| 椎管重建内固定术有限元模型的构建及稳定性分析 |
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Received:June 12, 2023
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| 作者 | Author | 单位 | Unit | E-Mail |
| 陈建民 |
CHEN Jian-min |
南京医科大学金陵临床医学院骨科, 江苏 南京 210002 |
Department of Orthopaedics, Jinling Hospital of Nanjing Medical University, Nanjing 210002, Jiangsu, China |
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| 刘国印 |
LIU Guo-yin |
南京医科大学金陵临床医学院骨科, 江苏 南京 210002 |
Department of Orthopaedics, Jinling Hospital of Nanjing Medical University, Nanjing 210002, Jiangsu, China |
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| 黄伟谦 |
HUANG Wei-qian |
南京医科大学金陵临床医学院骨科, 江苏 南京 210002 |
Department of Orthopaedics, Jinling Hospital of Nanjing Medical University, Nanjing 210002, Jiangsu, China |
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| 练仲华 |
LIAN Zhong-hua |
厦门医疗器械研发检测中心有限公司, 福建 厦门 361027 |
Xiamen Medical Device Testing and Research Co., Ltd, Xiamen 361022, Fujian, China |
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| 张二来 |
ZHANG Er-lai |
厦门医疗器械研发检测中心有限公司, 福建 厦门 361027 |
Xiamen Medical Device Testing and Research Co., Ltd, Xiamen 361022, Fujian, China |
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| 赵建宁 |
ZHAO Jian-ning |
南京医科大学金陵临床医学院骨科, 江苏 南京 210002 |
Department of Orthopaedics, Jinling Hospital of Nanjing Medical University, Nanjing 210002, Jiangsu, China |
zhaojianning.0207@163.com |
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| 期刊信息：《中国骨伤》2024年37卷，第3期，第271-277页 |
| DOI：10.12200/j.issn.1003-0034.20230091 |
| 基金项目:国家自然科学基金青年科学基金项目(编号:82102547);南京军区重点项目(编号:15ZD020) |
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目的:构建椎管重建内固定术的有限元模型,并分析椎管重建内固定术对脊柱稳定性的影响,验证椎管重建内固定术在椎管内手术中的有效性和可靠性。
方法:筛选1名30岁男性,身高172 cm,体重75 kg的健康志愿者并采集其腰椎CT资料,建立正常腰椎L3-L5的有限元模型,并与体外实体结果和已发表的有限元分析结果进行比较,以验证该模型的有效性。根据处理方式不同分为正常组、椎板切除组和椎管重建组。在相同边界固定和生理载荷条件下,实施前屈、后伸、左弯、右弯、左旋和右旋6种工况活动,分析6种工况活动下L3-L4和L4-L5观察节段的活动度(range of motion,ROM)和L3-L5整体最大ROM的变化情况。
结果:构建的L3-L5有限元模型各节段ROM位移与体外实体结果和既往文献数据结果吻合,确认了该模型的有效性。在L3-L4中,椎管重建组仅在后伸时较正常组增加,ROM变化百分比>5%;其他工况下的ROM与正常组相近,变化百分比<5%;而椎板切除组在前屈、后伸、左旋和右旋时的ROM较正常组和椎管重建组增加,变化百分比>5%。在L4-L5中,椎管重建组,在各工况下的ROM与正常组相近,变化百分比<5%,而椎板切除组在6种工况下的ROM均大于正常组和椎管重建组,变化百分比>5%。在L3-L5的整体最大ROM中,椎管重建组仅在后伸时超过正常组,变化百分比>5%;而椎板切除在前屈、后伸、左旋和右旋时大于正常组和椎管重建组,变化百分比>5%。L3-L5各节段ROM及总体ROM的变化趋势为:椎板切除组>椎管重建组>正常组。
结论:椎板切除会严重影响脊柱生物力学的稳定性,而应用椎管重建内固定的方式可有效减少脊柱责任节段的ROM位移并维持其生物力学稳定性。 |
| [关键词]:椎板切除 椎管重建 钢板内固定 有限元分析 稳定性 活动度 |
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| Construction and stability analysis of finite element model for spinal canal reconstruction with miniplates fixation |
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Abstract:
Objective To establish the finite element model of spinal canal reconstruction and internal fixation,analysis influence of spinal canal reconstruction and internal fixation on spinal stability,and verify the effectiveness and reliability of spinal canal reconstruction and internal fixation in spinal canal surgery.
Methods A 30-year-old male healthy volunteer with a height of 172 cm and weight of 75 kg was selected and his lumbar CT data were collected to establish a finite element model of normal lumbar L3-L5,and the results were compared with in vitro solid results and published finite element analysis results to verify the validity of the model. They were divided into normal group,laminectomy group and spinal canal reconstruction group according to different treatment methods. Under the same boundary fixation and physiological load conditions,six kinds of activities were performed,including forward bending,backward extension,left bending,right bending,left rotation and right rotation,and the changes of range of motion (ROM) of L3-L4,L4-L5 segments and overall maximum ROM of L3-L5 were analyzed under the six conditions.
Results The ROM displacement range of each segment of the constructed L3-L5 finite element model was consistent with the in vitro solid results and previous literature data,which confirms the validity of the model. In L3-L4,ROM of spinal canal reconstruction group was slightly increased than that of normal group during posterior extension(>5% difference),and ROM of other conditions was similar to that of normal group(<5% difference). ROM in laminectomy group was significantly increase than that in normal group and spinal canal reconstruction group under the condition of flexion,extension,left and right rotation. In L4-L5,ROM in spinal canal reconstruction group was similar to that in normal group(<5% difference),while ROM in laminectomy group was significantly higher than that in normal group and spinal canal reconstruction group(>5% difference). In the overall maximum ROM of L3-L5,spinal canal reconstruction group was only slightly higher than normal group under the condition of posterior extension(>5% difference),while laminectomy was significantly higher than normal group and spinal canal reconstruction group under the condition of anterior flexion,posterior extension,left and right rotation(>5% difference). The changes of each segment ROM and overall ROM of L3-L5 showed laminectomy group>spinal canal reconstruction group>normal group.
Conclusion Laminectomy could seriously affect biomechanical stability of the spine,but application of spinal canal reconstruction and internal fixation could effectively reduce ROM displacement of the responsible segment of spine and maintain its biomechanical stability. |
| KEYWORDS:Laminectomy Spinal canal reconstruction Miniplates fixation Finite element simulation Stability Range of motion |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈建民,刘国印,黄伟谦,练仲华,张二来,赵建宁.椎管重建内固定术有限元模型的构建及稳定性分析[J].中国骨伤,2024,37(3):271~277 |
| 英文格式: | CHEN Jian-min,LIU Guo-yin,HUANG Wei-qian,LIAN Zhong-hua,ZHANG Er-lai,ZHAO Jian-ning.Construction and stability analysis of finite element model for spinal canal reconstruction with miniplates fixation[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(3):271~277 |
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