累及椎板型颈椎棘突骨折有限元模型的建立和分析  

Establishment and analysis of a finite element model of cervical spinous process fracture(extension into the lamina)

作　　者：吴荣[1] 李强[1] 王朝阳[1] 沈彦[1] WU Rong;LI Qiang;WANG Chaoyang(Department of Orthopaedics, The PLA 98th Clinical College, Anhui Medical University, Huzhou 313000, China)

机构地区：[1]安徽医科大学解放军九八临床学院(中国人民解放军第九八医院),湖州313000

出　　处：《浙江医学》2016年第24期1966-1969,1992,共5页Zhejiang Medical Journal

基　　金：南京军区医学科技创新项目(MS009)

摘　　要：目的建立累及椎板型颈椎棘突骨折有限元模型（累及椎板型颈椎棘突骨折模型）并行活动度及应力分析，明确此型骨折对颈椎稳定性的影响。方法采集男性健康志愿者颈椎CT数据，运用有限元软件构建颈椎（C0~T1）全节段模型（正常颈椎模型），并与文献报道数据进行对比验证，正常颈椎模型活动度通过比较验证后，在正常颈椎模型基础上建立C7累及椎板型颈椎棘突骨折模型，测量C7累及椎板型颈椎棘突骨折模型在前屈、后伸、左右侧弯和左右旋转6种工况下的活动度，与正常颈椎模型进行比较，测量颈椎骨性结构及韧带的生物应力变化。结果建立的正常颈椎模型同文献报道的颈椎活动度比较符合有限元建模标准，在正常颈椎模型上结合临床骨折病例建立的累及椎板型颈椎棘突骨折模型外观逼真，活动度比较结果显示：在C6~7节段，骨折模型的前屈、侧弯及旋转活动度比正常模型减小（减少0.24°~1.60°），而后伸活动度略微增大（增加0.30°）；在C7~T1节段，除后伸活动外，其余活动度均比正常模型要大（增加0.91°~3.53°），且活动度变化范围较为明显（单侧旋转活动度增加36.7%）；其余节段两个模型活动度相差无几。累及椎板型颈椎棘突骨折模型在侧弯及旋转工况下应力值较正常模型相对升高。结论累及椎板型颈椎棘突骨折模型能较好地模拟临床实际骨折病例，C7累及椎板型棘突骨折模型有限元分析提示骨折局部稳定性变差，预示颈椎不稳发生，一旦发现颈椎不稳或神经损伤，需及时手术治疗。Objective To establish a three-dimensional finite element model of cervical spinous process fracture (extension into the lamina ) and assure its influence to cervical instability. Methods A male normal volunteer was chosen and the CT scan data were collected. By using specially designed modeling system,a high quality finite element model of complete cervical spine is generated. Based on the normal model, a finite element model of cervical spinous process fracture(extension into the lamina ) was developed according to a clinical case. The range of motion (ROM) under flexion, extension,lateral-bending and axial rotation were measured and analyzed in the normal and fracture model. Results The finite element model of cervical spinous process fracture(extension into the lamina ) had the same similarity and profile as the clinical case .The ROM on C6-7 segment under each movement in fracture model was reduced by 0.24°-1.60° comparing with normal model (flexion, lateral-bending and axial rotation). In the C7-T1 segment, the ROM of flexion, lateral-bending and axial rotation are larger than the normal model (0.91°-3.53°), and the degree of change is significant (unilateral rotation activity increased by 36.7%). Conclusion The finite element model can be used to simulate the biomechanics of cervical spinous process fracture (extension into the lamina ), indicating the potential for delayed instability which is helpful to determine the treating strategy.

关 键 词：颈椎棘突骨折 三维模型 有限元分析 颈椎不稳 

分 类 号：R683[医药卫生—骨科学]