去松质骨截骨与全脊柱截骨治疗强直性脊柱炎后凸畸形的有限元分析  

Finite element analysis of vertebral column resection versus vertebral column decancellation in treatment of ankylosing spondylitis kyphosis

作　　者：谢江[1] 张玉坤[1] 李栎[1] 马俊毅[1] 马原[1] 眭江涛 马涌[1] 李辉[1] Xie Jiang;Zhang Yu-kun;Li Li;Ma Jun-yi;Ma Yuan;Sui Jiang-tao;Ma Yong;Li Hui(First Department of Spine Surgery,the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第六附属医院脊柱外一科,新疆维吾尔自治区乌鲁木齐市830002

出　　处：《中国组织工程研究》2018年第7期1102-1107,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81360280)~~

摘　　要：背景:脊柱矢状面失衡对其生物力学有很大的影响,其复杂的生物力学特性对脊柱后凸截骨方案的设计影响很大。目的:应用计算机建模软件建立强直性脊柱炎后凸截骨三维有限元模型,并分析生物力学特性,为临床实践提供一定的理论依据。方法:基于CT数据建立强直性脊柱炎后凸畸形三维有限元模型,测量计算L2节段预截骨角度,模拟去松质骨截骨术和全脊柱截骨术进行截骨,并分析矫形后生物力学。结果与结论:(1)建立了完整强直性脊柱炎后凸截骨矫形三维有限元模型,并且模拟手术操作建立L2去松质骨截骨术式和全脊柱截骨术式两种不同术式截骨模型;(2)导入有限元分析软件Ansys workbench 15.0,脊柱去松质骨截骨模型共划分十节点四面体单元948 874,1 564 477个节点,全脊柱切除截骨模型共划分十节点四面体单元931 969,1 548 812个节点;(3)加载载荷计算得出:去松质骨截骨术式内固定和截骨面应力高于全脊柱截骨术式,其螺钉等效应力分别为40.946,67.26,493.64,304.05,75.359,146.31 MPa,钛棒等效应力为391.01 MPa;(4)结果表明,2种不同截骨手术方式均能重建矢状面平衡,但去松质骨截骨应力高于全脊柱截骨,且差距较为明显,在相同节段、相同角度下去松质骨截骨术发生内固定失败并发症的风险高于全脊柱截骨术。BACKGROUND:Sagittal imbalance makes significant effect on spinal biomechanics,and choosing osteotomy for ankylosing spondylitis depends on its biomechanics characteristics.OBJECTIVE:To establish a three-dimensional(3D)finite element model of kyphosis in ankylosing spondylitis treated by osteotomy on software,and to analyze its biomechanical properties,thus providing theoretical basis for clinical practice.METHODS:A 3D finite element model of kyphosis in ankylosing spondylitis was established based on CT data,and the predetermined angle of the osteotomy at L2 was measured.Afterwards,vertebral column decancellation and vertebral column resection were stimulated,and then the biomechanical parameters were analyzed.RESULTS AND CONCLUSION:(1)The 3D finite element models of kyphosis in ankylosing spondylitis treated by vertebral column decancellation or vertebral column resection at L2 were established successfully.(2)Finite element analysis on Ansys workbench 15.0 showed that the vertebral column decancellation(948 874,1 564 477 nodes)and vertebral column resection(931 969,1 548 812 nodes)were meshed and analyzed by 10-node tetrahedron solid element.(3)After loaded,the stress values of the vertebral column decancellation were higher than those of vertebral column resection;the equivalent stress on the screw was 40.946,67.26,493.64,304.05,75.359,and 146.31 MPa;the equivalent stress on the titanium rob was 391.01 MPa.(4)These results suggest that both two methods can reconstruct the sagittal balance,but vertebral column decancellation exhibits significantly higher stress values.Indeed,the incidence of internal fixation failure and complications in vertebral column decancellation is higher than that in vertebral column resection at the same segment and angle.

关 键 词：脊柱炎 强直性 脊柱后凸 生物力学 有限元分析 截骨术 组织工程 

分 类 号：R318[医药卫生—生物医学工程]