前路枕骨髁钢板螺钉内固定治疗上颈椎不稳的有限元分析  

Finite element study of anterior occipital condyle plate and screw in the treatment of upper cervical spine instability

作　　者：施凯日 王扬[2] 李豪杰 陈云琳[2] 胡旭栋[2] 周树一 彭宇杰 马维虎[1] Shi Kairi;Wang Yang;Li Haojie;Chen Yunlin;Hu Xudong;Zhou Shuyi;Peng Yujie;Ma Weihu(School of Medicine,Ningbo University,Ningbo 315211,China;Department of Spinal Surgery,Ningbo No.6 Hospital,Ningbo 315040,China)

机构地区：[1]宁波大学医学院,315211 [2]宁波市第六医院脊柱外科,315040

出　　处：《中华创伤杂志》2021年第11期997-1005,共9页Chinese Journal of Trauma

基　　金：浙江省自然科学基金(LY19H060002)。

摘　　要：目的探讨前路枕骨髁钢板螺钉内固定相较于常见前路枕颈融合内固定装置治疗上颈椎不稳的性能差异。方法选取1名28岁健康成年男性志愿者的枕颈部CT数据建立有限元模型,包括正常模型、单纯人工椎体(异形钛笼+斜坡螺钉)内固定模型、斜坡钢板螺钉内固定模型、前路枕骨髁钢板螺钉内固定模型,在枕骨上表面施加50 N载荷和1.5 N·m扭矩,使模型产生屈伸、侧弯及旋转运动。比较各模型在屈、伸、侧弯、旋转工况下的活动度、内固定应力峰值及颅骨应力峰值的分布。结果在屈、伸、侧弯、旋转工况下,正常模型活动度分别为18.65°、15.35°、9.82°、34.68°;单纯人工椎体内固定模型分别为3.20°、3.63°、2.94°、3.92°;斜坡钢板螺钉内固定模型分别为0.40°、0.50°、0.35°、0.89°;前路枕骨髁钢板螺钉内固定模型分别为0.27°、0.33°、0.13°、0.30°。在屈、伸、侧弯、旋转工况下,相较于单纯人工椎体内固定模型,斜坡钢板螺钉内固定模型活动度分别减少87.5%、86.2%、88.1%、77.3%,前路枕骨髁钢板螺钉内固定模型分别减少91.5%、90.1%、95.6%、92.3%。在屈伸、侧弯、旋转工况下,单纯人工椎体内固定的应力峰值分别为52.3 MPa、51.9 MPa、52.6 MPa;斜坡钢板螺钉内固定分别为100.1 MPa、158.1 MPa、170.6 MPa;前路枕骨髁钢板螺钉内固定分别为114.2 MPa、62.9 MPa、132.9 MPa。在屈伸、侧弯、旋转工况下,单纯人工椎体内固定时的颅骨应力峰值分别为52.9 MPa、50.9 MPa、62.3 MPa;斜坡钢板螺钉内固定时分别为19.7 MPa、55.9 MPa、38.3 MPa;前路枕骨髁钢板螺钉内固定时分别为37.8 MPa、15.0 MPa、16.3 MPa,舌下神经管附近骨质应力远小于颅骨应力峰值,接近于0 MPa。结论在异形钛笼前方加用前路枕骨髁钢板螺钉内固定能提升枕颈融合的稳定性,未见明显应力集中,并且对颅骨及舌下神经管影响较小,是上颈椎不稳的一种安全�Objective To explore the difference in properties of anterior occipital condyle plate screws compared with common anterior occipitalcervical fusion internal fixation.Methods A 28-year-old healthy adult male volunteer's CT data of the occiput and neck was selected to establish finite element models:including the normal model,simple artificial vertebral fixation model(special-shaped titanium cage+clival screws),anterior occipital condyle plate and screw fixation model,and clival plate and screw fixation model,then a 50 N gravity and a torque of 1.5 N m were exerted upon the upper surface of the occipital bone to make the model produce flexion and extension,lateral bending and rotation.The motion range,internal fixation stress distribution and occipital bone stress distribution of each model under varying conditions were compared.Results Under the conditions of flexion,extension,lateral bending and rotation,the range of motion of the normal model was 18.65°,15.35°,9.82°and 34.68°,respectively;that of the simple artificial vertebral fixation model was 3.20°,3.63°,2.94°and 3.92°,respectively;that of the clival plate and screw fixation model was 0.40°,0.50°,0.35°and 0.89°,respectively;that of the anterior occipital condylar plate and screw fixation model was 0.27°,0.33°,0.13°and 0.30°,respectively.Compared with the simple artificial vertebral fixation model,the range of motion of the clival plate and screw fixation model decreased by 87.5%,86.2%,88.1%and 77.3%in flexion,extension,lateral bending and rotation.The range of motion of the anterior occipital condylar plate and screw fixation model decreased by 91.5%,90.1%,95.6%and 92.3%,respectively.Under the conditions of flexion and extension,lateral bending and rotation,the stress peak of the simple artificial vertebral fixation model was 52.3 MPa,51.9 MPa,52.6 MPa,respectively;that of the clival plate and screw fixation was 100.1 MPa,158.1 MPa,170.6 MPa,respectively;that of the anterior occipital condylar plate and screw fixation was 114.2 MPa,62.9 MPa,1

关 键 词：颈椎 内固定器 有限元分析 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]