脊柱骨折矢状面不同角度置钉方式的有限元分析  

Finite element analysis of different angles of nail placement in sagittal plane of spinal fracture

作　　者：魏兵 常山[2] Wei Bing;Chang Shan(Department of Orthopedics,Yubei District People’s Hospital,Chongqing 401120,China;Department of Orthopedics,First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,Sichuan Province,China)

机构地区：[1]重庆市渝北区人民医院骨科,重庆市401120 [2]成都医学院第一附属医院骨科,四川省成都市610500

出　　处：《中国组织工程研究》2022年第6期864-869,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:对于脊柱骨折患者,术者采用后路置钉方式治疗时会根据自己的习惯采取不同角度置入,但何种角度对术后效果更优暂无明确定论。目的:建立胸腰段脊柱椎体骨折的有限元模型,以探讨矢状面不同角度置入椎弓根螺钉对脊柱稳定性的影响。方法:选择青壮年L_(1)椎体新鲜压缩性骨折患者3例,通过有限元软件构建骨折模型(L1椎体骨折,T_(12)-L_(2)模型),利用HyperMesh装配螺钉建立L_(1)骨折在矢状面3种不同角度(以矢状面平行上终板、斜向上终板7°、斜向下终板7°)置钉方式的模型,对模型施加各类载荷,对其受力情况进行生物力学分析。结果与结论:在垂直状态下,不同置钉方式后椎体的最大位移都出现在T_(12)椎体表面;在扭转状态下,椎体的最大位移均向后移动到了上位椎体后柱部分及连接杆上部;在前屈状态下,椎体最大位移出现在T_(12)椎体的前缘或者后柱部分;在后伸状态下,椎体最大位移主要集中在T_(12)椎体的后柱部分;在侧曲状态下,椎体较大位移主要集中在T12椎体侧曲方向一侧;在相同状态下,斜向上置钉下的椎体位移最小,表明斜向上7°置钉时椎体会取得更好的稳定性。BACKGROUND:For patients with spinal fractures,when the surgeon adopts the method of posterior implantation and nail placement,different angles will be adopted according to his own habits,but which angle is better for the postoperative effect is not yet clear.OBJECTIVE:To establish a finite element model of thoracolumbar vertebral body fracture to explore the influence of pedicle screws placed at different angles in the sagittal plane on spinal stability.METHODS:Three young and middle-aged patients with fresh compression fractures of the lumbar 1 vertebral body were selected.The fracture model was constructed by finite element software(lumbar 1 vertebral body fracture,T_(12)-L_(2) model),and the HyperMesh assembly screw was used to establish the model of the L1 fracture at three different angles(sagittal plane is parallel to the upper endplate;obliquely upward endplate 7°;obliquely downward endplate 7°)in the sagittal plane.Various loads were applied to the model,and biomechanical analysis of its force was conducted.RESULTS AND CONCLUSION:In the vertical state,the maximum displacement of the vertebral body after different nail placement methods all appeared on the surface of the thoracic 12 vertebral body.In the torsion state,the maximum displacement of the vertebral body all moved back to the upper vertebral body in the posterior column part and the upper part of the connecting rod.In the forward flexion state,the maximum displacement of the vertebral body occurred at the front edge or the posterior column part of the thoracic 12 vertebral body.In the extension state,the maximum displacement of the vertebral body was mainly concentrated in the posterior column of the thoracic 12 vertebral body.In the scoliosis state,the larger displacement of the vertebral body was mainly concentrated on the scoliosis side of the thoracic 12 vertebral body.In the same state,the body displacement of all vertebrae with the oblique upward screw is the smallest,indicating that the vertebral body will be more stable if the screw is

关 键 词：骨折 脊柱骨折 后路置钉 有限元分析 椎弓根螺钉 稳定性 矢状角 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]