传统椎弓根螺钉与改良皮质骨轨迹置钉技术的生物力学性能有限元分析  

Biomechanical properties of traditional trajectory screw technique and modified cortical bone trajectory technique:a finite element analysis

作　　者：周志豪 阿拉法特·卡哈尔 王轶希 刘东山 希尔艾力·麦麦提 石文杰 帕尔哈提·热西提[1] Zhou Zhihao;Alafate·Kahaer;Wang Yixi;Liu Dongshan;Xieraili·Maimaiti;Shi Wenjie;Paerhati·Rexiti(Department of Spine Surgery,First Affiliated Hospital,Xinjiang Medical University,Urumqi 830054,Xinjiang Uygur Autonomous Region,China;Xinjiang Medical University,Urumqi 830054,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第一附属医院脊柱外科,新疆维吾尔自治区乌鲁木齐市830054 [2]新疆医科大学,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国组织工程研究》2022年第18期2789-2794,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81960415),项目名称:腰椎改良皮质骨螺钉技术相关生物力学、3D导板设计与应用研究,项目负责人:帕尔哈提·热西提;新疆维吾尔自治区研究生创新项目(XJ2021G206),项目名称:有限元分析不同直径螺钉在腰椎改良皮质骨与传统椎弓根置钉技术生物力学性能的差异,项目负责人:周志豪。

摘　　要：背景:根据现有皮质骨轨迹置钉技术的不足,作者提出了改良皮质骨轨迹置钉技术,但尚不清楚改良皮质骨轨迹置钉技术实际的力学性能表现。目的:通过有限元方法,对比改良皮质骨轨迹置钉技术与传统椎弓根螺钉技术应用于骨质疏松腰椎后生物力学性能上的差异。方法:获取4具人骨质疏松椎体标本的CT扫描数据,建立L4椎体有限元模型,创建螺钉模型,改良皮质骨轨迹置钉技术选用4种规格(直径为4.5,5.0,5.5,6.0 mm,长度均为40 mm)的螺钉,传统椎弓根螺钉技术选用2种规格(直径为6.0,6.5 mm,长度均为45 mm)的螺钉。首先,对螺钉依次进行安全性测试,置钉时导致椎弓根骨皮质发生破坏者被排除。确定安全直径后,分析螺钉的单钉拔出力、螺钉稳定性及椎体稳定性。结果与结论:①螺钉安全性测试:传统椎弓根螺钉技术选用直径6.5 mm、改良皮质骨轨迹置钉技术选用直径6.0 mm螺钉置入时存在骨质破坏的风险,其余直径螺钉无风险,该两组直径螺钉被排除后续测试;传统椎弓根螺钉技术螺钉安全直径为6.0 mm,改良皮质骨轨迹置钉技术螺钉安全直径为4.5,5.0,5.5 mm;②单钉拔出力:传统椎弓根螺钉技术组(直径6.0 mm)螺钉的单钉拔出力低于改良皮质骨轨迹置钉技术组(直径5.5,5.0,4.5 mm)(P<0.05);③螺钉稳定性:改良皮质骨轨迹置钉技术组(直径5.5,5.0 mm)上、下、左、右方向的载荷位移比均大于传统椎弓根螺钉技术(直径6.0 mm)(P<0.05);④椎体稳定性:改良皮质骨轨迹置钉技术组(直径5.5 mm)前屈、后伸、侧屈、旋转工况下的载荷位移比均大于传统椎弓根螺钉技术(直径6.0 mm),改良皮质骨轨迹置钉技术组(直径5.0 mm)前屈、后伸工况下的载荷位移比大于传统椎弓根螺钉技术(直径6.0 mm)(P<0.05);⑤结果提示:在L4椎体,综合螺钉的安全性和力学性能考虑,改良皮质骨轨迹螺钉直径5.0 mm是比较理想的选择。BACKGROUND:Based on the shortcomings of the existing cortical bone trajectory,we proposed a new screw trajectory of modified cortical bone trajectory,but it is not clear how the actual mechanical performance of the modified cortical bone trajectory is.OBJECTIVE:To compare the biomechanical difference of screws between modified cortical bone trajectory and traditional trajectory in osteoporotic lumbar spine by finite element method.METHODS:CT scan data of four human osteoporosis specimens were obtained.The finite element model of L4 vertebral body was established,and the screw model was created.The screws with specifications(diameter=4.5,5.0,5.5,6.0,length=40 mm)were selected for modified cortical bone trajectory,and(diameter=6.0,6.5,length=45 mm)for traditional trajectory.Firstly,the safety of screws was tested in turn.Those who caused damage to the cortical bone of pedicle during screw placement were excluded.After determining the safe diameter,the pull-out strength,screw stability,and vertebral body stability were analyzed.RESULTS AND CONCLUSION:(1)Screw safety test:When traditional trajectory(diameter=6.5 mm)and modified cortical bone trajectory(diameter=6.0 mm)were implanted,there was a risk of bone destruction,and there was no risk for other diameter screws.Therefore,the above two diameter screws were excluded from subsequent tests.The safety diameter of traditional trajectory was 6.0 mm,and that of modified cortical bone trajectory was 4.5,5.0,and 5.5 mm.(2)Pullout force:The force of traditional trajectory(diameter=6.0 mm)was lower than that of modified cortical bone trajectory(diameter=5.5,5.0,4.5 mm)(P<0.05).(3)Screw stability:The load-displacement ratio of modified cortical bone trajectory(diameter=5.5,5.0 mm)in the upper,down,left and right directions was greater than that of traditional trajectory(diameter=6.0 mm)(P<0.05).(4)Vertebral stability:The load-displacement ratio of modified cortical bone trajectory(diameter=5.5 mm)was greater than that of traditional trajectory(diameter=6.0 mm),and the load-d

关 键 词：骨质疏松 腰椎 有限元分析 皮质骨轨迹置钉技术 生物力学 椎弓根螺钉技术 

分 类 号：R459.9[医药卫生—治疗学] R318.01[医药卫生—临床医学]