杂交术治疗多节段颈椎病后生物力学有限元分析

郑羽晨; 闵少雄; 张力; 张辉; 曹延林; 段扬; 靳安民

中国临床解剖学杂志 ›› 2012, Vol. 30 ›› Issue (2) : 221-224.

郑羽晨，　闵少雄，　张　力，　张　辉，　曹延林，　段　扬，　靳安民

作者信息 +

Biomechanic effects of hybrid technique on treating multilevel cervical disease by Mobi-C prosthesis: a finite element model analysis

ZHENG Yu-chen，MIN Shao-xiong, ZHANG Li, ZHANG Hui, CAO Yan-lin, DUAN Yang, JIN An-min

Author information +

文章历史 +

摘要

目的　有限元分析法探讨应用Mobi-C假体的颈人工椎间盘置换（artificial cervical disc 　replacement, ACDR）联合椎间植骨融合术（Anterior cervical decompression and fusion，ACDF）治疗多节段颈椎病的生物力学特点。方法　在已验证的下颈椎有限元模型基础上，对模型施加了头颅预载荷74 N及1.8 Nm纯力矩，模拟2组行C-ADR联合ACDF手术方式及1组行三节段ACDF手术方式，在各工况下分析术后2组杂交术式假体各部件的应力特点和3组重建模型各节段关节突关节的应力改变。结果　⑴杂交术式重建模型中Mobi-C假体上终板应力均高于下终板应力；⑵终板应力分布主要集中在终板中央偏后，最高值分别为M1组79.4Mpa，M2组为70.9Mpa；内衬应力分布集中于中央两翼，最高值分别为M1组11.6Mpa，M2组为14.4Mpa；⑶三处理组与正常组相比，行C-ADR节段的关节突关节应力增加；行ACDF节段的关节突关节应力降低；而三节段融合组邻段关节突关节应力较正常组及杂交术式组明显增高。结论　应用Mobi-C假体的杂交术式治疗多节段颈椎病，假体不易出现下沉，较多节段融合术式能更好的维持邻段关节突关节应力。

Abstract

Objective　To investigate the stress patterns of a hybrid technique combined cervical ACDR and ACDF in treating multilevel cervical disease by Mobi-C prosthesis.　Methods　A previously validated FE model of a subaxial cervical spine was used. The skull load of 74N and torsion preload of 1.8Nm were simulated on C2. Two hybrid models and a three-level fusion model were simulated to analyze the prosthesis including endplate and inlay and the facet joint force of all the segments.　Results　⑴ The stress on the superior endplate of Mobi-C prosthesis was higher than the inferior endplate in the two hybrid models. ⑵ The high stress concentrated around the middle and posterior regions of the endplate. The maximum stress in M1 was 79.4Mpa while in M2 was 70.9Mpa. The peak stress concentrated around the bilateral parts of the core. The maximum stress in M1 was 11.6Mpa while in M2 was 14.4Mpa. ⑶ Comparison of three reconstruction models with intact model, the facet joint force showed decrease in the fusion segment but increase in ACDR segment. The facet joint at adjacent segments of operation was significant increased in the three-level fusion model than hybrid models.　Conclusions　For the application of the hybrid technique by Mobi-C prosthesis in treating multilevel cervical disease, the result of the study showed that the hybrid technique has a low incidence of subsidence and can effectively restore pressure of facet joint compared with three-level ACDF.

导出引用

郑羽晨, 闵少雄, 张力, 张辉, 曹延林, 段扬, 靳安民. 杂交术治疗多节段颈椎病后生物力学有限元分析[J]. 中国临床解剖学杂志. 2012, 30(2): 221-224

ZHENG Hu-Chen, MIN Shao-Xiong, ZHANG Li, ZHANG Hui, CAO Yan-Lin, DUAN Yang, JIN An-Min. Biomechanic effects of hybrid technique on treating multilevel cervical disease by Mobi-C prosthesis: a finite element model analysis[J]. Chinese Journal of Clinical Anatomy. 2012, 30(2): 221-224

中图分类号： R318.01

参考文献

[1] Nasca RJ. Cervical radiculopathy: current diagnostic and treatment options
[J]. J Surg Orthop Adv,2009,18(1):13-18.

[2] Hee HT, Majd ME, Holt RT, et al. Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating
[J]. J Spinal Disord Tech,2003,16(1):1-8, 8-9.

[3] Faizan A, Goel VK, Garfin SR, et al. Do design variations in the artificial disc influence cervical spine biomechanics? A finite element investigation
[J]. Eur Spine J,2009，
[Epub ahead of print]

[4] Anderson PA, Rouleau JP. Intervertebral disc arthroplasty
[J]. Spine,2004,29(23):2779-2786.

[5] Barbagallo GM, Assietti R, Corbino L, et al. Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques?
[J]. Eur Spine J,2009,18(Suppl 1):29-39.

[6] Ahn HS, Diangelo DJ. A biomechanical study of artificial cervical discs using computer simulation
[J]. Spine,2008,33(8):883-892.

[7] Hong-Wan N, Ee-Chon T, Qing-Hang Z. Biomechanical effects of C2-C7 intersegmental stability due to laminectomy with unilateral and bilateral facetectomy
[J]. Spine,2004,29(16):1737-1745, 1746.

[8] Yoganandan N, Kumaresan S, Pintar FA. Biomechanics of the cervical spine Part 2. Cervical spine soft tissue responses and biomechanical modeling
[J]. Clin Biomech (Bristol, Avon),2001,16(1):1-27.

[9] Duan Y, Zhang H, Min S X, et al. Posterior cervical fixation following laminectomy: a stress analysis of three techniques
[J]. Eur Spine J,2011, 20(9):1552-1559.

[10]Rohlmann A, Zander T, Bergmann G. Effect of total disc replacement with ProDisc on intersegmental rotation of the lumbar spine
[J]. Spine . 2005,30(7):738-743.

[11]Sfantos GK, Aliabadi MH. Total hip arthroplasty wear simulation using the boundary element method
[J]. J Biomech,2007,40(2):378-389.

[12]Cardoso MJ, Rosner MK. Multilevel cervical arthroplasty with artificial disc replacement
[J]. Neurosurg Focus,2010,28(5):E19.

[13]Nagaraja S, Couse TL, Guldberg RE. Trabecular bone microdamage and microstructural stresses under uniaxial compression
[J]. J Biomech,2005,38(4):707-716.

[14]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
[J]. Spine,2011,36(9):700-708.

[15] 李光灿，李靖年，郑连杰，等. 颈椎终板抗压强度分布规律的生物力学研究
[J]. 中国矫形外科杂志,2011,19(15):1287-1290.

[16] Chang UK, Kim DH, Lee MC, et al. Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion
[J]. J Neurosurg Spine,2007,7(1):33-39.

[17]Rousseau MA, Bonnet X, Skalli W. Influence of the geometry of a ball-and-socket intervertebral prosthesis at the cervical spine: a finite element study
[J]. Spine,2008,33(1):E10-E14.