下頸椎前路椎弓根螺釘人工椎體系統的有限元研究_《中國修復重建外科雜志》

作者：

吳衛東 ^1,2,3 , 孫培棟 ^1,2,3 , 劉雄 ^1,2,3 , 陳春 ^1,2 , 吳長福 ⁴ , 歐陽鈞 ^1,2,3

1 南方醫科大學人體解剖學教研室（廣州，510515）;;
2廣東省醫學生物力學重點實驗室;;
3 廣東省骨科研究院臨床解剖與生物力學研究所;;
4 莆田學院附屬醫院骨科;

關鍵詞：

下頸椎前路椎弓根螺釘人工椎體有限元分析

DOI：

10.7507/1002-1892.20130322

視頻：

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目的利用有限元研究方法，比較下頸椎前路椎弓根螺釘人工椎體系統（anterior transpedicular screw-artificial vertebral body， AVB）與傳統頸椎前路釘板系統的生物力學性能。方法采集1名38歲正常女性志愿者頸椎（C1～T1）CT數據，應用Mimics 14.0、Geomagic Studio 2013、ANSYS 14.0軟件建立下頸椎（C3～7）完整模型、頸椎前路鈦板椎體釘（anterior screw plate system，AP）固定模型、AVB固定模型。在C3上分別施加74 N軸向壓力及1 N·m純力偶矩，使模型產生前屈、后伸、左側彎、右側彎、左旋和右旋運動，記錄AP組及AVB組Von Mises應力云圖及最大應力值，計算并比較3組椎間活動度（range of motion，ROM）。結果實驗建立了正常人下頸椎（C3～7）有限元模型，模型包括 286 382個單元，414 522個節點，其椎間ROM與Panjabi等及Kallemeyn等實驗數據吻合度較好。AP組在釘板連接部位出現應力集中，AVB組應力分布較均勻。在74 N軸向壓力、前屈、后伸、左旋、右旋工況下，AP組與AVB組最大應力值差異明顯。與AP組相比，AVB組固定節段ROM更小，鄰近節段ROM相對較大；與完整組相比，AP組與AVB組的整體ROM減小約3°，但鄰近C3、4及C6、7節段的ROM代償增加約5°。結論AVB作為一種新型固定技術，其穩定性優于AP，且固定系統斷裂的風險顯著低于AP。

引用本文： 吳衛東,孫培棟,劉雄,陳春,吳長福,歐陽鈞. 下頸椎前路椎弓根螺釘人工椎體系統的有限元研究. 中國修復重建外科雜志, 2013, 27(12): 1466-1470. doi: 10.7507/1002-1892.20130322 復制

1.	Boockvar JA, Philips MF, Telfeian AE, et al. Results and risk factors for anterior cervicothoracic junction surgery. J Neurosurg, 2001, 94(1 Suppl): 12-17.
2.	Okawa A, Sakai K, Hirai T, et al. Risk factors for early reconstruction failure of multilevel cervical corpectomy with dynamic plate fixation. Spine (Phila Pa 1976), 2011, 36(9): E582-587.
3.	Koller H, Hempfing A, Acosta F, et al. Cervical anterior transpedicular screw fixation. Part I: Study on morphological feasibility, indications, and technical prerequisites. Eur Spine J, 2008, 17(4): 523-538.
4.	歐陽鈞, 陳春, 吳長福. 一種頸椎的人工椎體: 中國, 201220178924. 7 [P]. 2012-11-21.
5.	Mercer S, Bogduk N. The ligaments and annulus fibrosus of human adult cervical intervertebral discs. Spine (Phila Pa 1976), 1999, 24(7): 619-628.
6.	Lee SH, Im YJ, Kim KT, et al. Comparison of cervical spine biomechanics after fixed- and mobile-core artificial disc replacement: a finite element analysis. Spine (Phila Pa 1976), 2011, 36(9): 700-708.
7.	Hussain M, Natarajan RN, Fayyazi AH, et al. Screw angulation affects bone-screw stresses and bone graft load sharing in anterior cervical corpectomy fusion with a rigid screw-plate construct: a finite element model study. Spine J, 2009, 9(12): 1016-1023.
8.	Tchako A, Sadegh AM. Stress changes in intervertebral discs of the cervical spine due to partial discectomies and fusion. J Biomech Eng, 2009, 131(5): 051013.
9.	王成燾. 人體生物摩擦學. 北京: 科學出版社, 2008: 428-432.
10.	Panjabi MM, Crisco JJ, Vasavada A, et al. Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves. Spine (Phila Pa 1976), 2001, 26(24): 2692-2700.
11.	Kallemeyn N, Gandhi A, Kode S, et al. Validation of a C2-C7 cervical spine finite element model using specimen-specific flexibility data. Med Eng Phys, 2010, 32(5): 482-489.
12.	李家順, 賈連順. 頸椎外科學. 上海: 上海科學技術出版社, 2004: 294-298.
13.	陳春, 趙衛東, 孫培棟, 等. 釘道強化對頸椎前路椎間融合術式穩定性影響的生物力學研究. 中國修復重建外科雜志, 2010, 24(10): 1174-1179.
14.	Hussain M, Natarajan RN, An HS, et al. Progressive disc degeneration at C5-C6 segment affects the mechanics between disc heights and posterior facets above and below the degenerated segment: A flexion-extension investigation using a poroelastic C3-T1 finite element model. Med Eng Phys, 2012, 34(5): 552-558.
15.	Fice JB, Cronin DS, Panzer MB. Cervical spine model to predict capsular ligament response in rear impact. Ann Biomed Eng, 2011, 39(8): 2152-2162.
16.	Lau D, Song Y, Guan Z, et al. Radiological outcomes of static vs expandable titanium cages after corpectomy: a retrospective cohort analysis of subsidence. Neurosurgery, 2013, 72(4): 529-539.
17.	Kim HW, Ryu JI, Bak KH. The safety and efficacy of cadaveric allografts and titanium cage as a fusion substitutes in pyogenic osteomyelitis. J Korean Neurosurg Soc, 2011, 50(4): 348-356.

