斜外侧腰椎椎间融合侧方钉棒位置对节段活动度、内固定和cage应力的影响  

Effects of lateral screw-rod placement positions on segmental range of motion,internal fixation and cage stress during oblique lumber interbody fusion

作　　者：马涛 李星 韦亚军 邓俊才[2] Ma Tao;Li Xing;Wei Yajun;Deng Juncai(Clinical Medical College of Chengdu University of TCM,Chengdu 610075,Sichuan Province,China;Department of Spinal Surgery,No.3 Affiliated Hospital of Chengdu University of TCM(West District),Chengdu 611730,Sichuan Province,China)

机构地区：[1]成都中医药大学临床医学院,四川省成都市610075 [2]成都中医药大学附属第三医院(西区)脊柱外科,四川省成都市611730

出　　处：《中国组织工程研究》2025年第33期7165-7172,共8页Chinese Journal of Tissue Engineering Research

基　　金：四川省中医药管理局科研专项课题面上项目(2023MS031),项目负责人:邓俊才;成都中医药大学“杏林学者”学科人才科研提升计划项目(YYZX2022091),项目负责人:邓俊才。

摘　　要：背景:斜外侧腰椎椎间融合目前已成为一种成熟的腰椎融合方式,其在同一通道下辅助侧方钉棒固定的方式近年来受到了大家的关注,但目前对于术中侧方钉棒放置的最佳位置没有统一定论,且缺乏相关的生物力学依据。目的:建立不同的斜外侧腰椎椎间融合联合侧方钉棒固定模型,评估其对腰椎生物力学的影响,为侧方钉棒置入提供一定的生物力学依据。方法:采用1名健康成人的计算机断层扫描图像,利用Mimics、Geomagic和SolidWorks软件建立L_(4)-L_(5)单纯斜外侧腰椎椎间融合无内固定模型及不同置钉位置的侧方钉棒固定模型,其中双钉棒固定模型9种、单钉棒固定模型5种。在Ansys workbench软件中分析各模型屈伸、侧弯及旋转工况下的活动度、内固定和cage的应力峰值。结果与结论:①所有内固定模型的活动度均小于单纯斜外侧腰椎椎间融合无内固定模型;双钉棒与单钉棒均在贴近L_(4)和L_(5)上终板放置时的活动度最小,且前者对活动度的限制更多;②所有内固定模型的cage应力峰值均小于单纯斜外侧腰椎椎间融合无内固定模型;除右旋工况外,双钉棒放置在L_(4)和L_(5)前上、后下时融合器应力最小,与贴近L_(4)下终板和L_(5)上终板放置时相接近;单钉棒则在贴近L_(4)下终板和L_(5)上终板处放置时最小;③在屈伸工况下,双钉棒在贴近L_(4)和L_(5)上终板放置时内固定应力峰值最小;单钉棒则贴近L_(4)下终板和L_(5)上终板放置时最小;④提示侧方钉棒的位置是影响斜外侧腰椎椎间融合生物力学性能的重要因素之一,双钉棒固定的生物力学性能总体优于单钉棒;当双钉棒贴近椎体上终板放置时可以获得最好的生物力学稳定性,一定程度降低螺钉断裂的风险;而当双钉棒放置在上下椎的前上和后下象限或紧邻上下终板时可以极大降低cage沉降的发`生率。BACKGROUND:Oblique lumber interbody fusion has become a mature lumbar fusion method at present,and its method of assisting lateral screw-rod fixation under the same channel has attracted attention in recent years.However,there is currently no consensus on the optimal intraoperative placement of lateral screw-rod,and there is a lack of relevant biomechanical evidence.OBJECTIVE:To establish various oblique lumber interbody fusion combined with lateral screw-rod fixation models,evaluate their impact on lumbar spine biomechanics,and provide biomechanical foundations for the implantation of lateral screw-rod.METHODS:Using CT images of a healthy adult,the L_(4)-L_(5) Stand-Alone oblique lumber interbody fusion model and lateral screw-rod fixation models with different screw placement positions were established by using Mimics,Geomagic and SolidWorks software,including nine double screw-rod fixation models and five single screw-rod fixation models.Ansys Workbench software was employed to analyze the range of motion,peak stress of internal fixation and cage under conditions of flexion,lateral bending,and rotation.RESULTS AND CONCLUSION:(1)The range of motion of all internal fixation models was less than Stand-Alone oblique lumber interbody fusion model.Both single screw-rod and double screw-rod showed the least range of motion when placed close to the upper endplates of L_(4) and L_(5),and the former had more restrictions on the motion.(2)The peak stress of cage in all internal fixation models was lower than Stand-Alone oblique lumber interbody fusion model.Except for right rotation condition,double screw-rod was minimal cage stress when placed anterior superior and posterior inferior quadrants of L_(4) and L_(5),which was similar to that when placed proximaly to L_(4) lower and L_(5) upper endplates;screw-rod showed minimal stress when placed proximally to L_(4) lower and L_(5) upper endplates.(3)Under flexion-extension condition,double rod-screw exhibited minimal internal fixation stress when positioned close to the up

关 键 词：斜外侧腰椎椎间融合 侧方钉棒 钉棒位置 有限元分析 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] R687.3