颈椎前路椎体骨化物可控前移融合对后纵韧带骨化物和内植物影响的有限元分析  

Effect of anterior controllable anteriodisplacement and fusion on vertebrae-ossification of posterior longitudinal ligament complex and implants:a finite element analysis

作　　者：李良奎 黄永灿 王鹏 于滨生[2,3] Li Liangkui;Huang Yongcan;Wang Peng;Yu Binsheng(Zhuhai Campus,Zunyi Medical University,Zhuhai 519041,Guangdong Province,China;Shenzhen Key Laboratory of Spine Surgery,Department of Spine Surgery of Peking University Shenzhen Hospital,Shenzhen 518036,Guangdong Province,China;Institute of Orthopedics,Shenzhen Peking University-Hong Kong University of Science and Technology Medical Center,Shenzhen 518036,Guangdong Province,China;Clinical College,Peking University Shenzhen Hospital,Anhui Medical University,Shenzhen 518036,Guangdong Province,China)

机构地区：[1]遵义医科大学珠海校区,广东省珠海市519041 [2]深圳市脊柱外科重点实验室,北京大学深圳医院脊柱外科,广东省深圳市518036 [3]深圳北京大学香港科技大学医学中心骨病研究所,广东省深圳市518036 [4]安徽医科大学北京大学深圳医院临床学院,广东省深圳市518036

出　　处：《中国组织工程研究》2025年第9期1761-1767,共7页Chinese Journal of Tissue Engineering Research

基　　金：深圳市脊柱外科重点实验室项目(ZDSYS201505051109056),项目负责人:于滨生。

摘　　要：背景:颈椎前路椎体骨化物可控前移融合对颈椎力学的影响尚未明确,既往研究主要集中在颈椎前路椎体骨化物可控前移融合的手术技巧、中长期疗效和术后并发症等。目的:运用有限元方法分析颈椎前路椎体骨化物可控前移融合对颈椎后纵韧带骨化物和内植物生物力学的影响。方法:选择一名健康男性志愿者进行全颈椎薄层CT扫描,应用有限元分析软件构建正常全颈椎模型,与既往文献进行对比验证其有效性;随后在模型上构建累及C4、C5和C6节段的连续型颈椎后纵韧带骨化物的术前模型;以术前模型为基础,创建颈椎前路椎体骨化物可控前移融合手术三维有限元模型,约束2个模型C7椎体下表面,于C1椎体上表面施加50 N的轴向力和1.0 N·m的力矩,在屈伸、侧弯、旋转6个工况下,分析颈椎前路椎体骨化物可控前移融合对骨化物和内植物应力的影响。结果与结论:①从术前模型得出骨化物应力主要集中在C4/5节段,在前屈、后伸、左侧弯、右侧弯、左旋转、右旋转6个工况下骨化物最大应力分别为10.1,148.6,68.9,74.8,83.8和85.1 MPa;②颈椎前路椎体骨化物可控前移融合术后,骨化物应力集中分布区域未见明显改变,但该手术会改变骨化物应力大小,除在前屈位颈椎前路椎体骨化物可控前移融合模型骨化物应力较术前模型增大(+44.7%)外,在其他5个工况下,骨化物应力较术前模型明显降低,其中后伸位下降最明显(-74.1%),在左侧弯、右侧弯、左旋转、右旋转下骨化物应力分别下降62.2%,63.3%,66.4%,67.9%;③钛板、螺钉应力主要集中在头尾两端,后伸应力最大(149.5 MPa),前屈应力最小(43.3 MPa);4个椎间融合器应力主要集中在C3/4、C6/7融合器,应力主要分布在融合器的上下表面周围,后伸应力最大(30.8 MPa),前屈应力最小(11.5 MPa);内植物(钛板、螺钉和椎间融合器)应力主要集中于头尾两端,应力较大易导BACKGROUND:The effect of anterior controllable anteriodisplacement and fusion on the biomechanics of cervical spine is still unclear.Previous studies have majorly focused on surgical techniques,the medium-and long-term efficacy,and postoperative complications of anterior controllable anteriodisplacement and fusion.OBJECTIVE:To analyze the biomechanical effects of anterior controllable anteriodisplacement and fusion on vertebrae-ossification of posterior longitudinal ligament complex and implants of the cervical spine using finite element method.METHODS:A healthy male volunteer was recruited for CT scanning of the entire cervical spine.Using the finite element analysis software,a normal whole cervical spine model was constructed and its validity was verified by comparison with the previous articles.Subsequently,a preoperative model of continuous posterior longitudinal ligament ossification involving C4,C5,and C6 was constructed.Based on the preoperative model,a three-dimensional finite element model of anterior controllable anteriodisplacement and fusion was created.After constrain of the lower surface of the C7 vertebral body of the two models,an axial force of 50 N and a moment of 1.0 N·m were applied to the upper surface of the C1 cone body.Under forward flexion,posterior extension,left/right bending,and left/right rotation conditions,the effects of anterior controllable anteriodisplacement and fusion on vertebrae-ossification of posterior longitudinal ligament complex and implants were further analyzed.RESULTS AND CONCLUSION:(1)From the preoperative model,it was found that the ossification stress was mainly concentrated in the C4/5 segment;the maximum stresses of vertebrae-ossification of posterior longitudinal ligament complex under the conditions of forward flexion,posterior extension,left bending,right bending,left rotation and right rotation were 10.1,148.6,68.9,74.8,83.8,and 85.1 MPa,respectively.(2)After anterior controllable anteriodisplacement and fusion,the distribution area of stress concentration a

关 键 词：颈椎后纵韧带骨化症 颈椎前路椎体骨化物可控前移融合术 有限元分析 韧带骨化物 内植物 生物力学 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R686.5