新型关节突钉板系统联合单侧椎弓根螺钉固定的生物力学研究  

Biomechanical Study of Novel Articular Process Fixation System Combined with Unilateral Pedicle Screw Fixation

作　　者：缪伟 施建东 陆爱清[1] 王素春[1] 李霞[1] 王志荣 张文[2] MIAO Wei;SHI Jiandong;LU Aiqing;WANG Suchun;LI Xia;WANG Zhirong;ZHANG Wen(Department of Orthopaedics,Zhangjiagang Hospital Affiliated to Nanjing University of Chinese Medicine,Suzhou 215600,Jiangsu,China;Institute of Orthopaedics at Soochow University,Suzhou 215006,Jiangsu,China)

机构地区：[1]南京中医药大学张家港附属医院骨科,江苏苏州215600 [2]苏州大学骨科研究所,江苏苏州215006

出　　处：《医用生物力学》2021年第2期201-207,共7页Journal of Medical Biomechanics

基　　金：苏州市产业技术创新专项-民生科技医疗卫生应用基础研究项目(SYSD2017008);张家港市科技计划项目(ZKS1919)。

摘　　要：目的研究经椎间孔入路椎体间融合术(transforaminal lumbar interbody fusion,TLIF)结合新型关节突钉板系统(articular process fixation system,APFS)的腰椎稳定性。方法在已验证的有限元模型L3~S1完整节段(模型A)上,模拟TLIF手术,建立双侧椎弓根螺钉固定TLIF模型(模型B)、右单侧椎弓根螺钉固定TLIF模型(模型C)、APFS联合右侧椎弓根螺钉固定TLIF模型(模型D)。观察不同工况下腰椎模型的活动度(range of motion,ROM)以及椎弓根螺钉、APFS、椎间融合器应力分布情况。结果不同工况下,模型B、C、D整体ROM相当,均小于生理状态模型。模型D与模型B、C相比,右侧椎弓根螺钉及椎间融合器最大压应力在不同工况下最小或介于模型B、C之间。模型D在前屈状态下APFS及右侧椎弓根螺钉应力峰值均最大。结论APFS联合对侧椎弓根螺钉固定可作为腰椎TLIF手术的一种新型固定方式。Objective To study the stability of lumbar spine after transforaminal lumbar interbody fusion(TLIF)surgery combined with a novel articular process fixation system(APFS).Methods Based on the validated finite element model of L3-S1 intact segment(Model A),TLIF surgery was simulated to establish bilateral pedicle screw TLIF model(Model B),right unilateral pedicle screw TLIF model(Model C),APFS combined with right pedicle screw fixation TLIF model(Model D).The range of motion(ROM)of the lumbar spine model and stress distributions on pedicle screws,APFS and interbody fusion cages under different working conditions were observed.Results The overall ROMs of Models B,C,and D under different working conditions were comparable,which were all smaller than those of the physiological model.Compared with Models B and C,the maximum compressive stress of the right pedicle screw and the interbody fusion cage in Model D was the smallest or between Models B and C under different working conditions.Model D had the largest peak stress of APFS and right pedicle screw during anterior flexion.Conclusions APFS combined with contralateral pedicle screw fixation can be used as a novel fixation method for TLIF surgery of lumbar spine.

关 键 词：椎弓根螺钉 关节突 椎体间融合 有限元分析 

分 类 号：R318.01[医药卫生—生物医学工程]