两种改良Goel技术治疗颅底凹陷症稳定性的有限元分析

doi:10.13418/j.issn.1001-165x.2019.03.013

中国临床解剖学杂志 ›› 2019, Vol. 37 ›› Issue (3): 304-310.doi: 10.13418/j.issn.1001-165x.2019.03.013

两种改良Goel技术治疗颅底凹陷症稳定性的有限元分析

张宝成¹，　蔡贤华^{1, 2}，　刘海波³，　王志华³，　徐峰^{1, 2}，　康辉¹，　丁然¹

1.中国人民解放军中部战区总医院骨科，武汉 430070；　2.南方医科大学研究生院，广州 510515
3.太原理工大学应用力学与生物医学工程研究所，太原 030024

出版日期:2019-05-25 发布日期:2019-06-14
通讯作者: 蔡贤华，教授，主任医师，博士生导师，Tel:13871162208, E-mail: wgcaixh@163.com
作者简介:张宝成(1983-)，男，山西平遥人，主治医师，研究方向：上颈椎疾病的基础与临床研究, E-mail：baocheng255@163.com
基金资助:
武汉市高新技术产业发展行动计划攻关课题（201260523184）；全军医学科学研究“十一五”计划攻关课题（08G031）

Biomechanical comparison of two modified Goel techniques for the treatment of basilar invagination by finite element analysis

ZHANG Bao-cheng¹, CAI Xian-hua^1,2, LIU Hai-bo³, WANG Zhi-hua³, XU Feng^1,2, KANG Hui¹，DING Ran¹

1.Department of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan 430070, China; 2.Postgraduate Institute, Southern Medical University, Guangzhou 510515, China; 3.Institute of Applied Mechanics and Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China

Online:2019-05-25 Published:2019-06-14

摘要/Abstract

摘要： 目的　应用有限元分析评价C2双皮质椎板螺钉和C2椎弓根螺钉联合关节内Cage在寰枢固定中的生物力学差异。方法　采集1名35岁正常男性上颈椎（C0~2）CT数据，通过Mimics10.01和Abaqus6.11软件建立C0~2节段三维有限元完整模型并进行有效性验证。在失稳模型上分别建立后路C1侧块螺钉+Cage+C2双皮质椎板螺钉组成的钉棒系统模型（C1 lateral mass screw+Cage+bicortical C2 laminar screw, C1L+Cage+BC2L）、后路C1侧块螺钉+Cage+C2椎弓根螺钉组成的钉棒系统模型（C1 lateral mass screw+Cage+C2 pedicle screw, C1L+Cage+C2P）。在枕骨髁上施加40 N轴向压力模拟头颅重力，同时在枕骨上施加1.5 Nm力矩使模型产生前屈、后伸、侧弯、旋转运动，记录C1L+Cage+BC2L组及C1L+Cage+C2P组的应力云图及应力峰值，计算C1~2节段活动度（range of motion，ROM）。结果　在任何工况下C1L+Cage+BC2L组和C1L+Cage+C2P组的C1~2节段ROM差异均小于0.1°,且两组内固定所有螺钉的应力分布和应力峰值无明显差异。在后伸工况下两组内固定Cage内植骨应力最小，存在明显应力遮挡, 尤其是C1L+Cage+C2P组。结论　对于BI的治疗， C1L+Cage+BC2L内固定系统的稳定性与C1L+Cage+C2P相当，与C2P技术相比，BC2L技术简单、易行，同时能有效避免椎动脉和脊髓的损伤。为了避免内固定失效和应力遮挡，术后患者应避免颈部后伸运动。

关键词: 改良Goel技术, 　C2椎弓根螺钉, 　C2双皮质椎板螺钉, 　颅底凹陷症, 　有限元分析

Abstract: Objectives 　To determine the biomechanical differences between C2 pedicle screw and bicortical C2 laminar screw with intra-articular Cage in C1~2 fixation by finite element analysis. 　Methods A validated three-dimensional finite element model of the upper cervical spine (C0~2) was established, and an unstable model was also established after removing the transverse ligament. Two different implanted models: C1 lateral mass screws+Cage+C2 pedicle screw (C1L+Cage+C2P) and C1 lateral mass screws+Cage+bicortical C2 laminar screw (C1L+Cage+BC2L) were integrated at the C1~2 segment into the unstable model. To study the biomechanics, vertical load of 40 N was applied in the inferior direction on the occipital condyles, to simulate head weight and 1.5 Nm torque was applied to the occiput to simulate flexion, extension, lateral bending, and rotation.　Results　There was no significant difference in the range of motion between C1L+Cage+BC2L and C1L+Cage+C2P implanted models ( <0.1° for all loading cases)，and also there was no significant difference in stress distribution and maximum stress between the 2 implanted models. Bone graft stress of the 2 implanted models, especially the C1L+Cage+C2P fixation model, were minimum under extension loading condition. 　Conclusions 　Our results indicate that the C1L+Cage+BC2L fixation offers similar stability to C1L+Cage+C2P for the treatment of basilar invagination. Compared to C2P technique, the BC2L is an easy, effective technique and it can avoid vertebral artery and spinal cord injury. To avoid the instrumentation failure and stress shelter, neck extension movement should be restricted or banned after surgery.

Key words: Modified Goel technique, 　C2 pedicle screw, 　Bicortical C2 laminar screw, 　Basilar invagination, 　Finite element analysis

中图分类号:

R318.01

张宝成, 蔡贤华, 刘海波, 王志华, 徐峰, 康辉, 丁然. 两种改良Goel技术治疗颅底凹陷症稳定性的有限元分析[J]. 中国临床解剖学杂志, 2019, 37(3): 304-310.

ZHANG Bao-cheng, CAI Xian-hua, LIU Hai-bo, WANG Zhi-hua, XU Feng, KANG Hui, DING Ran . Biomechanical comparison of two modified Goel techniques for the treatment of basilar invagination by finite element analysis [J]. Chinese Journal of Clinical Anatomy, 2019, 37(3): 304-310.

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两种改良Goel技术治疗颅底凹陷症稳定性的有限元分析

Biomechanical comparison of two modified Goel techniques for the treatment of basilar invagination by finite element analysis

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