颈椎椎间孔螺钉、侧块螺钉、椎弓根螺钉生物力学强度有限元分析  

Finite element analysis of biomechanical strength of cervical paravertebral foramen screws,lateral mass screws and pedicle screws

作　　者：陈建清 叶春平[1] 赵刘军[2] 黄维运 曹扬 Chen Jianqing;Ye Chunping;Zhao Liujun;Huang Weiyun;Cao Yang(Department of Spinal Surgery,Jinhua People’s Hospital,Jinhua 321000,Zhejiang,China;Department of Orthopaedics,Ningbo Sixth Hospital,Ningbo 315040,Zhejiang,China)

机构地区：[1]金华市人民医院脊柱外科,金华321000 [2]宁波市第六医院骨科,宁波315040

出　　处：《脊柱外科杂志》2023年第6期396-402,共7页Journal of Spinal Surgery

基　　金：浙江省医药卫生科技计划项目(2022KY341);浙江省基础公益研究计划项目(LGF18C100004);金华市科技计划项目(2019-3-017)。

摘　　要：目的运用有限元方法比较颈椎椎间孔螺钉(PVFS)、侧块螺钉(LMS)和椎弓根螺钉(PS)的生物力学强度。方法采集1名22岁健康男性志愿者颈椎C2~T1 CT数据,应用有限元软件建立下颈椎(C3~7)完整模型(对照组)以及C5/C6节段PVFS(PVFS组)、LMS(LMS组)和PS(PS组)内固定重建模型。在C3上分别施加头颅载荷75 N,力矩为1 N/m,使模型产生前屈后伸、左右侧曲、左右旋转运动,计算各组C5/C6节段活动度(ROM)、螺钉应力及螺钉-骨界面应力。结果实验建立了健康人下颈椎(C3~7)有限元模型,共获得654982个单元,869841个节点,通过网格加密方法验证了本模型的有效性。PVFS组有限元模型获得639846个单元,850923个节点;LMS组有限元模型获得2648732个单元,859105个节点;PS组有限元模型获得650953个单元,861843个节点。与对照组相比,6种工况下PVFS、LMS及PS组C5/C6节段ROM均降低:前屈(-66.9%,-56.2%,-72.8%),后伸(-53.3%,-49.4%,-63.9%),左侧曲(-60.2%,-55.3%,-64.9%),右侧曲(-61.7%,-57.3%,-65.8%),左旋(-38.8%,-35.4%,-49.1%),右旋(-41.7%,-37.9%,-51.4%)。在6种工况下PS组螺钉和螺钉-骨界面应力最小,PVFS组次之,LMS组最大。结论与传统颈椎后路内固定方式相比,PVFS能够提供良好稳定性,可以作为后路内固定方式的一种补充。Objective To compare the biomechanical strength of cervical paravertebral foramen screws(PVFS),lateral mass screws(LMS)and pedicle screws(PS)with finite element method.Method C2-T1 CT data was collected from a 22 year old normal male volunteer,and to establish a complete model of the lower cervical spine(C3-7)(control group),as well as C5/C6 segment PVFS(PVFS group),LMS(LMS group)and PS(PS group)internal fixation reconstruction models used finite element software.A head load of 75 N and a torque of 1 N/m on C3 was applied to generate flexion and extension,left and right bending,left and right rotation movements in the model.The range of motion(ROM)of C5/C6 segment,screw stress and screw-bone interface stress under conditions of flexion and extension,left and right lateral bending,left and right rotation in each group were calculated.Results A finite element model of the lower cervical spine(C3-7)in normal individuals was established,with a total of 654982 elements and 869841 nodes.The effectiveness of the model was verified through mesh refinement methods.The finite element model of PVFS group obtained 639846 elements and 850923 nodes,2648732 elements and 859105 nodes of LMS group,650953 elements and 861843 nodes of PS group.Compared with the control group,the ROMs of C5/C6 segment for PVFS,LMS and PS groups were decreased:flexion(-66.9%,-56.2%,-72.8%),extension(-53.3%,-49.4%,-63.9%),left bending(-60.2%,-55.3%,-64.9%),right bending(-61.7%,-57.3%,-65.8%),left rotation(-38.8%,-35.4%,-49.1%),right rotation(-41.7%,-37.9%,-51.4%).In terms of screw and screw-bone interface stress,PS group was the least,followed by PVFS group,and LMS group was the largest under 6 conditions.Conclusion Compared with traditional posterior cervical fixation methods,PVFS can provide good stability,and can be used as a supplement method to posterior internal fixation.

关 键 词：颈椎 骨钉 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]