摘要
背景:椎弓根螺钉固定椎体是目前临床治疗腰椎退行性疾病的主要手段,从生物力学的角度可以很好地评价椎弓根固定系统稳定性,利用有限元分析法进行椎弓根螺钉固定椎体的应力分析成为越来越多研究者的选择。目的:从生物力学角度分析单侧及双侧椎弓根螺钉固定时人体腰椎弯曲运动时的应力、位移变化,为实际临床应用提供理论借鉴。方法:基于志愿者腰椎CT数据建立腰椎三维模型,与志愿者签署了知情同意书,且得到医院伦理委员会批准。利用Abaqus软件模拟实际腰椎受力情况,对单侧及双侧椎弓根螺钉固定时腰椎的弯曲运动进行有限元分析,观察2种固定方式下腰椎椎体、椎间盘、椎弓根钉的受力大小和位移情况。结果与结论:①双侧固定下左侧螺钉受力为22.2 MPa,右侧螺钉受力为21.14 MPa,远远小于单侧固定时螺钉所受应力79.19 MPa;椎间盘在单侧固定下应力值比双侧固定时大87%;椎体在双侧固定时,要比单侧固定所受应力小72%;②从位移情况来看,双侧固定时,螺钉、椎间盘与椎体的位移要比单侧固定分别小53%,55%以及62%;③因此从力学角度分析,双侧椎弓根螺钉固定时受力小,要比单侧固定对人体更加友好,更有利于患者的恢复。
BACKGROUND:Pedicle screw fixation is the preferred surgical treatment for clinical treatment of lumbar degenerative disease currently.The stability of pedicle screw fixation system can be evaluated from the perspective of biomechanics and finite element method is more and more popular in analyzing stress of pedicle screw fixation of vertebral body for researchers.OBJECTIVE:To analyze the stress and displacement changes of human lumbar spine in bending movement from the biomechanical point of view when unilateral and bilateral pedicle screws are fixed,providing theoretical reference for practical clinical application.METHODS:Three-dimensional models were established based on CT data of the volunteers.The volunteers signed the informed consent.This study was approved by the Hospital Ethics Committee.Abaqus software was used to simulate the actual stress conditions.Finite element analysis of lumbar spine flexion was performed during unilateral and bilateral pedicle screw fixation.The stress and displacement of lumbar vertebra,disc and pedicle screw were observed under two fixation methods.RESULTS AND CONCLUSION:(1)Under bilateral fixation,the stress on the left screw was 22.2 MPa,and the stress on the right screw was 21.14 MPa,which was far less than the stress of the screw under unilateral fixation(79.19 MPa).The stress of intervertebral disc in unilateral fixation was 87%larger than that in bilateral fixation;the stress of vertebral body in bilateral fixation was 72%smaller than that in unilateral fixation.(2)From the perspective of displacement,the displacement of screw,lumbar disc and centrum under bilateral fixation were 53%,55%and 62%smaller than that under unilateral fixation,respectively.(3)Therefore,from the mechanical point of view,bilateral pedicle screw fixation has less stress level,which is friendlier to the human body than unilateral fixation and thus more conducive to the recovery of patients.
作者
陆向东
赵轶波
王少伟
赵晓峰
赵斌
Lu Xiangdong;Zhao Yibo;Wang Shaowei;Zhao Xiaofeng;Zhao Bin(Second Hospital,Shanxi Medical University,Taiyuan 030051,Shanxi Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2020年第12期1886-1890,共5页
Chinese Journal of Tissue Engineering Research
基金
山西省软科学研究项目(2018041027-2)，项目负责人：陆向东
山西省卫生健康科研课题(2018049)，项目负责人：陆向东~~
关键词
腰椎
椎弓根螺钉
双侧内固定
单侧内固定
应力分析
lumbar spine
pedicle screw
bilateral internal fixation
unilateral internal fixation
stress analysis
