计算机辅助改良椎板钩的设计及其固定腰椎峡部裂的生物力学有限元分析  

Computer‑aided design of an improved lamina hook and finite element analysis of its use in fixation of lumbar spondylolysis

作　　者：高红亮 刘华 张涛 杨成伟 王仪哲 黄子荣 章文华 陈龙 康兵[1] 马玉轩 李松凯 Gao Hongliang;Liu Hua;Zhang Tao;Yang Chengwei;Wang Yizhe;Huang Zirong;Zhang Wenhua;Chen Long;Kang bing;Ma Yuxuan;Li Songkai(Department of Spine Surgery,940th Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050,China;First Clinical Medical College of Gansu University of Chinese Medicine,Lanzhou 730030,China;Department of Sports Medicine,Shenzhen Second People′s Hospital,First Affiliated Hospital of Shenzhen University,Shenzhen 518000,China)

机构地区：[1]中国人民解放军联勤保障部队第九四〇医院脊柱外科,兰州730050 [2]甘肃中医药大学第一临床医学院,兰州730030 [3]深圳大学第一附属医院深圳市第二人民医院运动医学科,深圳518000

出　　处：《中华创伤杂志》2024年第7期593-604,共12页Chinese Journal of Trauma

基　　金：军队后勤科研项目(2023HQZZ‐08);院内应用基础研究面上项目(2021yxky008);院内临床研究面上项目(2023YXKY021)。

摘　　要：目的设计改良椎板钩系统,并与传统椎板钩系统固定腰椎峡部裂的生物力学特性进行比较。方法收集2021年1月至2022年8月中国人民解放军联勤保障部队第九四〇医院门诊体检的20名男性健康青年军人腰骶椎薄层CT数据。受试者年龄20~30岁[(25.0±3.0)岁]。通过三维建模软件,建立L_(5)椎体三维模型,测量L_(5)双侧椎板中间区域厚度、纵向最长径、下缘弧度半径、上下面尾端之间的夹角、下缘厚度及下缘最长径,进而设计新型改良椎板钩。再选择1名上述受试者,利用三维虚拟软件建立L_(4)~S节段线性有限元模型(正常模型,A模型),并在此基础上构建L_(5)双侧峡部裂模型(B模型)、改良与传统椎板钩固定模型(C、D模型)。通过约束骶骨两边,于L_(4)椎体上施加400 N纵向载荷模拟身体上1/3重力及沿X、Y、Z 3个方向上10 N·m的弯矩模拟前屈、后伸、侧弯及旋转等状态,评估A模型L_(4/5)节段和L_(5)/S_(1)节段活动度,并与既往研究进行对比,验证A模型的有效性;比较A、B、C、D模型的整体活动度、L_(4/5)和L_(5)/S_(1)节段活动度、整体最大位移、峡部的最大位移与最大应力,C、D模型中内固定的应力分布和最大应力,以及C、D模型中椎体的应力分布和最大应力。结果(1)A模型L_(4/5)节段在前屈、后伸、侧弯、旋转时的活动度分别为5.01°、4.03°、3.91°、1.42°,L_(5)/S_(1)节段活动度分别为4.62°、2.51°、2.40°、1.23°。(2)A、C、D模型的整体活动度、L_(4/5)和L_(5)/S_(1)节段活动度、整体最大位移在轴向压缩、前屈、后伸、左侧弯及左旋转时结果相似,而B模型则明显增大。(3)A、C、D模型在不同运动状态下峡部的最大位移差异不明显,而B模型峡部的最大位移均明显高于A、C、D模型,尤其在旋转时更明显,较A、C、D模型分别增大295%、277%、276%。C模型峡部的最大应力分别为0.938 MPa、1.698 MPa、0.410 MPa、2.775 MPa、1.554 MPObjective To design an improved lamina hook system and compare its biomechanical properties with traditional lamina hook system in fixation of lumbar spondylolysis.Methods The thin layer CT data of the lumbosacral vertebrae of 20 healthy young male servicemen who underwent physical examination in the outpatient department of the 940th Hospital of Joint Logistics Support Force of PLA from January 2021 to August 2022 were collected.The age of the subjects was 20-30 years[(25.0±3.0)years].A 3‐dimensional model of the L_(5)vertebral body was constructed using the 3‐dimensional modeling software.The new improved lamina hook was designed according to the measurements including the thickness of the middle area,the longest longitudinal diameter,the curvature radius of the lower edge,the angle between the upper and lower tail ends,the thickness of the lower edge,and the longest diameter of the lower edge of the bilateral L_(5)vertebral plates.One serviceman was selected from the aforementioned group to construct a linear finite element model of segments L_(4)‐S using the 3‐dimensional virtual software(normal model,model A),based on which,the L_(5)bilateral spondylolysis model(model B),improved lamina hook model(model C)and traditional lamina hook models(model D)were designed.By constraining both sides of the sacrum and applying a longitudinal load of 400 N on the L_(4)vertebral body,the upper 1/3 gravity of the body was simulated,and with a bending moment of 10 N·m along the X,Y,and Z directions,motions of forward flexion,backward extension,lateral bending,rotation,etc were simulated.The range of motion of segment L_(4/5)and L_(5)/S_(1)of model A was evaluated and compared with the findings of the previous researches to verify its effectiveness.The overall range of motion of models A,B,C,and D,the range of motion of segment L_(4/5)and L_(5)/S_(1),the maximum overall displacement,the maximum displacement and stress of the isthmus,the stress distribution and maximum stress of internal fixation of models C and D,an

关 键 词：腰椎 脊椎滑脱 内固定器 计算机辅助设计 有限元分析 生物力学 

分 类 号：R687.1[医药卫生—骨科学]