特发性脊柱侧凸矫正手术不同置钉体系生物力学对比  

Biomechanical Comparison of Different Nail Placement Systems in Idiopathic Scoliosis Correction Surgery

作　　者：富荣昌 张怀悦 王召耀 FU Rong-chang;ZHANG Huai-yue;WANG Zhao-yao(College of Intelligent Manufacturing Modern Industry,Xinjiang University,Urumqi 830017,China)

机构地区：[1]新疆大学智能制造现代产业学院,乌鲁木齐830017

出　　处：《科学技术与工程》2025年第5期1840-1849,共10页Science Technology and Engineering

基　　金：国家自然科学基金(32260235)。

摘　　要：为了探究特发性脊柱侧凸矫形时不同内固定系统对术后脊柱的生物力学特性影响,从生物力学的角度为内固定系统的改进提供理论依据。基于逆向工程、拓扑优化及有限元建模技术,以实际病例为例,建立特发性脊柱侧凸脊柱有限元模型;对个性化融合器进行设计;建立全置钉与间隔置钉两种不同的内固定系统。模拟特发性脊柱侧凸手术,对比术后不同置钉系统下,脊柱与内固定系统在各生理工况下的生物力学差异。结果表明:皮质骨与松质骨在全置钉方案下平均应力较间隔置钉分别提高了17.19%、12.37%;纤维环基质与髓核最大等效应力在间隔置钉下较全置钉分别提高了1.78%、1.1%;椎弓根螺钉最大等效应力在全置钉下较间隔置钉提高了11.64%;椎间融合器平均应力在全置钉下较间隔置钉提高了6.15%。可知,相较于间隔置钉方案,全置钉方案在椎骨安全性上较优,但是螺钉滑移与脱落风险较高;相较于全置钉方案,间隔置钉方案椎骨融合效果更好,有效缓解了应力遮挡,但是产生骨质增生几率有所增加。In order to explore the effects of different internal fixation systems on the biomechanical characteristics of the spine after orthopedic idiopathic scoliosis,a theoretical basis for the improvement of the internal fixation system was provided from the perspective of biomechanics.Based on reverse engineering,topology optimization and finite element modeling techniques,the finite element model of idiopathic scoliosis was established by taking actual cases as examples.The personalized fusion device was designed.Two kinds of internal fixation systems were established,namely full fixation and interval fixation.To simulate idiopathic scoliosis surgery and compare the biomechanical differences between spine and internal fixation system under different physiological conditions.The results show that the average stress of cortical bone and cancellous bone is increased by 17.19%and 12.37%,respectively,compared with that of interlocking nails.The maximum equivalent stress of fibrous annulus matrix and nucleus pulposus is increased by 1.78%and 1.1%,respectively,compared with that of full nailing.The maximum equivalent stress of pedicle screws is 11.64%higher than that of interlocking screws.The average stress of interbody fusion is increased by 6.15%compared with that of interbody fusion.In conclusion,compared with the interspaced nailing scheme,the total nailing scheme is better in vertebrae safety,but the risk of screw slip and screw loss is higher.Compared with the total nailing scheme,the interstice nailing scheme has better spinal fusion effect and effectively alleviates stress occlusion,but the incidence of bone hyperplasia is increased.

关 键 词：特发性脊柱侧凸 内固定系统 椎弓根螺钉 融合器 有限元 

分 类 号：R318.01[医药卫生—生物医学工程]