| 陈龙,王小阵,席金涛,等.后路短节段固定在OF 4型胸腰段椎体爆裂性骨折中的有限元研究.骨科,2025,16(3): 230-237. |
| 后路短节段固定在OF 4型胸腰段椎体爆裂性骨折中的有限元研究 |
| Finite element analysis of posterior short-segment fixation in OF Type 4 thoracolumbar burst fractures |
| 投稿时间：2025-01-17 |
| DOI：10.3969/j.issn.1674-8573.2025.03.007 |
| 中文关键词: 有限元分析 胸腰椎 骨质疏松 后路 混合固定 |
| 英文关键词: Finite element analysis Thoracolumbar spine Osteoporosis Posterior approach Hybrid fixation |
| 基金项目:湖北省自然科学基金（2023AFB645）；武汉中西医结合骨科医院（武汉体育学院附属医院）院级课题（WTFY202305、WTFY202401） |
|
| 摘要点击次数: 35 |
| 全文下载次数: 12 |
| 中文摘要: |
| 目的 采用有限元分析的方法，探讨不同后路短节段固定治疗OF 4型胸腰段椎体爆裂性骨折的生物力学特点。方法 通过一名志愿者的CT扫描获得T9~L3节段的Dicom格式图像，并转移到Geomagic软件中建立三维模型。采用SolidWorks软件模拟T12椎体OF 4型骨折模型和四种不同后路短节段固定方式。M1：跨伤椎的4枚骨水泥强化钉棒系统；M2：经伤椎的6枚普通钉棒系统；M3：经伤椎的6枚骨水泥强化钉棒系统；M4：跨伤椎的4枚骨水泥强化螺钉混合经皮后凸椎体成型术（percutaneous kyphoplasty，PKP）固定（混合固定）。收集不同运动条件下固定节段的活动范围（range of motion，ROM）、钉棒的最大von Mises应力值及邻近节段的椎间盘内最大压力值（maximum intervertebral pressure，MIP）。结果 M1组固定节段ROM值最大，M3组、M4组较小。M1组在各运动状态下钉棒系统的最大von Mises应力值也最大，M2组、M3组次之，M4组最小。四组连接棒的最大von Mises应力值分别为359.87 MPa、359.31 MPa、340.49 MPa、213.48 MPa。椎间盘的压力主要集中在纤维环外周，且T10/11的MIP都高于L1/2的MIP。其中M1组最高，M3组、M2组次之，M4组最小。结论 四组短节段后路内固定治疗T12椎体OF 4型爆裂性骨折虽然都能取得较好的稳定性，但单纯后路固定连接棒的最大应力值处于疲劳损伤状态。而且，对邻近节段椎间盘的影响也更大。因此，短节段固定联合PKP的混合固定具有更好的生物力学特性，可以减少断钉断棒、邻近节段退变的风险。 |
| 英文摘要: |
| Objective To explore the biomechanical characteristics of different posterior short-segment fixation techniques for treating OF 4-type thoracolumbar burst fractures using finite element analysis. Methods DICOM-format CT images of the T9-L3 segments from a volunteer were collected and transferred to Geomagic software to build a 3D model. The T12 vertebral OF 4 fracture model and 4 posterior short-segment fixation strategies were simulated using SolidWorks software: M1, 4 pedicle screws with a cement-augmented rod system spanning the fracture; M2, 6 ordinary pedicle screws passing through the fractured vertebra; M3, 6 pedicle screws with cement augmentation passing through the fractured vertebra; M4 (hybrid fixation), 4 cement-augmented pedicle screws spanning the fracture combined with percutaneous kyphoplasty (PKP). Data on range of motion (ROM) of the fixed segments, the maximum von Mises stress on the screw-rod system, and the maximum intervertebral pressure (MIP) in adjacent intervertebral discs were collected under different loading conditions. Results ROM was largest in M1, and smallest in M3 and M4. The maximum von Mises stress on the screw-rod system was highest in M1, followed by M2 and M3, and lowest in M4. The maximum von Mises stress on the connecting rods for the 4 groups was 359.87, 359.31, 340.49, and 213.48 MPa, respectively. The intervertebral stress was mainly concentrated on the outer annulus fibrosus, with less stress on the nucleus pulposus. The MIP in T10/11 was higher than in L1/2 for all groups. M1 had the highest MIP, followed by M3 and M2, with M4 being the lowest. Conclusion All 4 posterior short-segment fixation methods provided good stability for the treatment of OF 4-type T12 burst fractures. However, the maximum stress on the connecting rods in non-mixed fixation groups exceeded the fatigue damage threshold. Moreover, it has a greater impact on the adjacent segmental intervertebral discs. Therefore, short-segment fixation combined with PKP demonstrates superior biomechanical properties and can reduce the risk of screw or rod breakage as well as adjacent segment degeneration. |
|
查看全文
下载PDF阅读器 |
| 关闭 |
|
|
|
