下颈椎前路椎弓根螺钉人工椎体系统的有限元研究_《中国修复重建外科杂志》

作者：

吴卫东 ^1,2,3 , 孙培栋 ^1,2,3 , 刘雄 ^1,2,3 , 陈春 ^1,2 , 吴长福 ⁴ , 欧阳钧 ^1,2,3

1 南方医科大学人体解剖学教研室（广州，510515）;;
2广东省医学生物力学重点实验室;;
3 广东省骨科研究院临床解剖与生物力学研究所;;
4 莆田学院附属医院骨科;

关键词：

下颈椎前路椎弓根螺钉人工椎体有限元分析

DOI：

10.7507/1002-1892.20130322

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的利用有限元研究方法，比较下颈椎前路椎弓根螺钉人工椎体系统（anterior transpedicular screw-artificial vertebral body， AVB）与传统颈椎前路钉板系统的生物力学性能。方法采集1名38岁正常女性志愿者颈椎（C1～T1）CT数据，应用Mimics 14.0、Geomagic Studio 2013、ANSYS 14.0软件建立下颈椎（C3～7）完整模型、颈椎前路钛板椎体钉（anterior screw plate system，AP）固定模型、AVB固定模型。在C3上分别施加74 N轴向压力及1 N·m纯力偶矩，使模型产生前屈、后伸、左侧弯、右侧弯、左旋和右旋运动，记录AP组及AVB组Von Mises应力云图及最大应力值，计算并比较3组椎间活动度（range of motion，ROM）。结果实验建立了正常人下颈椎（C3～7）有限元模型，模型包括 286 382个单元，414 522个节点，其椎间ROM与Panjabi等及Kallemeyn等实验数据吻合度较好。AP组在钉板连接部位出现应力集中，AVB组应力分布较均匀。在74 N轴向压力、前屈、后伸、左旋、右旋工况下，AP组与AVB组最大应力值差异明显。与AP组相比，AVB组固定节段ROM更小，邻近节段ROM相对较大；与完整组相比，AP组与AVB组的整体ROM减小约3°，但邻近C3、4及C6、7节段的ROM代偿增加约5°。结论AVB作为一种新型固定技术，其稳定性优于AP，且固定系统断裂的风险显著低于AP。

引用本文： 吴卫东,孙培栋,刘雄,陈春,吴长福,欧阳钧. 下颈椎前路椎弓根螺钉人工椎体系统的有限元研究. 中国修复重建外科杂志, 2013, 27(12): 1466-1470. doi: 10.7507/1002-1892.20130322 复制

