两种植骨方式治疗L1椎体爆裂骨折的有限元研究
Finite element study on two kinds of bone grafting methods for the treatment of first lumbar vertebral burst fracture
目的 建立L1椎体爆裂骨折的有限元模型，分析比较经椎弓根椎体内植骨和经椎管椎体内植骨的应力分布。 方法 通过CT扫描、Mimics三维重建、ANSYS前处理等方法建立胸腰段T12~L2有限元模型，据此建立L1椎体爆裂骨折后经椎弓根椎体内植骨和经椎管椎体内植骨加椎弓根钉棒后路固定模型。并对模型在前屈、后伸、侧弯和旋转下加载350N/8Nm，观察分析应力分布情况。 结果 正常胸腰段、L1椎体爆裂骨折、经椎弓根植骨和经椎管植骨模型的等效应力峰值如下，前屈：6.89、54.10、8.03、5.92 MPa；后伸：56.70、109.00、12.50、8.61 MPa；侧弯：6.83、47.50、11.30、3.60 MPa；旋转：23.80、112.00、13.10、7.65 MPa。未植骨时应力主要集中于螺钉的尾部和连接棒，植骨后应力明显降低，并向螺钉中部分散分布。 结论 两种植骨方式的模型均重建了伤椎的强度，增加即时稳定性，但经椎管椎体内植骨更充分、更有效减小内固定应力，增加其力学安全性，从生物力学角度是一种植得推广的术式。
Objective To construct a finite element model(FEM) of first lumbar vertebral burst fracture, and compare the stress distributions between transpedicular grafting and transcanal grafting. Method The FEM of normal thoracolumbar segment T12~L2 with first lumbar vertebral burst fracture was established through thin layer CT scan, three-dimensional reconstruction by using Mimics and ANSYS software, respectively. The model was fixed by the posterior pedicle screws. On the basis of the models, we subsequently generated another 2 models simulating 2 types of surgical techniques, transpedicular grafting (TPG) and transcanal grafting(TCG). The stress distribution of model was observed in the respective 4 models when spine was exposed to a stress of 350N/8Nm in the position of flexion, extension，lateral bending and rotation. Results Through the static analysis of Ansys software, it was concluded 4 model under various conditions of equivalent stress nephogram, and display the equivalent stress peak, flexion: 6.89, 54.10, 8.03, 5.92 MPa; extension: 56.70, 109.00, 12.50, 8.61 MPa; lateral bending: 6.83, 47.50, 11.30, 3.60 MPa; rotation: 23.80, 112.00, 13.10, 7.65 MPa. Not concentrated stress at the time of bone graft screw of the tail and connecting rods, stress significantly decreased after bone graft, assuming a scattered distribution to the central screw. Conclusion Both of the 2 types of grafting procedure/technique can reconstruct the strength of injured vertebrae and enhance the instant stability. Nevertheless, the technique of transcanal grafting may offer a better mechanical performance through decreasing the stress on the internal fixation in a more adequate and efficient way. Therefore this study concludes that it is a better surgical technique worth of being popularized in clinic.
Thoracolumbar / Burst fracture / Bone grafting / Finite element
[1] 欧阳钧, 翟文亮, 朱青安, 等. 胸腰段脊柱爆裂型骨折机理及实验模型[J].中华骨科杂志, 1998, 18(5):282-285.
[2] 俞宇,田晓华. 经伤椎椎弓根椎体内植骨加椎弓根螺钉固定术治疗胸腰椎骨折的远期随访[J].安徽医学, 2014, 35(10):1402-1403.
[3] 王春, 单方军. 经椎管椎体植骨治疗胸腰椎爆裂骨折远期疗效分析[J]. 颈腰痛杂志, 2008, 29(3):241-243.
[4] 敖俊, 薛鹏举, 段领燕, 等. 经单侧椎管撬拨复位椎体内植骨治疗胸腰椎骨折[J].中国现代医学杂志, 2013, 23(22):47-52.
