不同截骨节段重建ⅢA型强直性脊柱后凸矢状面平衡的生物力学分析  

Biomechanical analysis of sagittal plane balance of typeⅢA ankylosing kyphosis reconstructed by different osteotomy segments

作　　者：李辉[1] 高晓玲[2] 马原[3] Li Hui;Gao Xiaoling;Ma Yuan(Department of Cardiovascular Surgery,Linfen People's Hospital,Linfen 041000,Shanxi Province,China;CT Diagnostics Department,Linfen People's Hospital,Linfen 041000,Shanxi Province,China;Department of Spine Surgery,The Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]临汾市人民医院心脏大血管外科,山西省临汾市041000 [2]临汾市人民医院CT室,山西省临汾市041000 [3]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830002

出　　处：《中国组织工程研究》2020年第30期4824-4828,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:强直性脊柱后凸畸形的矫形技术已较为成熟,术者也可根据患者的弯曲类型、弯曲度数等选择不同的截骨术式,但由于缺少被广泛认可的分型系统,导致强直性脊柱后凸畸形的描述和手术策略制定都较为混乱。目的:应用计算机辅助软件建立强直性脊柱炎后凸截骨三维有限元模型,分析其生物力学特性。方法:获取1例301分型ⅢA型强直性脊柱后凸畸形患者的影像资料,建立强直性脊柱后凸畸形三维有限元模型,测量T12、L1、L2和L34个不同节段截骨角度,模拟去松质骨截骨术,对截骨矫形后的模型进行钉棒系统固定,分析其生物力学特性。结果与结论:①截骨节段越靠近尾端螺钉应力越大,螺钉应力分布大小的顺序为L3>L2>L1>T12,不同截骨节段的螺钉应力分布特点相同,都集中在截骨节段的相邻上/下2个节段的螺钉上,明显大于其他节段的螺钉应力;②钛棒的应力大小顺序为L2>L3>L1>T12;③截骨节段越靠近头端截骨接触面应力越大,截骨接触面应力大小顺序为T12>L1>L2>L3;④结果表明对于ⅢA型强直性脊柱后凸畸形,选择L2截骨节段可获得较佳的矫形程度、降低内固定应力分布集中导致的并发症发生。BACKGROUND:Orthopedic technique of ankylosing kyphosis is more mature.The surgeons can also choose different osteotomy methods according to the patients’bending type and bending degree.However,due to the lack of widely recognized classification system,the description of ankylosing kyphosis and the formulation of operation strategy are confused.OBJECTIVE:To establish a three-dimensional finite element model of kyphosis osteotomy in ankylosing spondylitis using computer-aided software and analyze its biomechanical characteristics.METHODS:Image data of a patient with ankylosing kyphosis of type IIIA with strong 301 classification were obtained to establish a three-dimensional finite element model of ankylosing kyphosis.The osteotomy angles of T12,L1,L2 and L3 different segments were measured.Osteotomy of cancellous bone was simulated.The model after osteotomy was fixed with nail bar system.Biomechanical characteristics were analyzed.RESULTS AND CONCLUSION:(1)The closer the osteotomy segment was to the tail end,the greater the screw stress was,and the order of the screw stress distribution was L3>L2>L1>T12.The stress distribution characteristics of different osteotomy segments were the same.The screw stress was concentrated on the adjacent upper/lower two segments of the osteotomy segment,and was significantly greater than that of other segments.(2)The order of the titanium rod stress was L2>L3>L1>T12.(3)The closer the bone segment was to the head,the greater the stress was,and the order of the stress was T12>L1>L2>L3.(4)The results show that for the type IIIA ankylosing kyphosis,the better degree of orthopedic can be obtained by selecting L2 osteotomy segment,and the complications caused by the concentration of internal fixation stress distribution can be reduced.

关 键 词：强直性脊柱后凸 脊柱后凸畸形 301分型 生物力学 有限元分析 脊柱去松质骨截骨 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]