不同颈椎前路椎间融合系统内固定颈椎的生物力学变化  

Biomechanical changes of the cervical spine in internal fixation with different anterior cervical interbody fusion systems

作　　者：王强 李世芸[1] 熊鹰[2] 李甜甜 Wang Qiang;Li Shiyun;Xiong Ying;Li Tiantian(School of Mechanical and Electrical Engineering,Kunming University of Science and Technology,Kunming 650000,Yunnan Province,China;Department of Orthopedics,Yan’an Hospital,Kunming Medical University,Kunming 650051,Yunnan Province,China;Shanneng New Energy(Dongying)Co.,Ltd.,Dongying 257000,Shandong Province,China)

机构地区：[1]昆明理工大学机电工程学院,云南省昆明市650000 [2]昆明医科大学附属延安医院骨科,云南省昆明市650051 [3]山能新能源(东营)有限公司,山东省东营市257000

出　　处：《中国组织工程研究》2024年第6期821-826,共6页Chinese Journal of Tissue Engineering Research

基　　金：云南省科技厅重大科技专项计划(202102AA310040),项目负责人:熊鹰。

摘　　要：背景:针对在颈椎病治疗过程中,颈椎前路椎间融合系统Zero-P系统在术后会出现螺钉松动、断裂等问题,研发出一种新型Low-P系统。目的:对比新型Low-P与Zero-P型颈椎前路椎间融合系统对颈椎邻近节段生物力学的影响,并对内固定系统进行应力分析,从而为临床治疗提供理论参考。方法:建立无损颈椎C_(1)-C_(7)节段完整模型,基于模型有效性,建立在C_(4)-C_(5)节段置入Low-P型(Z型Low-P和H型Low-P)与Zero-P型系统的有限元模型,在前屈、后伸、侧弯和旋转4种工况下,分析置入器械、邻近椎体髓核、纤维环与终板的应力分布情况。结果与结论:(1)置入Low-P型与Zero-P型内固定器械后,H型Low-P系统活动范围大,Z型Low-P系统最大应力值较小,Zero-P型对邻近节段髓核最大应力较大,终板最大应力较小;(2)3种内固定系统对邻近节段纤维环的影响相接近;(3)Zero-P型内固定系统螺钉应力远大于Low-P系统;(4)提示相比Zero-P型内固定系统,新型Low-P系统降低了钢板和螺钉的应力值,可以降低螺钉松动、内固定系统失效等问题;Low-P型系统对于邻近椎间盘髓核的应力较小,可降低邻近节段椎间盘退变;此次研究结果可为Low-P型内固定系统的临床研究提供理论依据。BACKGROUND:Due to the treatment of cervical spondylosis,the Zero-P system of the anterior cervical interbody fusion system will have problems such as screw loosening and fracture after operation,so a novel Low-P system has been developed.OBJECTIVE:To compare the effects of the novel Low-P and Zero-P anterior cervical intervertebral fusion systems on the biomechanical properties of adjacent segments of the cervical spine and to perform stress analysis on the internal fixation system,so as to provide a theoretical reference for clinical treatment.METHODS:A complete model of the C_(1)-C_(7) segment of the cervical spine was established.Based on the effectiveness of the model,a finite element model of Low-P(type Z Low-P and type H Low-P)and Zero-P system implanted in C_(4)-C_(5) segments was established.The stress distribution of implanted devices and adjacent vertebral nucleus pulposus,fibrous rings and end plates was analyzed under the conditions of forward flexion,posterior extension,lateral bending and rotation.RESULTS AND CONCLUSION:(1)After implantation of Low-P and Zero-P internal fixation devices,the range of motion of the type H Low-P system was large;the maximum stress value of type Z Low-P system was small;the maximum stress of Zero-P on the nucleus pulposus of adjacent segments was large;the maximum stress of end plate was small.(2)The influence of three internal fixation systems on adjacent segment fiber rings was close.(3)The screw stress of the Zero-P internal fixation system was much greater than that of the Low-P system.(4)It is indicated that compared with Zero-P type internal fixation system,the novel Low-P system reduces the stress value of steel plate and screw,which can reduce screw loosening and internal fixation system failure.The Low-P system has less stress on the nucleus pulposus of adjacent discs and reduces disc degeneration in adjacent segments.This paper provides a theoretical basis for the clinical study of a Low-P type internal fixation system.

关 键 词：颈椎前路内固定系统 Low-P型 Zero-P型 颈椎 生物力学 有限元分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R445