[5] Park WM, Park YS, Kim K, et al. Biomechanical comparison of instrumentation techniques in treatment of thoracolumbar burst fractures: a finite element analysis[J].J Orthop Sci, 2009,14(4):443-449.
[6] Rohlmann A, Boustani HN, Bergmann G, et al. A probabililistic finite element analysis of the stresses in the augmented vertebral body after vertebroplasty[J].Eur Spine, 2010,19(9):1585-1595.
[7] Strange DG, Fisher ST, Boughtouu PC, et al. Restoration of compressive loading properties of lumbar discs with a nucleus implant-a finite element analysis study[J].Spine, 2010,10(7):602-609.
[8] Hussain M, Gay RE, An KN. Reduction in disk and fiber stresses by axial distraction is higher in cervical disk withfibers oriented toward the vertical rather than horizontal plane: a finite element model analysis[J].J Manipulative Physiol Ther, 2010, 33(4):252-260.
[9] He Jian-ying, Dong Xie-ping. Advance of finite element methods in spinal biomechanical research[J]. Journal of Clinical Rehabilitative Tissue Engineering Research, 2011,15(26):4936-4940.
[10]敖俊, 方国芳, 冯伟, 等. 以三维有限元模型分析短节段腰椎椎弓根螺钉系统固定后螺钉应力的分布[J]. 中国组织工程研究与临床康复, 2008, 12(39):7601-7604.
[11] Qiu TX, Tan KW, Lee VS, et al. Investigation of thoracolumbar T12–L1 burst racture mechanism using finite lement method[J]. Med Eng Phys, 2006, 28(7):656-664.
[12] Chang DK, Wang WK, Wang JP, et al. The effects of fixation methods of thoracolumbar burst fracture under sagittal plane motion by finite element analysis[J]. J Biomech, 2007, 40(Suppl 2):598.
[13]Esses SI, Botsford DJ, Kostuik JP. Evaluation of surgical treatment for burst fractures[J]. Spine,1990,15:667-673.
[14]Kaneda K,Taneichi H, Abumi K, et al. Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits[J]. J Bone Joint Surg Am ,1997, 79(1):69-83.
[15]Rohlmann A, Zander T, Bergmann G. Spinal loads after osteoporotic vertebral fractures treated by vertebroplasty or kyphoplasty[J]. Eur Spine J, 2006, 15(8):1255-1264.
[16]王春,刘清平,刘成招,等. 经椎管椎体植骨加AF固定治疗胸腰椎爆裂型骨折.骨与关节损伤杂志[J].2002, 17(6):415-416.
[17]敖俊,兰美兵,薛鹏举,等.脊柱胸腰段椎内静脉丛的应用解剖学研究[J].中国现代医学杂志, 2013, 23(28):29-32.
[18]敖俊, 王震, 覃建朴, 等. 胸腰段和腰椎椎体矢状骨折线的CT影像学分析[J].实用医学杂志2013, 29(1):4-6.
[19]敖俊, 辛志军, 陈方, 等. 两种植骨法对胸腰椎爆裂骨折复位后骨缺损空隙残存率及压缩刚度的影响[J].中国重建和修复外科杂志, 2013, 27(8):974-979.
[20]敖俊, 方国芳, 靳安民, 等. 以有限元法比较前路腰椎间融合后路关节突关节螺钉/椎弓根螺钉的固定应力[J].中国组织工程与临床康复, 2009, 13(35):6855-6860.
[21]梁宁, 康意军, 陈飞. 不同植入物固定L1节段爆裂性骨折的三维有限元分析[J].中国组织工程研究, 2012, 16(44):8218-8217.
[22]李书皖, 陆斌, 张国桥, 等. 腰椎后路椎间融合内固定有限元模型的建立及内固定物力学分析[J].中国临床解剖学杂志, 2014, 32(5):609-612.
贵州省科学技术基金（2010J2179）；遵义医学院博士启动基金（201019）
京ICP备08002354号-3/
| 〈 |
|
〉 |
