单椎节与单节段内固定治疗腰椎椎弓峡部裂的有限元分析
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浙江省杭州市科技发展项目(20080333B11)


Finite element analysis on intra-segmental fixation and inter-segmental fixation for lumbar spondylolysis
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    摘要:

    目的 通过单椎节和单节段内固定治疗腰椎椎弓峡部裂三维有限元模型的生物力学实验,比较峡部裂状态和两种内固定情况下邻近终板的应力变化。方法 利用已经建立的L4双侧椎弓峡部裂三维有限元模型,重建下腰椎内固定物如椎弓根螺钉和连接杆,将两者组合构建单椎节和单节段内固定治疗腰椎椎弓峡部裂的有限元模型,在同样约束条件及载荷下进行有限元分析,比较腰椎峡部裂状态、单椎节、单节段内固定3种力学状态下邻近终板的应力变化情况。结果 轴向加压时,两种内固定方式与峡部裂状态相比较在L4下终板应力均值差异有统计学意义(P<0.05),前屈、后伸、侧屈时单椎节固定方式终板应力均值与峡部裂状态相仿,而单节段固定方式与峡部裂状态相比较在L4下终板应力均值增高有统计学意义(P<0.05),在S1上终板应力均值差异也有统计学意义(P<0.05),旋转时单椎节固定方式与其他两种状态相比在S1上终板应力均值下降有统计学意义(P<0.05)。结论 单椎节经椎弓根钉棒固定系统治疗腰椎弓峡部裂在轴向加压、前屈、后伸、侧屈、旋转时不仅能提供良好的固定,而且最大程度地保留了上下椎间盘的活动,尤其在旋转运动时对下一节椎间盘有良好的稳定作用。

    Abstract:

    Objective To compare the stresses on the end plate of adjacent lumbar vertebrae between intra-segmental fixation and inter-segmental fixation in treating lumbar spondylolysis by three-dimensional finite element analysis. Method Based on the established finite element model of L4 lumbar spondylolysis, the lumbar internal fixation such as rods and trans-pedicle screws were reconstructed to make the finite element models of intra segmental and inter segmental internal fixation with the same constraint and loading conditions. The stresses on endplate of adjacent lumbar vertebrae of finite element models were measured under three mechanical conditions:spondylolysis, intra-segmental fixation and inter-segmental fixation. Results High stresses were observed under two kinds of internal fixation conditions compared with the spondylolysis condition at the lower endplate of L4 under axial loading(P<0.05). The stresses at the lower endplate of L4 under intra segmental fixation condition were similar as that of the spondylolysis condition under flexion, extension and lateral bending loading. With the same loading, higher stresses were observed under inter-segmental fixation condition compared with the spondylolysis condition, and so did the lower stresses at upper endplate of S1(P<0.05). The lower stresses at the upper endplate of S1 under intra-segmental fixation condition were observed compared with the other two conditions under rotating loading (P<0.05). Conclusions The intra segmental fixation can not only provide stability for lumbar spondylolysis under axial, flexion, extension, lateral bending,but also preserve the normal activity at adjacent disc levels, especially under rotating loading.

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顾晓民,贾连顺,陈雄生,鲁成林,刘洋,张东升.单椎节与单节段内固定治疗腰椎椎弓峡部裂的有限元分析[J].医用生物力学,2011,26(1):63-68

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  • 收稿日期:2010-07-20
  • 最后修改日期:2010-12-14
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