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山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (1): 55-64.doi: 10.6040/j.issn.1671-7554.0.2021.0609

• 临床医学 • 上一篇    下一篇

3种不同的腰椎内固定融合方式的有限元分析

李明波1,黄燕波1,任东成2,刘俊城1,谭成双3,徐继禧4,丁金勇4   

  1. 1.广州中医药大学第一临床医学院, 广东 广州 510405;2.深圳市第三人民医院骨科, 广东 深圳 518112;3.广州市番禺区第二人民医院骨科, 广东 广州 511400;4.广州中医药大学第一附属医院脊柱专科, 广东 广州 510405
  • 发布日期:2022-01-08
  • 通讯作者: 丁金勇. E-mail:Spinegzding@163.com
  • 基金资助:
    广东省科技厅基金(2017ZC0137)

Afinite element analysis of three different fusion methods of lumbar internal fixation

LI Mingbo1, HUANG Yanbo1, REN Dongcheng2, LIU Juncheng1, TAN Chengshuang3, XU Jixi4, DING Jinyong4   

  1. 1. The First Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510405, Guangdong, China;
    2. Department of Orthopedics, The Third Peoples Hospital of Shenzhen, Shenzhen 518112, Guangdong, China;
    3. Department of Orthopedics, The Second Peoples Hospital of Panyu Guangzhou, Guangzhou 511400, Guangdong, China;
    4. Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
  • Published:2022-01-08

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摘要： 目的 观察3种不同的腰椎内固定融合方式手术节段和邻近节段的生物力学差异。 方法 构建3种不同的L4~5内固定融合方式模型,包括斜外侧入路椎间融合术(OLIF)模型、单侧微创-经椎间孔腰椎椎间融合术(MIS-TLIF)模型、双侧MIS-TLIF模型。模拟正常人体前屈、后伸、左侧弯、右侧弯、左旋弯和右旋转6种运动状态。对6种不同运动状态下各个模型的邻近节段椎间盘应力峰值、邻近节段椎体最大位移、手术节段融合器应力峰值、内固定应力峰值、L3下终板和L4上终板应力峰值的变化情况进行观察分析。 结果 在3种模型中,OLIF模型在L3~4椎间盘内应力峰值、L3椎体最大位移、内固定应力峰值和L3下终板应力峰值中,均明显小于单侧MIS-TLIF模型和双侧MIS-TLIF模型。在融合器应力峰值比较中,OLIF内固定方式模型融合器应力峰值明显小于单侧MIS-TLIF模型,但在大部分情况下,应力峰值均大于双侧MIS-TLIF模型。而单侧MIS-TLIF内固定方式模型中,融合器应力峰值明显高于双侧MIS-TLIF模型。在内固定应力峰值比较中,OLIF内固定模型生物力学最优,其次是双侧MIS-TLIF,最后是单侧MIS-TLIF。 结论 在3种有限元研究模型中,OLIF模型生物力学效果最优,而且手术损伤相对较小,为临床医师在手术选择上提供参考价值。

关键词: 腰椎内固定融合术, 斜外侧入路椎间融合术, 微创-经椎间孔腰椎椎间融合术, 有限元, 生物力学

Abstract: Objective To observe the biomechanical differences between the operative segments and adjacent segments of three different lumbar internal fixation and fusion methods. Methods Three models of L4-5 internal fixation fusion mode were constructed, including oblique lateral interbody fusion(OLIF)model, unilateral minimally invasive surgery-transforaminal lumbar interbody fusion(MIS-TLIF)model, and bilateral MIS-TLIF model. Six stress states as normal body were simulated, including forward flexion, extension, left flexion, right flexion, left rotation and right rotation. The changes of the peak stress of the intervertebral disc, the maximum displacement of the vertebral body, the peak stress of the cage, the peak stress of the internal fixation, the peak stress of the endplate under L3 and the peak stress of the endplate on L4 in each model under 6 different motion states were observed and analyzed. Results Among the three models, the OLIF model was significantly lower than the other two models in terms of the peak stress in the intervertebral disc at L3-4, the maximum displacement of the vertebral body at L3, the peak stress of internal fixation and the peak stress of the endplate under L3. In comparison of the stress peak of the cage, the stress peak of the OLIF internal fixation model was significantly lower than that of the unilateral MIS-TLIF model, but in most cases, it was greater than that of the bilateral MIS-TLIF model. However, the stress peak of the cage in the unilateral MIS-TLIF internal fixation model was significantly higher than that in the bilateral MIS-TLIF model. In comparison of internal fixed stress peak, the OLIF model had the best biomechanics, followed by the bilateral MIS-TLIF, and the unilateral MIS-TLIF. Conclusion Among the three finite element research models, OLIF model has the best biomechanical effect and relatively small surgical injury, which provides a reference value for clinicians in the choice of surgery.

Key words: Lumbar internal fixation and fusion, Oblique lateral interbody fusion, Minimally invasive surgery-transforaminal lumbar interbody fusion, Finite element, Biomechanics

中图分类号: 

  • R681.5
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