北京生物醫(yī)學工程

新型腰椎后路動態(tài)穩(wěn)定系統(tǒng)的三維有限元分析

The three-dimensional finite element analysis of the dynamic stable system of the new lumbar spine

作者：蔣帥劉洋陳元元馮勇袁文

單位：海軍軍醫(yī)大學第二附屬醫(yī)院脊柱外科(上海 200003)  海軍軍醫(yī)大學第三附屬醫(yī)院骨科(上海 200438)  微創(chuàng)醫(yī)療器械（上海）有限公司(上海 201203)

關(guān)鍵詞：腰椎后路；動態(tài)穩(wěn)定系統(tǒng)；生物力學；三維有限元；椎間盤；內(nèi)固定

分類號：R318.04； R687.3

出版年·卷·期（頁碼）：2021·40·1（24-30）

摘要：

目的對新型腰椎后路動態(tài)穩(wěn)定系統(tǒng)進行三維有限元分析，研究其在穩(wěn)定節(jié)段及鄰近節(jié)段的生物力學影響，為下腰痛的脊柱內(nèi)植物的設(shè)計和應(yīng)用提供參考。方法基于正常腰椎有限元模型，構(gòu)建腰椎不穩(wěn)損傷模型，即腰椎切除腰4和腰5之間的雙側(cè)小關(guān)節(jié)、腰4椎板下1/2、后縱韌帶，形成脊柱失穩(wěn)模型，分別在失穩(wěn)模型上進行堅強內(nèi)固定系統(tǒng)和后路動態(tài)穩(wěn)定系統(tǒng)，比較兩種術(shù)式對手術(shù)節(jié)段和臨近階段的活動度、各個節(jié)段的彎曲剛度、椎間盤應(yīng)力水平、前縱韌帶應(yīng)力水平及小關(guān)節(jié)韌帶拉力的變化情況。結(jié)果對內(nèi)固定橋接節(jié)段（腰4/腰5）應(yīng)用新型腰椎后路動態(tài)穩(wěn)定系統(tǒng)和堅強內(nèi)固定系統(tǒng)后，在屈伸、側(cè)屈、軸向旋轉(zhuǎn)方向上的活動度均明顯減小，但堅強固定后活動度減小更明顯，應(yīng)用動態(tài)穩(wěn)定系統(tǒng)活動度更接近于正常腰椎節(jié)段；腰4/腰5椎間盤最大應(yīng)力均減小，但堅強固定后活動度減小更明顯，應(yīng)用動態(tài)穩(wěn)定系統(tǒng)活動度更接近于正常腰椎節(jié)段；對鄰近節(jié)段（腰3/腰4、腰5/S1）應(yīng)用新型腰椎后路動態(tài)穩(wěn)定系統(tǒng)和堅強內(nèi)固定系統(tǒng)后，在屈伸、側(cè)屈、軸向旋轉(zhuǎn)方向上的活動度均有所增大，但堅強固定后活動度增加更明顯，應(yīng)用動態(tài)穩(wěn)定系統(tǒng)鄰近節(jié)段活動度更接近于正常腰椎節(jié)段；鄰近節(jié)段椎間盤最大應(yīng)力均增大，但堅強固定后增大更明顯，應(yīng)用動態(tài)穩(wěn)定系統(tǒng)更接近于正常腰椎節(jié)段；應(yīng)用腰椎內(nèi)固定后，鄰近節(jié)段的小關(guān)節(jié)應(yīng)力峰值增大，并且應(yīng)用腰椎堅強內(nèi)固定模型的小關(guān)節(jié)應(yīng)力增大更多；應(yīng)用腰椎動態(tài)固定的模型鄰近關(guān)節(jié)應(yīng)力峰值更加接近完整腰椎模型。結(jié)論新型腰椎后路動態(tài)穩(wěn)定系統(tǒng)對比堅強內(nèi)固定系統(tǒng)能夠使失穩(wěn)節(jié)段的活動更加接近于正常，減小鄰近節(jié)段的活動度增加，減小鄰近節(jié)段椎間盤及小關(guān)節(jié)壓力，說明新型腰椎動態(tài)穩(wěn)定系統(tǒng)達到設(shè)計要求。

Objective A three-dimensional finite element analysis of the dynamic stability system of the new lumbar spine was studied, which also focused on the biomechanical effects of the stable segment and adjacent segment. Methods Based on the finite element model of lumbar vertebra, the model of lumbar instability damage was constructed. With resection on the lumbar spine model between L4 and L5 on both sides of the small joints, waist 4 longitudinal ligament and vertebral plate under 1/2, a spinal instability model was built, on which a pedicle screw system and a posterior dynamic stabilization system were added respectively. Then we compared how they were influenced by surgical operation sections and adjacent stages of activity, the bending stiffness of each section, intervertebral disc stress levels, anterior longitudinal ligament stress levels and the changes of the small joint ligament strain. Results For internal fixation of bridge section (L4/L5), after the new lumbar posterior dynamic stabilization and rigid internal fixation systems were applied, the activity of it in the directions of flexion, lateral bending and axial rotation was significantly decreased, but the activity decreased more obviously under the posterior dynamic stabilization system while it was closer to the normal one under the lumbar posterior dynamic stabilization system; the maximum stress of L4/L5 intervertebral disc decreased, but the decrease of the activity degree of strong fixation was more obvious, whereas that of the dynamic stable system was more similar to the normal lumbar segment. For adjacent segment (L3/ L4, L5/S1), with application of the two systems, the activity of it in the directions of flexion, lateral bending and axial rotation has increased, but the activity increased more obviously under the posterior dynamic stabilization system while it was closer to the normal one under the lumbar posterior dynamic stabilization system; the maximum stress of intervertebral disc in adjacent segment increased, but the increase of the activity degree of strong fixation was more obvious, whereas that of the dynamic stable system was more similar to the normal lumbar segment. The stress peak of small joints in adjacent segment increased under the rigid internal fixation system with the stress of small joints increasing more while the stress peak of the adjacent joints was closer to the complete lumbar model under the lumbar posterior dynamic stabilization system. Conclusions Compared with the strong internal fixation system, the new lumbar posterior dynamic stability system can make the instability of segmental activity closer to the normal, reduce the increase of adjacent segment activity as well as the pressure of adjacent segment disc and small joints, which suggests that the new lumbar dynamic stability system has met the design requirements.

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