有较大影响；术前椎间隙高度150%是较为合适的植骨高度，邻近节段椎间�Objective The finite element method was used to analyze the effect of height of bone graft on adjacent segment stress after anterior cervical decompression and fusion.Methods One healthy adult male was included in this study. A detailed, geometrically accurate three-dimensional cervical spine model had been successfully developed from computed tomography （CT） scanning of a healthy adult male. A pure moment of 1.0 N·m was applied in different directions on the upper endplate of C3 to simulate flexion, extension, left-right lateral bending, and left-right axial rotation. We did biomechanical experiment with goat cervical specimens in terms of the moment-rotation responses. The finite element （FE） model was compared and validated with the experimental data. The relevant data in the literature was also applied for comparison and validation. To construct the post-surgery model, we turned the property of disk annulus and disk nucleus into that of the cancellous bone at C4-5. The internal fixation systems were also implanted. We changed the height of bone graft in C4-5 to be 90%, 150%, 175% and 200% of the height between C4-5 pre-surgery. The finite element models were built to simulate the post-surgery scenarios with different bone graft height, respectively. A stress analysis was conducted on the bone graft and adjacent disks.Results Under different height of bone graft, the maximum von Mises stress on C3-4 showed when the height of bone graft was 200%. The values were 0.99 MPa, 0.85 MPa, 0.91 MPa and 0.89 MPa in different loading condition. The values at 150% of the height between C4-5 pre-surgery were only 81%, 73%, 80% and 87% of the values at 200%. For C5-6, the maximum von Mises stress were 0.77 MPa, 0.83 MPa, 0.91 MPa and 0.81 MPa, observed at the height of bone graft was 175% except extension. The values at 150% of the height between C4-5 pre-surgery were only 76%, 93%, 86% and 78% of the biggest values. With regard to C4-5, the biggest von Mises stress was 1.25 MPa, 1.77 MPa, 1.75 MPa and 1.81 MPa. It

关 键 词：有限元分析 颈椎 脊柱融合术 骨移植 

分 类 号：R681.55[医药卫生—骨科学]