重度骨质疏松条件下后路枢椎三种内固定方式的有限元分析

doi:10.13418/j.issn.1001-165x.2022.2.15

摘要/Abstract

摘要： 目的　通过有限元分析重度骨质疏松（Severe osteoporosis，SOP）条件下后路枢椎不同植钉方式在上颈椎中的生物力学特性。方法　对1例健康成年男性进行上颈椎CT扫描，获得图像。结合有限元前处理软件，设置材料属性模拟出SOP的寰枢椎（C1~C2）失稳模型，依据手术方案建立后路寰椎双侧椎弓根螺钉（B-C1PS）+枢椎3种不同植钉方式固定：枢椎双侧椎弓根螺钉（B-C2PS，模型A）；枢椎双侧椎板螺钉(B-C2TL，模型B)；B-C2PS联合B-C2TL（模型C）。分析3种模型屈伸、侧弯和轴向旋转工况下的C1~C2关节活动度、C1位移以及C2螺钉应力分布情况。结果在SOP的C1~C2失稳有限元模型上，模型C在不同工况下C1~C2关节活动度和C1位移最小。C2联合固定时螺钉受到的最大应力较单一固定小：模型C枢椎椎板钉在各个工况下最大应力值小于模型B，模型C枢椎椎弓根螺钉在各个工况下最大应力值小于模型A。模型C应力主要集中于C2PS根部及寰枢椎椎弓根螺钉与钉棒连接处。结论在SOP条件下采取模型C内固定方式较模型A、B稳定性更好。枢椎螺钉受到的应力产生分散，枢椎螺钉更加不容易产生术后疲劳性松动脱出。

关键词: 寰枢椎失稳, 　重度骨质疏松, 　椎弓根螺钉, 　椎板螺钉, 　有限元

Abstract: Objective　To analyze the biomechanical characteristics of posterior axis different planting methods in upper cervical vertebra under severe osteoporosis (SOP). Methods A CT scanning on cervical vertebra was performed on a healthy adult man. Combined with the finite element pre-processing software, the atlantoaxial instability model (C1~C2) of SOP was stimulated by setting material properties. According to the surgical plan, posterior bilateral atlas pedicle screw (B-C1PS)+ Axis of three different ways of planting nail fixation was established: axis bilateral pedicle screw (B-C2PS, model A) fixation, axis bilateral laminar screw (B-C2TL, model B) fixation, B-C1PS combined with B-C2TL fixation(model C). The range of motion of C1-C2 joint, C1 displacement and C2 screw stress distribution of the three internal fixation methods were analyzed under the bending extension, lateral bending and axial rotation conditions of the finite element model. Results The finite element model of C1-C2 instability in the SOP, Model C had the lowest range of motion of C1-C2 joint, C1 displacement in different conditions. Fixed screw under the maximum stress of C2 joint combined fixation was smaller than that of single fixation. The maximum stress of pedicle screw of the axis in the Model C was less than that of Model B under various working conditions, that of pedicle screw in the Model C was less than that of Model A. In Model C, the stress was mainly concentrated at C2PS roots and the joint between atlanto-axial vertebral pedicle screw and screw rod. Conclusions The inner fixation stability of Model C is better than that of Model A and Model B under SOP condition. The stress of axis is dispersed, and the axis screw is less prone to postoperative fatigue loosening and prolapse.

Key words: Atlantoaxial instability, 　Severe osteoporosis, 　Pedicle screw, 　Laminar screw, 　Finite element

中图分类号:

R318.01

姚文君, 李才, 许刚, 叶雨辰, 朱坤, 王艳丽, 张长春. 重度骨质疏松条件下后路枢椎三种内固定方式的有限元分析[J]. 中国临床解剖学杂志, 2022, 40(2): 198-203.

Yao Wenjun, Li Cai , Xu Gang , Ye Yuchen , Zhu Kun , Wang Yanli , Zhang Changchun. Finite element analysis of three kinds of internal fixation method of posterior axis in the condition of severe osteoporosis[J]. Chinese Journal of Clinical Anatomy, 2022, 40(2): 198-203.

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