改良皮质骨轨迹螺钉联合椎弓根螺钉技术对融合节段影响的有限元分析  

Effects on Fusion Segment by Combining Modified Cortical Bone Trajectory Screw and Pedicle Screw Techniques:A Finite Element Analysis

作　　者：肖扬 王轶希 张瑞[1] 张涛 阿卜杜萨拉木·托合提 陈琪豪 木再帕尔·买吐送 帕尔哈提·热西提[1,2,3] XIAO Yang;WANG Yixi;ZHANG Rui;ZHANG Tao;TUOHETI Abdusalamu;CHEN Qihao;Muzaipaer MAITUSONG;Paerhati REXITI(Minimally Invasive Spine and Precision Orthopedics,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China;Xinjiang Clinical Research Center for Orthopedics,Urumqi 830000,China;Key Laboratory of High Incidence Disease Research in Xinjiang(Xinjiang Medical University),Ministry of Education,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院脊柱微创及精准骨科,乌鲁木齐830000 [2]新疆骨科疾病临床医学研究中心,乌鲁木齐830000 [3]新疆地区高发疾病研究教育部重点实验室(新疆医科大学),乌鲁木齐830000

出　　处：《医用生物力学》2024年第6期1114-1122,共9页Journal of Medical Biomechanics

基　　金：新疆维吾尔自治区杰出青年科学基金项目(2021D01E29);“天山英才”医药卫生高层次人才培养计划基金(TSYC202301B026)。

摘　　要：目的基于L4~5节段后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)模型研究双侧椎弓根螺钉(bilateral pedicle screw,BPS)和双侧改良皮质骨轨迹螺钉(bilateral modified cortical bone trajectory screw,BMCS)联合固定技术的生物力学特性。方法根据3具尸体腰椎标本,建立L1~S1椎体有限元模型。BPS-BPS(TT螺钉位于L4~5)、BPS-BMCS(TT螺钉位于L4,MCBT螺钉位于L5)、BMCS-BPS(MCBT螺钉位于L4,TT螺钉位于L5节段)和BMCS-BMCS(MCBT螺钉位于L4~5)植入有限元模型中。在400 N载荷和7.5 N·m力矩的屈曲、后伸、弯曲和旋转条件下,比较L4~5节段运动范围(range of motion,ROM)以及内固定系统、融合器和连接棒的峰值应力。结果BMCS-BPS组在旋转工况下ROM以及融合器、内固定系统和连接棒峰值应力均小于BPS-BPS组、BPSBMCS组、BMCS-BMCS组。BPS-BMCS组和BMCS-BPS组较BPS-BPS组显著降低了弯曲、旋转工况下L4~5节段ROM,较BMCS-BMCS组显著降低了旋转工况下L4~5节段ROM。BPS-BMCS组和BMCS-BPS组在弯曲工况下较BPS-BPS组和旋转工况下较传BMCS-BMCS组显著减少融合器沉降的风险。BPS-BMCS组和BMCS-BPS组较BPSBPS组、BMCS-BMCS组显著降低了弯曲、旋转工况下连接棒断裂失效的风险,且增强了内固定系统的稳定性。结论PLIF联合BPS-BMCS和BMCS-BPS固定技术,可为人体在弯曲和旋转时可提供较好的内固定系统稳定性、椎体稳定性以及较低的融合器沉降和连接棒断裂风险,从而提高手术成功率和患者的康复效果。Objective To evaluate the biomechanical properties of the bilateral pedicle screw(BPS)and bilateral modified cortical bone trajectory screw(BMCS)fixation techniques in the posterior lumbar interbody fusion(PLIF)model of the L4-5 segment.Methods Finite element models of the L1-S1 lumbar spine were established using three cadaveric lumbar spine specimens.BPS-BPS(TT at the L4-5 segment),BPS-BMCS(TT at the L4 segment and MCBT at the L5 segment),BMCS-BPS(MCBT at the L4 segment and TT at the L5 segment),and BMCS-BMCS(MCBT at the L4-5 segment)were implanted into the finite element model.The range of motion(ROM)at the L4-5 segment and the peak von Mises stress on the internal fixation system,cage,and connecting rods were compared under bending,extension,flexion,and rotation conditions with a 400 N load and 7.5 N·m torque.Results The BMCS-BPS group showed lower ROM and von Mises stress on the cage,internal fixation system,and connecting rods under rotational conditions than the BPS-BPS,BPSBMCS,and BMCS-BMCS groups.The BPS-BMCS and BMCS-BPS groups had significantly reduced ROM of the L4-5 segment under bending and rotational conditions compared with the BPS-BPS group,and significantly decreased ROM under rotational conditions compared with the BMCS-BMCS group.The BPS-BMCS and BMCSBPS groups had a significantly reduced risk of cage subsidence under bending conditions compared with the BPSBPS group,and under rotational conditions compared with the BMCS-BMCS group.The BPS-BMCS and BMCSBPS groups had a significantly reduced risk of connecting rod fractures under bending and rotational conditions compared with the BPS-BPS and BMCS-BMCS groups.This enhanced the stability of the internal fixation system.Conclusions PLIF combined with the BPS-BMCS and BMCS-BPS fixation techniques can provide better stability for the internal fixation system and vertebral body as well as a lower risk of cage subsidence and connecting rod fracture during bending and rotation in the human body.This would improve the success rate of surgery and recov

关 键 词：椎弓根螺钉 改良皮质骨轨迹螺钉 后路腰椎椎间融合术 内固定 

分 类 号：R318.01[医药卫生—生物医学工程]