有限元分析对骨质疏松条件下L5/S1斜外侧椎间融合与两种后路固定的生物力学研究  

Biomechanical Research on Oblique Lateral Interbody Fusion at L5/S1 under Osteoporotic Conditions and Two Types of Posterior Fixation:A Finite Element Analysis

作　　者：马玉轩 张涛 杨成伟 高杰 高红亮 李松凯 MA Yuxuan;ZHANG Tao;YANG Chengwei;GAO Jie;GAO Hongliang;LI Songkai(First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China;Spinal Surgery Department,Joint Logistics Support Force 940 Hospital,Lanzhou 730050,China)

机构地区：[1]宁夏医科大学第一临床医学院,银川750004 [2]联勤保障部队第九四〇医院脊柱外科,兰州730050

出　　处：《宁夏医科大学学报》2024年第6期627-633,共7页Journal of Ningxia Medical University

基　　金：甘肃省部级基金项目(2023HQZZ-08);院内应用基础研究面上项目(2021yxky008;2023yxky021)。

摘　　要：目的评估在骨质疏松条件下,行L5/S1节段斜外侧椎间融合术(oblique lateral interbody fusion at L5/S1,OLIF51)及其联合双侧皮质骨轨迹螺钉(cortical bone trajectory screw,CBT)和双侧椎弓根螺钉(bilateral pedicle screw,BPS)的生物力学性能。方法招募1名健康青年男性作为志愿者,获得其腰骶椎三维CT数据,在有限元分析软件中完成L4~S1三维模型,采用前路钛板(titanium plate,TP)固定的OLIF51手术模型、OLIF51+CBT和OLIF51+BPS手术模型的构建,分别命名为A、B、C、D模型。通过赋值、设定条件、施加载荷,分析不同条件下的生物力学特性。结果顺利完成4种有限元模型的构建。4种模型在所有运动中的平均活动度(range of motion,ROM)变化趋势为A模型>B模型>C模型>D模型;其中,与A模型相比,B模型降幅为84.21%~94.42%,C模型降幅为88.12%~96.40%,D模型降幅为90.07%~96.49%(P均<0.05);与B模型相比,C模型降幅为7.41%~52.38%,D模型降幅为27.78%~58.33%(P均<0.05)。3种手术模型在所有运动中的融合器(Cage)平均最大应力变化趋势为B模型>C模型>D模型;其中,与B模型相比,C模型降幅为12.89%~57.62%,D模型降幅为36.43%~73.11%;D模型和C模型相比,除左侧弯外差异均有统计学意义(P均<0.05);D模型降幅为21.83%~37.67%。3种手术模型在所有运动中的内固定平均最大应力变化趋势为B模型>C模型>D模型;与B模型相比,C模型降幅为3.55%~65.47%,D模型降幅为18.58%~84.41%;CBT应力大于BPS应力(P<0.05)。结论在OLIF51手术中,补充后路内固定可以增强融合节段的稳定性并减轻TP上的应力。不建议对骨质疏松症患者单独进行OLIF51手术,使用BPS辅助固定可达到最佳生物力学特性。接受CBT辅助内固定的患者术后需要佩戴支具,并尽量避免融合部位的右侧弯曲运动。Objective To evaluate the biomechanical performance of oblique lateral interbody fusion at L5/S1 segment(OLIF51)and its combination with bilateral cortical bone trajectory screw(CBT)and bilateral pedicle screw(BPS)under osteoporotic conditions.Methods One male healthy youth was recruited as a volunteer to obtain 3D CT data of the lumbosacral spine,and the modeling of the L4-S13D model,the OLIF51 surgical model with only anterior titanium plate(TP)fixation,the OLIF51+CBT,and the OLIF51+BPS surgical model was completed in finite element analysis software and were named as models A,B,C,and D respectively.The values were assigned,conditions were set,loads were applied,and the biomechanical properties were analyzed under different conditions.Results The construction of four finite element models was completed.The mean range of motion for the four models over all motions tended to be model A>model B>model C>model D;Among which,compared with model A,model B decreased from 84.21%to 94.42%,model C decreased from 88.12%to 96.40%,and model D decreased from 90.07%to 96.49%(P all<0.05);Compared with model B,model C decreased from 7.41%to 52.38%and model D decreased from 27.78%to 58.33%(P all<0.05).The trend of the mean maximum stress change of Cage in all motions for the three surgical models was model B>model C>model D;Among which,compared with model B,the decrease of model C was 12.89%-57.62%,and the decrease of model D was 36.43%-73.11%;there was a significant difference between model D and model C compared with model B,except for the left lateral bending(P all<0.05);The decrease of model D was 21.83%-37.67%.The trend of the mean maximum internal fixation stresses in all movements for the three surgical models was model B>model C>model D;Compared with model B,the decrease ranged from 3.55%to 65.47%for model C and 18.58%to 84.41%for model D;and the CBT stresses were greater than the BPS stresses(P<0.05).Conclusion Supplemental posterior internal fixation in the OLIF51 procedure enhances the stability of the fused segment an

关 键 词：L5/S1节段斜外侧椎间融合术 稳定性 内固定 有限元分析 

分 类 号：R681.5[医药卫生—骨科学]