斜外侧腰椎椎间融合与双侧皮质骨轨迹螺钉置入后腰椎生物力学的有限元分析  

Finite element analysis of lumbar vertebra biomechanics after oblique lateral interbody fusion combined with bilateral cortical bone trajectory screw fixation

作　　者：鄢来军 葛海雅 周斌[1] 糜大国[1] 王鹏翔[1] 李楠[3] Yan Laijun;Ge Haiya;Zhou Bin;Mi Daguo;Wang Pengxiang;Li Nan(Nantong Hospital of Traditional Chinese Medicine,Nantong 226000,Jiangsu Province,China;Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200125,China;Key Laboratory of Orthopedics&Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education,Fujian University of Traditional Chinese Medicine,Fuzhou 350122,Fujian Province,China)

机构地区：[1]南通市中医院,江苏省南通市226000 [2]上海中医药大学附属曙光医院,上海市200125 [3]福建中医药大学中医骨伤及运动康复教育部重点实验室,福建省福州市350122

出　　处：《中国组织工程研究》2023年第13期1969-1974,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目(81973880),项目负责人:李楠;南通市卫生和计划生育委员会科研课题计划资助(QA2021025),项目负责人:鄢来军。

摘　　要：背景:皮质骨轨迹螺钉是一种新型的脊柱微创内固定技术,相比于传统的椎弓根螺钉具有创伤小、抗拔出力强的特点,对骨质疏松患者具有较强的生物力学稳定性,但目前探讨应用皮质骨轨迹螺钉联合斜外侧腰椎椎间融合固定术式的研究仍少见。目的:通过建立单纯斜外侧腰椎椎间融合无螺钉固定(OLIF stand-alone)、斜外侧腰椎椎间融合联合双侧椎弓根螺钉(OLIF+BPS)与斜外侧腰椎椎间融合联合皮质骨轨迹螺钉(OLIF+CBT)3种有限元模型,评估斜外侧腰椎椎间融合联合不同内固定方式对椎间融合器(cage)及L_(4-5)下终板的应力分布变化及腰椎活动度的影响。方法:采集成人腰椎薄层CT图像,通过Mimics、Geomagic和SolidWorks软件建立3种斜外侧腰椎椎间融合术式有限元模型:OLIF stand-alone模型、OLIF+BPS模型及OLIF+CBT模型。通过Ansys workbench模拟施加人体屈伸、左右侧弯及左右旋转6种不同运动载荷,计算3种腰椎手术模型的cage和终板应力分布及腰椎活动度的变化差异,以比较3种手术方案对腰椎生物力学效应的影响。结果与结论:①成功构建OLIF stand-alone、OLIF+BPS及OLIF+CBT三种有限元模型;②OLIF+CBT模型在前屈、后伸、左右侧弯及左右旋转活动工况下,其活动度与OLIF stand-alone模型差异不大;③OLIF+CBT模型在屈伸、侧弯活动工况下,其cage最大应力小于OLIF stand-alone模型,且稍大于OLIF+BPS模型;在旋转活动工况下,相较其他两种模型,OLIF+CBT模型cage最大应力最大;(3)OLIF+CBT模型在各个运动载荷下,下终板最大应力均小于OLIF stand-alone模型,且稍大于OLIF+BPS模型;④结果表明,斜外侧腰椎椎间融合联合皮质骨轨迹螺钉固定在保证腰椎活动度的前提下为融合节段椎体提供良好的稳定支撑,且具有相对较好的生物力学效应。BACKGROUND:Cortical bone trajectory screw is a new type of spinal minimally invasive internal fixation technology.Compared with traditional pedicle screws,it has the characteristics of less trauma and strong pullout resistance,and has strong biomechanical properties for patients with osteoporosis.However,studies on the application of cortical bone trajectory screws combined with oblique lateral interbody fusion and fixation are still rare.OBJECTIVE:To evaluate the effect of oblique lateral interbody fusion combined with various fixation methods on stress distribution and range of motion of cage and L_(4-5) lower endplate by constructing three kinds of finite element models including oblique lateral interbody fusion(OLIF stand-alone)model,OLIF combined with bilateral pedicle screw(OLIF+BPS)model and OLIF combined with cortical bone trajectory screw(OLIF+CBT)model.METHODS:The CT images of adult lumbar spine were used to establish the three kinds of OLIF finite element models:OLIF stand alone,OLIF+BPS,and OLIF+CBT.Ansys workbench was used to simulate the application of six different motion loads of human body fexion and extension,left and right bending,and left and right rotation to calculate stress distribution and the changes in the range of motion of the lumbar spine of the cage and endplate of the three lumbar spine surgery models and to compare the effects of three surgical options on the biomechanical effects of the lumbar spine.RESULTS AND CONCLUSION:(1)The OLIF stand-alone model,OLIF+BPS model and OLIF+CBT model were constructed successfully.(2)In terms of range of motion,OLIF+CBT model presented no obvious difference with that of OLIF stand-alone model in fexion and extension,left and right lateral bending,and left and right rotation motions.(3)In fexion,extension,and lateral bending conditions,the maximum stress of cage of OLIF+CBT model was smaller than that of OLIF stand-alone model and slightly greater than that of OLIF+BPS model.When it came to rotating condition,the maximum stress of cage in OLIF+CBT

关 键 词：脊柱 椎间盘 斜外侧腰椎椎间融合 皮质骨轨迹螺钉 有限元 

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