3D打印假体与单纯钉棒系统用于全骶骨切除重建的有限元分析比较  

Comparison of 3D-printed prosthesis and screw-rod system for reconstruction after total sacrectomy: A finite element analysis

作　　者：张亚 马晓孟 孙允龙 李锋[4] Zhang Ya;Ma Xiaomeng;Sun Yunlong;Li Feng(Department of Emergency Surgery,Xiehe Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan Hubei,430030;Wuhan JiaYi 3D Technology Application Co.,Ltd.,Wuhan Hubei,430061;Department of Spine Surgery,Qingdao Municipal Hospital,Qingdao Shandong,266000;Department of Orthopedics,Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan Hubei,430030,China)

机构地区：[1]华中科技大学同济医学院附属协和医院急诊外科,湖北武汉430030 [2]武汉嘉一三维技术应用有限公司,湖北武汉430061 [3]青岛市市立医院脊柱外科中心,山东青岛266000 [4]华中科技大学同济医学院附属同济医院骨科,湖北武汉430030

出　　处：《生物骨科材料与临床研究》2022年第2期26-32,共7页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的 比较3D打印假体与单纯钉棒系统用于全骶骨切除后腰椎-骨盆稳定性重建效果的有限元分析差异。方法 创建三种腰椎-骨盆重建的有限元分析模型:模型1为单侧双髂骨钉双棒重建;模型2为单侧双髂骨钉双棒+3D打印假体重建,其中下方髂骨钉穿过假体;模型3为单侧双髂骨钉双棒+3D打印假体重建,髂骨钉不穿过假体。在有限元分析软件中为三组模型施加同样的材料属性和约束条件,假体与髂骨截骨面设定为表面-表面接触,摩擦系数为0.3,其余相互关系均设为绑定。限制双侧髋臼在三维坐标系上任意方向的移动,在L_(3)椎体上终板施加960 N垂直向下的压力。记录内固定钉棒的平均最大应力以及L_(5)椎体的下沉距离。结果 模型1所有髂骨钉、连接棒、L_(3)和L_(5)椎弓根钉平均最大应力及L_(5)下沉距离均显著大于模型2与模型3(P<0.01),L_(4)椎弓根钉平均最大应力显著小于模型3(P<0.01),与模型2无显著差异(P>0.05);模型2上位髂骨钉和L_(3)椎弓根钉平均最大应力显著大于模型3(P<0.01),L_(4)和L_(5)椎弓根钉、锁定钉及内侧连接棒平均最大应力显著小于模型3(P<0.05),下位髂骨钉和外侧连接棒平均最大应力与模型3无显著差异(P>0.05)。模型1和模型2上位髂骨钉平均最大应力均显著大于下位髂骨钉(P<0.05),模型3髂骨钉平均最大应力无显著差异(P>0.05);模型3内侧连接棒平均最大应力显著大于外侧连接棒(P<0.05);在模型1和模型2中,内、外侧连接棒平均最大应力无显著差异(P>0.05)。结论 使用3D打印假体重建全骶骨切除后腰椎-骨盆稳定性可以减少钉棒系统平均最大应力,降低钉棒断裂的风险,是一种值得推广的重建技术,但假体与钉棒的组合方式仍需继续探索。Objective To explore the finite element analysis difference between 3D-printed prosthesis and only screw-rod system for lumbo-pelvic stability reconstruction after total sacrectomy. Methods Three finite element analysis models were built: Model 1 was built with double rods and double iliac screws on each side;Model 2 was built with double rods and double iliac screws on each side and 3D-printed prosthesis, in which a iliac screw was inserted through the prosthesis;Model 3 was similar to Model 2, but the iliac screw did not penetrate the prosthesis. In finite element analysis software models were given the same material property and constraints, the prosthesis-bone surface was defined as surface-surface contact relation, and the rest of the relationship were binding. Arbitrary direction freedom of bilateral acetabulum in the three-dimensional coordinates was limited, the L_(3)upper endplate was imposed 960 N axial stress, and the average maximum stress of internal fixation system and L_(5)subsidence distance were recorded. Results The results of three finite element models were calculated successfully. The average maximum stress of bilateral iliac screws, rods, L_(3)and L_(5)pedicle screws and the subsidence distance of L_(5)in model 1 were higher than those in the other two groups significantly(P<0.01).The average maximum stress of L_(4)pedicle screws in Model 1 showed significant difference with Model 3(P<0.01), and no significant difference with Model 2(P>0.05). In Model 2 the average maximum stress of upper iliac screws and L_(3)pedicle screws was significantly greater than those in model 3(P<0.01), while the average maximum stress of L_(4)and L_(5)pedicle screws, locking screws and the inner rods was significantly less than that in model 3(P<0.05), and the average maximum stress of lower iliac screws and the outer rods showed no significant difference with Model 3(P>0.05). In Model 1 and Model 2, the average maximum stress of the upper iliac screws was significantly higher than that of lower iliac screws(P<0.

关 键 词：骶骨切除 3D打印 假体 有限元分析 

分 类 号：R318[医药卫生—生物医学工程]