青少年胸椎经关节螺钉固定的有限元分析  

Finite element analysis of transarticular screw fixation of adolescent thoracic vertebra

作　　者：和雨洁 康志杰 薛明明 金凤[4] 李志军 王星 许阳阳 高明杰 李佳伟 李筱贺 王海燕 He Yujie;Kang Zhijie;Xue Mingming;Jin Feng;Li Zhijun;Wang Xing;Xu Yangyang;Gao Mingjie;Li Jiawei;Li Xiaohe;Wang Haiyan(Department of Human Anatomy of School of Basic Medicine,Inner Mongolia Medical University,Hohhot 010010,Inner Mongolia Autonomous Region,China;Graduate School,Inner Mongolia Medical University,Hohhot 010010,Inner Mongolia Autonomous Region,China;Department of Physiology of School of Basic Medicine,Inner Mongolia Medical University,Hohhot 010010,Inner Mongolia Autonomous Region,China;Department of Imaging of Affiliated Hospital,Inner Mongolia Medical University,Hohhot 010010,Inner Mongolia Autonomous Region,China;Department of Rehabilitation,Changzhi People’s Hospital,Changzhi 046000,Shanxi Province,China)

机构地区：[1]内蒙古医科大学基础医学院人体解剖学教研室,内蒙古自治区呼和浩特市010010 [2]内蒙古医科大学研究生院,内蒙古自治区呼和浩特市010010 [3]内蒙古医科大学基础医学院生理学教研室,内蒙古自治区呼和浩特市010010 [4]内蒙古医科大学附属医院影像科,内蒙古自治区呼和浩特市010010 [5]长治市人民医院康复科,山西省长治市046000

出　　处：《中国组织工程研究》2023年第9期1365-1370,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81860383),项目负责人:李志军;国家自然科学基金资助项目(81860558),项目负责人:金凤;内蒙古自然科学基金资助项目(2021MS08086),项目负责人:王海燕;内蒙古医科大学2020年大学生科技创新“英才培育”项目(YCPY20200015),项目负责人:王海燕;内蒙古医科大学2020年大学生科技创新“英才培育”项目(YCPY20200018),项目负责人:和雨洁;内蒙古医科大学2020年“三位一体”大学生创新创业培育项目(SWYT2020025),项目负责人:王海燕;内蒙古医科大学2020年“三位一体”大学生创新创业培育项目(SWYT2020021),项目负责人:和雨洁;内蒙古医科大学第一临床医学院2020年大学生“启蒙计划”项目(FYQMJH2020033),项目负责人:王海燕;内蒙古医科大学2020年度校级科研项目“成果转化”项目(YKD2020CGZH009),项目负责人:王海燕;内蒙古自治区级大学生创新创业训练计划项目(201910132019),项目负责人:王海燕;内蒙古自治区科技发展计划项目(2019GG115),项目负责人:李志军。

摘　　要：背景:关节突关节螺钉内固定作为一种被接受的内固定方法,目前已在颈椎和腰椎中进行了广泛的研究和应用。目的:拟通过有限元法定量分析比较青少年胸椎经关节螺钉内固定和传统椎弓根螺钉内固定的生物力学特性,探索前者在胸椎内固定术中应用的可行性。方法:建立14岁青少年全胸椎经关节螺钉固定(B组模型)和传统椎弓根螺钉固定(A组模型)的有限元模型。将连续扫描的胸椎断层影像原始数据以DICOM格式导入Mimics 21.0,分别重建T_(1)-T_(12),再导入到3-Matic,建立椎间盘、关节突关节、螺钉和钛棒的初步几何模型,再进行去噪、铺面、平滑等处理,完善后的模型导入Hypermesh软件进行网格划分,对材料进行属性赋值后导入ANSYS 19.2中显示有限元模型,设定边界和载荷条件。观测椎弓根、椎间盘、螺钉和钛棒等结构的活动度和应力情况;分析二者是否具有相同的受力情况和生物力学稳定性。结果与结论:(1)椎弓根螺钉各节段关节突关节的活动度在6种工况(前屈、后伸、左旋转、右旋转、左侧屈、右侧屈)下均大于小关节螺钉,最大值均位于左侧屈状态下的T_(11/12)节段(A组模型0.691°;B组模型0.563°);(2)前屈、后伸、侧屈和左旋转运动状态时,A、B两组模型椎弓根的应力值组间比较差异均无显著性意义(P>0.05);右旋转状态时,差异有显著性(P<0.05)的节段分别位于T_(3)、T_(6)-T_(9),A组模型应力值均大于B组模型;(3)前屈、后伸和侧屈运动状态时,A、B两组模型上关节突的应力值组间比较差异均无显著性意义(P>0.05);左旋转、右旋转状态时,差异有显著性(P<0.05)的节段分别位于T_(10)和T_(8),且B组模型上关节突关节面应力值均大于A组;(4)B组模型仅在前屈、右侧屈和右旋转工况下T_(1-2)节段椎间盘平均应力值大于A组,其余情况下应力值均小于A组,钛钉和钛棒的整体应力云图中,A组模型平均应力BACKGROUND:Facet screw fixation is currently accepted as an internal fixation method.It has been extensively studied and applied in the cervical spine and lumbar spine.OBJECTIVE:To quantitatively analyze and compare biomechanical properties of transarticular screw fixation and traditional pedicle screw fixation in adolescents using finite element method to explore the feasibility of the former in thoracic internal fixation.METHODS:The finite element models of total thoracic vertebral pedicle screw fixation(Model A)and transarticular screw fixation(Model B)were established in 14-year-old adolescents.The original data of continuous scan thoracic vertebral tomography images were imported into Mimics 21.0 in DICOM format.T_(1)-T_(12) were reconstructed and then imported into 3-Matic to establish preliminary geometric models of discs,facet joints,screws and titanium rods,and then processed with denoising,surfacing,smoothing and so on.The models were imported into Hypermesh software to carry on the grid.After attribute assignment,materials were imported into Ansys 19.2 to show the finite element model.Boundary and load condition were set.The motion range and stress of pedicles,intervertebral discs,screws,and titanium rods were observed,and whether the two had the same force and biomechanical stability were analyzed.RESULTS AND CONCLUSION:(1)The range of motion of facet joints in all segments of pedicle screws was greater than that of facet screws in all six working conditions(flexion,extension,left rotation,right rotation,left flexion,right flexion).The maximum motion was located at T_(11/12) segment in the left flexion state(Model A:0.691°;Model B:0.563°).(2)There was no significant difference in the stress value of the pedicle between the two groups in flexion,extension,lateral flexion and left rotation(P>0.05).In right-rotation state,the segments with significant differences(P<0.05)were located at T_(3) and T_(6)-T_(9),respectively,and the stress values of the model in Model A were higher than those in Model B.(3)

关 键 词：胸椎 小关节螺钉 椎弓根 青少年 有限元分析 

分 类 号：R459.9[医药卫生—治疗学] R496[医药卫生—临床医学] R318