ACDF术中螺钉位置与邻近节段退变关系的三维有限元分析  

The finite element analysis of ACDF surgery screw position influence on adjacent segment

作　　者：李浩曦 巴兆玉 刘涛 雍之瑶 黄宇峰 吴德升 

机构地区：[1]上海市东方医院(同济大学附属东方医院)脊柱外科,上海200120

出　　处：《中国骨与关节损伤杂志》2018年第1期1-4,共4页Chinese Journal of Bone and Joint Injury

基　　金：国家自然科学基金(81371994);上海市卫计委科研项目(201440016)

摘　　要：目的建立颈椎三维有限元模型,比较分析颈椎前路减压融合固定(ACDF)术中不同置钉位置的生物力学特点。方法收集1名30岁健康成年男性志愿者颈椎CT数据建立C_(2~7)三维有限元模型。在C_(4~6)椎体加入螺钉,根据螺钉远端的位置分为4组。Ⅰ组为椎体前上方,Ⅱ组为椎体前下方,Ⅲ组为椎体后上方,Ⅳ组为椎体后下方。予C_2齿突左右旋转、左右侧屈、前屈、后伸6个方向1 Nm的扭矩,测量前屈+后伸、左旋+右旋、左侧屈+右侧屈时C_(2、3)、C_(3、4)、C_(4、5)、C_(5、6)、C_(6、7)活动度,以及前屈、后伸、旋转、侧屈时C_(2、3)、C_(3、4)、C_(4、5)、C_(5、6)、C_(6、7)椎间盘内压力,并与正常颈椎模型(对照组)进行比较。结果在相同扭矩下与对照组相比,C_(2、3)节段旋转活动度变大,C_(2、3)、C_(3、4)侧屈活动度变大。在相同扭矩下与对照组相比,C_(3、4)椎间盘内压力在前屈时减小,旋转和侧屈时增大,而C_(6、7)椎间盘内压力在前屈、侧屈时增大。Ⅰ组和Ⅲ组、Ⅱ组和Ⅳ组在活动度和椎间盘内压力方面表现出相似的规律,即螺钉的上下位置较前后位置对活动度和椎间盘内压力的影响更大一些,通过应力云图可以发现螺钉前后位置更多地影响螺钉与钢板的受力情况。结论ACDF术中螺钉置入椎体前下方能提供更接近正常颈椎的活动度和椎间盘内压力,同时具有较强的生物力学稳定性。Objective To evaluate the biomechanical characteristics of different fixation sites in anterior cervical discectomy and fusion（ACDF） with three-dimensional finite element analysis. Methods Cervical CT data were collected from a 30-year- old healthy adult male volunteer to establish C2-7 three-dimensional finite element model The C4-6 vertebral body screws were divided into 4 groups according to the location of the distal screw. Group Ⅰ was anterior-superior of vertebral body, group Ⅱ anterior-inferior of vertebral body, group Ⅲ was posterior-superior of vertebral body, and group Ⅳ was posterior-inferior of vertebral body. With the C2 odontoid left and fight rotation, left and right lateral flexion, flexion, extension, in 6 directions, of 1 Nm of torque, flexion and extension, left and right spin, left flexion plus fight flexion C2、 3, C3、 4, C4、 5, C5、 6, C6、 7 activity were measured as well as flexion, extension, rotation, lateral flexion C2、3, C3、 4, C4、 5, C5、 6, C6、7 intervertebral disc pressure, and also compared with normal cervical model（control group）. Results In the same torque compared with the control group, C2、3 segment rotation activity became larger, C2、3, C3、4 lateral flexion activity became larger. Under the same torque compared with the control group, C3、4 intervertehral disc pressure decreased in flexion, rotation and flexion increased, and C6、 7 intervertebral disc pressure in flexion, flexion increased. Group Ⅰ and group Ⅲ, group Ⅱ and group Ⅳ showed a similar pattern of activity and intervertebral disc pressure. The screw superior and inferior position had more influence on activity and disc pressure than the anterior and posterior position. The stress cloud map showed the anterior and posterior position had more affect on the force of the screw and the plate. Conclusion The ACDF operation with screw placement in the anterior-posterior vertebral body can provide the activity and intervertebral disc pressure more like the normal cervical sp

关 键 词：颈椎 颈椎前路减压融合固定术 螺钉位置 邻近节段 有限元分析 

分 类 号：R687.3[医药卫生—骨科学]