腰椎斜外侧椎间融合后融合器侧方移位的生物力学有限元分析  

Biomechanical finite element analysis of lateral displacement of the cage after oblique lumbar interbody fusion

作　　者：吕杰 王永峰[2] 原杰 徐朝健[2] 秦一川 郝家齐 LüJie;Wang Yongfeng;Yuan Jie;Xu Zhaojian;Qin Yichuan;Hao Jiaqi(Second Clinical Medical College of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China;Department of Orthopedics,Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第二临床医学院,山西省太原市030001 [2]山西医科大学第二医院骨科,山西省太原市030001

出　　处：《中国组织工程研究》2021年第33期5301-5306,共6页Chinese Journal of Tissue Engineering Research

基　　金：山西省自然科学基金资助项目(201801D121220),项目负责人:王永峰。

摘　　要：背景:斜外侧椎间融合是当前临床治疗腰椎退行性疾病的有效手段,而术后发生融合器侧移的处理方式尚无定论,利用有限元法进行斜外侧椎间融合后不同情况的生物力学分析成为越来越多研究者的一种选择。目的:运用有限元分析法评估斜外侧椎间融合后椎间融合器(cage)侧方移位对腰椎生物力学的影响,为术后该情况的处理提供生物力学依据。方法:选择1名健康男性行腰椎CT扫描,获得其扫描数据。利用Mimics、Geomagic、Solidworks和Ansys workbench软件建立L_(3)-L_(5)三维有限元模型,设定为正常对照组,同时建立斜外侧椎间融合独立融合固定组(SA组)和斜外侧椎间融合联合双侧椎弓根钉棒固定组(BPS组)模型。根据cage移位程度将SA组具体分为:cage无移位模型(SA_(0))、cage右缘中点移位至L5上终板横径右1/8点(SA_(1))、2/8点(SA_(2))、3/8点(SA_(3))、4/8点(SA_(4))。在SA分组基础上,联合钉棒固定的模型分别是BPS_(0)、BPS_(1)、BPS_(2)、BPS_(3)、BPS_(4)。对不同模型施加相同的加载条件,模拟脊椎前屈、后伸、侧屈及旋转运动状态,观察各模型不同工况下腰椎活动度以及椎间融合器和钉棒系统的应力峰值。结果与结论:①SA_(0)、SA_(1)、SA_(2)在不同运动状态的活动度均小于正常对照组,而SA_(3)在后伸以及SA_(4)在后伸、右侧屈状态的活动度大于正常对照组;②在不同状态下,SA组和BPS组的活动度和融合器应力峰值在整体上均随融合器侧移距离的增加而呈现上升趋势;③当cage处于同一位置时,BPS组在所有状态下的活动度和融合器应力峰值均小于SA组;④在各个状态下,BPS组的钉棒系统应力峰值为:BPS_(0)<BPS_(1)<BPS_(2)<BPS_(3)<BPS_(4);⑤提示当斜外侧椎间融合独立融合固定后发生融合器左侧移位时,随移位距离增加,各种状态下腰椎活动度和融合器的应力峰值在整体上均逐渐增加,存在脊柱失稳趋势。在此基础�BACKGROUND:Oblique lateral interbody fusion is an effective method for the current clinical treatment of lumbar degenerative diseases.However,the treatment for postoperative lateral displacement of the cage has not been determined yet.Therefore,using finite element analysis to analyze the biomechanics of different conditions after oblique lateral interbody fusion has become a choice for more and more researchers.OBJECTIVE:To evaluate the effect of lateral displacement of cage on the lumbar biomechanics after oblique lateral interbody fusion with finite element analysis,and to provide biomechanical basis for the treatment of this condition.METHODS:A healthy male was selected to undergo lumbar CT scanning,and the scanning data were obtained.The three-dimensional finite element model of L_(3)-L_(5) was established by Mimics,Geomagic,SolidWorks and ANSYS Workbench software,and was set as normal control group.Oblique lateral interbody fusion Stand alone fixation group(SA)and oblique lateral interbody fusion with bilateral pedicle screws fixation group(BPS)were established.According to the degree of Cage displacement,the SA group was divided into five groups:the cage non-displaced model(SA_(0)),the midpoint of the right edge of the cage shifted to the right 1/8 point(SA_(1)),2/8 point(SA_(2)),3/8 point(SA_(3)),and 4/8 point(SA_(4))of the transverse diameter of the upper endplate of L_(5).On the basis of SA grouping,the models with bilateral pedicle screws were BPS_(0),BPS_(1),BPS_(2),BPS_(3) and BPS_(4),respectively.The same loading conditions were applied to different models to simulate the flexion,extension,lateral flexion and rotation of the spine.The range of motion of the lumbar spine and the stress peak of the cage and screw-rod system were observed under different working conditions.RESULTS AND CONCLUSION:(1)The range of motion of SA_(0),SA_(1) and SA_(2) was lower than that of normal control group in different motion states,while the range of motion of SA_(3) and SA_(4) was greater than that of normal control g

关 键 词：斜外侧椎间融合 融合器移位 活动度 有限元分析 生物力学 

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