双节段、单节段去松质骨截骨与全脊柱截骨强直性脊柱后凸矫形策略的有限元分析  

Finite element analysis of double-segment and single-segment vertebral column decancellation and vertebral column resection osteotomy for ankylotic kyphosis

作　　者：段延辑 陈晓 周永强[1] 黄凯[1] 沈东兰 马原[2] Duan Yanji;Chen Xiao;Zhou Yongqiang;Huang Kai;Shen Donglan;Ma Yuan(Department of Orthopedics,First People’s Hospital of Neijiang,Neijiang 641000,Sichuan Province,China;Department of Spine Surgery,Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 813002,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]内江市第一人民医院骨科,四川省内江市641000 [2]新疆医科大学第六附属医院脊柱外科,新疆维吾尔自治区乌鲁木齐市813002

出　　处：《中国组织工程研究》2020年第27期4285-4290,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81360280),项目负责人:马原。

摘　　要：背景:单节段与双节段的截骨手术常用于治疗强直性脊柱后凸畸形,但制定术前策略时对截骨节段、截骨方式的选择常依赖临床经验。目前国内外对双节段去松质骨截骨及全脊柱截骨的生物力学研究鲜有报道。目的:建立强直性脊柱后凸的单节段、双节段截骨模型,针对全脊柱位移、内固定系统应力、截骨接触面等效应力强度等方面进行比较与探讨。方法:通过MIMICS与Geomagic studio等医学软件建立强直性脊柱后凸畸形全脊柱截骨与去松质骨截骨两种模型,每种模型中再分为单节段截骨与双节段截骨,即L1单节段全脊柱截骨模型、L1单节段去松质骨截骨模型、L2单节段全脊柱截骨模型、L2单节段去松质骨截骨模型、T12L2双节段全脊柱截骨模型、T12L2双节段去松质骨截骨模型、T12L3双节段全脊柱截骨模型、T12L3双节段去松质骨截骨模型8组。导入ANASYS软件对模型进行加载,记录不同截骨工况下的全脊柱位移,以及椎弓根螺钉、连接棒、截骨接触面的等效应力云图。结果与结论:(1)无论是去松质骨截骨还是全脊柱截骨模型,单节段截骨的全脊柱位移小于双节段截骨;无论是单节段截骨还是双节段截骨模型,全脊柱截骨的全脊柱位移小于去松质骨截骨;L2单节段全脊柱截骨模型的位移最小;(2)无论是去松质骨截骨还是全脊柱截骨模型,单节段截骨的内固定装置等效应力均小于双节段截骨;无论是单节段截骨还是双节段截骨模型,全脊柱截骨的内固定装置等效应力均小于去松质骨截骨;其中L1单节段全脊柱截骨的内固定装置等效应力最小;(3)所有单节段截骨模型的截骨接触面等效应力值均较小,未超过28 MPa;在双节段截骨模型中,全脊柱截骨的截骨接触面等效应力值均小于去松质骨截骨;(4)结果表明,单节段截骨的生物力学稳定性优于双节段截骨,全脊柱截骨的稳定性优于去松质骨截BACKGROUND: Single-segment and double-segment osteotomies are often used to treat ankylotic kyphosis. However, the selection of preoperative strategies, especially for segmental and osteotomy methods, often depends on clinical experience. At present;there are few reports on the biomechanics of double-segment vertebral column decancellation and vertebral column resection osteotomy. OBJECTIVE: To establish a two-segment osteotomy model for ankylotic kyphosis, and to compare and discuss the total displacement of the spine, stress analysis of the internal fixation system, and equivalent stress intensity of the osteotomy contact surface. METHODS: MIMICS software and Geomagic studio software were used to establish two kinds of models of ankylotic kyphosis with vertebral column resection osteotomy and vertebral column decancellation. Each kind of model was divided into single-segment osteotomy and double-segment osteotomy, i.e., L1 single-segment vertebral column resection osteotomy model, L1 single-segment decancellated osteotomy model, L2 single-segment vertebral column resection osteotomy model, L2 single-segment vertebral column decancellation model, T12L2 double-segment vertebral column resection osteotomy model, T12L2 double-segment vertebral column decancellation model, T12L3 double-segment vertebral column resection osteotomy model, and T12L3 double-segment vertebral column decancellation model. ANASYS software was imported to load model. The whole spine displacement, pedicle screw, connecting rod, and bone interface equivalent stress nephogram were recorded under different conditions of osteotomy. RESULTS AND CONCLUSION:(1) Whether it was vertebral column decancellation or vertebral column resection osteotomy model, the total spinal displacement of single-segment osteotomy was less than that of double-segment osteotomy. The displacement of vertebral column resection osteotomy was less than that of vertebral column decancellation in both single-and double-segment osteotomy models. L2 single-segment vertebral col

关 键 词：生物力学 去松质骨截骨 强直性脊柱后凸 有限元分析 内固定 截骨接触面 等效应力 双节段截骨 截骨节段 

分 类 号：R459.9[医药卫生—治疗学] R311[医药卫生—临床医学]