1例Lenke 1BN型青少年特发性脊柱侧凸矫形术后的有限元生物力学分析  

A case of Lenke type 1BN adolescent idiopathic scoliosis after corrective surgery:a finite element biomechanical analysis

作　　者：吴浩然 王玲 张慧杰 倪松智 马晓 李明[1] WU Haoran;WANG Ling;ZHANG Huijie;NI Songzhi;MA Xiao;LI Ming(Department of Spinal Surgery,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China;Outpatient Department,The Second Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200003,China;Department of Spinal Surgery,The Second Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200003,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院脊柱外科,上海200433 [2]海军军医大学(第二军医大学)第二附属医院门诊部,上海200003 [3]海军军医大学(第二军医大学)第二附属医院脊柱外科,上海200003

出　　处：《海军军医大学学报》2024年第6期700-707,共8页Academic Journal of Naval Medical University

摘　　要：目的用有限元法模拟不同远端固定椎(LIV)选择下的青少年特发性脊柱侧凸(AIS)矫形手术,分析术后远端叠加现象发生的生物力学基础,为术后预防叠加现象提供参考依据和理论支持。方法选取在海军军医大学(第二军医大学)第一附属医院脊柱外科进行手术治疗的1例Lenke 1BN型AIS患者(年龄13岁,身高152 cm,体重51 kg),构建全脊柱三维仿真有限元模型,通过计算机模拟不同LIV选择下的矫形手术,分析选择不同LIV下术后次弯代偿表现及未融合部分各椎间盘的最大应力。结果未融合部分椎间盘最大应力从远端到近端逐渐增大,当LIV选择在下端椎L_(1)时L_(1/2)椎间盘最大应力超过L2/3椎间盘最大应力约85%,当LIV选择在下端椎下方椎体L2、L3时,未融合节段椎间盘近端与远端每节的最大应力差别在20%左右。结论对于Lenke 1BN型AIS患者,LIV选择在下端椎下方椎体可减少叠加现象的发生风险。Objective To analyze the biomechanical basis of adding-on phenomenon using finite element method to simulate orthodontic surgery for adolescent idiopathic scoliosis(AIS)under different lowest instrumented vertebra(LIV)selections,so as to provide reference and theoretical support for the prevention of adding-on phenomenon after operation.Methods A Lenke type 1BN AIS patient(age 13 years old,body height 152 cm,body weight 51 kg)treated in Department of Spinal Surgery of The First Affiliated Hospital of Naval Medical University(Second Military Medical University)was enrolled.A 3-dimensional finite element model of the patient’s spine was constructed.Then,the AIS orthomorphia under different LIV options was simulated by computer to study the sub-curve compensation and maximum stress of the different unfused intervertebral discs.Results The maximum stress of the unfused intervertebral discs gradually increased from distal to proximal.When the LIV was located at L_(1)(the lower end vertebra),the maximum stress of the L_(1/2)disc was about 85%higher than that of the L2/3 disc.When the LIV was located at L2 and L3,the maximum stress difference between unfused intervertebral discs was about 20%.Conclusion For Lenke type 1BN AIS patients,LIV below the lower end vertebra can reduce the risk of adding-on phenomenon.

关 键 词：青少年特发性脊柱侧凸 矫形模拟 有限元分析 生物力学 

分 类 号：R687.3[医药卫生—骨科学] R318.01[医药卫生—外科学]