1. Boockvar JA, Philips MF, Telfeian AE, et al. Results and risk factors for anterior cervicothoracic junction surgery. J Neurosurg, 2001, 94(1 Suppl): 12-17.
2. Okawa A, Sakai K, Hirai T, et al. Risk factors for early reconstruction failure of multilevel cervical corpectomy with dynamic plate fixation. Spine (Phila Pa 1976), 2011, 36(9): E582-587.
3. Koller H, Hempfing A, Acosta F, et al. Cervical anterior transpedicular screw fixation. Part I: Study on morphological feasibility, indications, and technical prerequisites. Eur Spine J, 2008, 17(4): 523-538.
4. 歐陽鈞, 陳春, 吳長福. 一種頸椎的人工椎體: 中國, 201220178924. 7 [P]. 2012-11-21.
5. Mercer S, Bogduk N. The ligaments and annulus fibrosus of human adult cervical intervertebral discs. Spine (Phila Pa 1976), 1999, 24(7): 619-628.
6. Lee SH, Im YJ, Kim KT, et al. Comparison of cervical spine biomechanics after fixed- and mobile-core artificial disc replacement: a finite element analysis. Spine (Phila Pa 1976), 2011, 36(9): 700-708.
7. Hussain M, Natarajan RN, Fayyazi AH, et al. Screw angulation affects bone-screw stresses and bone graft load sharing in anterior cervical corpectomy fusion with a rigid screw-plate construct: a finite element model study. Spine J, 2009, 9(12): 1016-1023.
8. Tchako A, Sadegh AM. Stress changes in intervertebral discs of the cervical spine due to partial discectomies and fusion. J Biomech Eng, 2009, 131(5): 051013.
9. 王成燾. 人體生物摩擦學. 北京: 科學出版社, 2008: 428-432.
10. Panjabi MM, Crisco JJ, Vasavada A, et al. Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves. Spine (Phila Pa 1976), 2001, 26(24): 2692-2700.
11. Kallemeyn N, Gandhi A, Kode S, et al. Validation of a C2-C7 cervical spine finite element model using specimen-specific flexibility data. Med Eng Phys, 2010, 32(5): 482-489.
12. 李家順, 賈連順. 頸椎外科學. 上海: 上海科學技術出版社, 2004: 294-298.
13. 陳春, 趙衛東, 孫培棟, 等. 釘道強化對頸椎前路椎間融合術式穩定性影響的生物力學研究. 中國修復重建外科雜志, 2010, 24(10): 1174-1179.
14. Hussain M, Natarajan RN, An HS, et al. Progressive disc degeneration at C5-C6 segment affects the mechanics between disc heights and posterior facets above and below the degenerated segment: A flexion-extension investigation using a poroelastic C3-T1 finite element model. Med Eng Phys, 2012, 34(5): 552-558.
15. Fice JB, Cronin DS, Panzer MB. Cervical spine model to predict capsular ligament response in rear impact. Ann Biomed Eng, 2011, 39(8): 2152-2162.
16. Lau D, Song Y, Guan Z, et al. Radiological outcomes of static vs expandable titanium cages after corpectomy: a retrospective cohort analysis of subsidence. Neurosurgery, 2013, 72(4): 529-539.
17. Kim HW, Ryu JI, Bak KH. The safety and efficacy of cadaveric allografts and titanium cage as a fusion substitutes in pyogenic osteomyelitis. J Korean Neurosurg Soc, 2011, 50(4): 348-356.

《中國修復重建外科雜志》

下頸椎前路椎弓根螺釘人工椎體系統的有限元研究

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《中國修復重建外科雜志》

下頸椎前路椎弓根螺釘人工椎體系統的有限元研究

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