聚醚醚酮棒与钛棒在后路腰椎椎间融合中的有限元分析  

Finite element analysis of polyetheretherketone and titanium rods in posterior lumbar interbody fusion

作　　者：李杰[1] 曹帅 郭栋[1] 张琼弛 贺西京[1] 李浩鹏[1] 卢腾 Li Jie;Cao Shuai;Guo Dong;Zhang Qiongchi;He Xijing;Li Haopeng;Lu Teng(Second Department of Orthopedics,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,Shaanxi Province,China;Department of Or thopedics,Civil Aviati on General Hospital,Beiji ng 100123,China)

机构地区：[1]西安交通大学第二附属医院骨二科,陕西省西安市710004 [2]民航总医院骨科,北京市100123

出　　处：《中国组织工程研究》2023年第22期3445-3450,共6页Chinese Journal of Tissue Engineering Research

基　　金：陕西省自然科学基础研究计划(2022-JQ195),项目负责人:卢腾;国家自然科学基金(82172396),项目负责人:李浩鹏。

摘　　要：背景:聚醚醚酮棒是一种新型的半刚性固定材料,但是其在后路腰椎椎间融合术中的生物力学性能仍不清楚。目的:对比聚醚醚酮棒与钛棒在后路腰椎椎间融合过程中的生物力学性能,尝试回答聚醚醚酮棒是否有潜力成为钛棒的替代品,尤其在前柱支撑不充分的情况下。方法:利用有限元方法构建完整的人腰椎(L)模型,并进一步构建4个后路腰椎椎间融合模型:①聚醚醚酮棒+cage;②钛棒+cage;③聚醚醚酮棒+纯植骨;④钛棒+纯植骨。比较不同模型中节段活动度、相关结构应力以及应变。结果与结论:①所有手术模型在限制L节段活动度方面无明显差异;②与钛棒相比,聚醚醚酮棒增加了椎间植骨的平均应变、增加了终板以及cage的峰值应力,同时降低了螺钉以及骨-螺钉界面的峰值应力;聚醚醚酮棒的峰值应力与屈服应力之比为6%-26%,高于钛棒的3%-12%;③在L节段上,聚醚醚酮棒仅轻微地降低了节段活动度与椎间盘峰值应力;④因此与钛棒相比,聚醚醚酮棒可能降低假关节、螺钉断裂与松动的风险,但是也可能导致终板塌陷、cage损坏以及棒断裂的风险更高;聚醚醚酮棒在延缓邻近节段退变中可能较钛棒有微弱的优势;在不使用cage而仅采用骨移植物进行椎间融合时,聚醚醚酮棒也许是一个可供选择的方案。BACKGROUND:Polyetheretherketone rod is a new mate rial for semi-rigid fixation;however,its biomechanical properties in posterior lumbar interbody fusion remain unclear.OBJECTIVE:To compare the biomechanical properties of polyetheretherketone rods and titanium rods in posterior lumbar interbody fusion,and try to answer whether polyetheretherketone rods have the potential to be a substitute for titanium rods,especially when the anterior column of the spine is not adequately supported.METHODS:An intact L3.5 lumbar model was constructed using the finite element method.The four posterior lumbar interbody fusion constructs were developed:(1) polyetheretherketone rods with cage;(2) titanium rods with cage;(3) polyetheretherketone rods with bone grafts alone;and(4) titanium rods with bone grafts alone.The range of motion,stress and strain of the related structures were compared among the four posterior lumbar interbody fusion constructs.RESULTS AND CONCLUSION:(1) There was no significant difference in the Lrange of motion among all surgical models.(2) Compared to titanium rods,polyetheretherketone rods increased the average strain of interbody bone grafts and the peak stresses of endplates and cages and reduced the peak stresses of the screws and bone-screw interfaces.The ratio of peak stress to yield stress for the polyetheretherketone rods(6%-26%) was higher than that for the titanium rods(3%-12%).(3) Polyetheretherketone rods only slightly reduced the range of motion and disc stress at the Lsegment.(4) Compared to titanium rods,polyetheretherketone rods maybe reduce the risks of pseudoarthroses,screw breaking,and loosening but lead to the higher ris ks of endplate collapse,cage failure,and rod fra cture.Polyetheretherketone rods may have a weak advantage over titanium rods in retarding adjacent segment degeneration.Polyetheretherketone rods may be an alternative when interbody fusion is performed with bone grafts alone instead of cages.

关 键 词：聚醚醚酮棒 钛棒 后路腰椎间融合 有限元分析 应力遮挡 纯植骨 邻近节段退变 

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