1.	Boockvar JA, Philips MF, Telfeian AE, et al. Results and risk factors for anterior cervicothoracic junction surgery. J Neurosurg, 2001, 94(1 Suppl): 12-17.
2.	Okawa A, Sakai K, Hirai T, et al. Risk factors for early reconstruction failure of multilevel cervical corpectomy with dynamic plate fixation. Spine (Phila Pa 1976), 2011, 36(9): E582-587.
3.	Koller H, Hempfing A, Acosta F, et al. Cervical anterior transpedicular screw fixation. Part I: Study on morphological feasibility, indications, and technical prerequisites. Eur Spine J, 2008, 17(4): 523-538.
4.	欧阳钧, 陈春, 吴长福. 一种颈椎的人工椎体: 中国, 201220178924. 7 [P]. 2012-11-21.
5.	Mercer S, Bogduk N. The ligaments and annulus fibrosus of human adult cervical intervertebral discs. Spine (Phila Pa 1976), 1999, 24(7): 619-628.
6.	Lee SH, Im YJ, Kim KT, et al. Comparison of cervical spine biomechanics after fixed- and mobile-core artificial disc replacement: a finite element analysis. Spine (Phila Pa 1976), 2011, 36(9): 700-708.
7.	Hussain M, Natarajan RN, Fayyazi AH, et al. Screw angulation affects bone-screw stresses and bone graft load sharing in anterior cervical corpectomy fusion with a rigid screw-plate construct: a finite element model study. Spine J, 2009, 9(12): 1016-1023.
8.	Tchako A, Sadegh AM. Stress changes in intervertebral discs of the cervical spine due to partial discectomies and fusion. J Biomech Eng, 2009, 131(5): 051013.
9.	王成焘. 人体生物摩擦学. 北京: 科学出版社, 2008: 428-432.
10.	Panjabi MM, Crisco JJ, Vasavada A, et al. Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves. Spine (Phila Pa 1976), 2001, 26(24): 2692-2700.
11.	Kallemeyn N, Gandhi A, Kode S, et al. Validation of a C2-C7 cervical spine finite element model using specimen-specific flexibility data. Med Eng Phys, 2010, 32(5): 482-489.
12.	李家顺, 贾连顺. 颈椎外科学. 上海: 上海科学技术出版社, 2004: 294-298.
13.	陈春, 赵卫东, 孙培栋, 等. 钉道强化对颈椎前路椎间融合术式稳定性影响的生物力学研究. 中国修复重建外科杂志, 2010, 24(10): 1174-1179.
14.	Hussain M, Natarajan RN, An HS, et al. Progressive disc degeneration at C5-C6 segment affects the mechanics between disc heights and posterior facets above and below the degenerated segment: A flexion-extension investigation using a poroelastic C3-T1 finite element model. Med Eng Phys, 2012, 34(5): 552-558.
15.	Fice JB, Cronin DS, Panzer MB. Cervical spine model to predict capsular ligament response in rear impact. Ann Biomed Eng, 2011, 39(8): 2152-2162.
16.	Lau D, Song Y, Guan Z, et al. Radiological outcomes of static vs expandable titanium cages after corpectomy: a retrospective cohort analysis of subsidence. Neurosurgery, 2013, 72(4): 529-539.
17.	Kim HW, Ryu JI, Bak KH. The safety and efficacy of cadaveric allografts and titanium cage as a fusion substitutes in pyogenic osteomyelitis. J Korean Neurosurg Soc, 2011, 50(4): 348-356.

1. Boockvar JA, Philips MF, Telfeian AE, et al. Results and risk factors for anterior cervicothoracic junction surgery. J Neurosurg, 2001, 94(1 Suppl): 12-17.
2. Okawa A, Sakai K, Hirai T, et al. Risk factors for early reconstruction failure of multilevel cervical corpectomy with dynamic plate fixation. Spine (Phila Pa 1976), 2011, 36(9): E582-587.
3. Koller H, Hempfing A, Acosta F, et al. Cervical anterior transpedicular screw fixation. Part I: Study on morphological feasibility, indications, and technical prerequisites. Eur Spine J, 2008, 17(4): 523-538.
4. 欧阳钧, 陈春, 吴长福. 一种颈椎的人工椎体: 中国, 201220178924. 7 [P]. 2012-11-21.
5. Mercer S, Bogduk N. The ligaments and annulus fibrosus of human adult cervical intervertebral discs. Spine (Phila Pa 1976), 1999, 24(7): 619-628.
6. Lee SH, Im YJ, Kim KT, et al. Comparison of cervical spine biomechanics after fixed- and mobile-core artificial disc replacement: a finite element analysis. Spine (Phila Pa 1976), 2011, 36(9): 700-708.
7. Hussain M, Natarajan RN, Fayyazi AH, et al. Screw angulation affects bone-screw stresses and bone graft load sharing in anterior cervical corpectomy fusion with a rigid screw-plate construct: a finite element model study. Spine J, 2009, 9(12): 1016-1023.
8. Tchako A, Sadegh AM. Stress changes in intervertebral discs of the cervical spine due to partial discectomies and fusion. J Biomech Eng, 2009, 131(5): 051013.
9. 王成焘. 人体生物摩擦学. 北京: 科学出版社, 2008: 428-432.
10. Panjabi MM, Crisco JJ, Vasavada A, et al. Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves. Spine (Phila Pa 1976), 2001, 26(24): 2692-2700.
11. Kallemeyn N, Gandhi A, Kode S, et al. Validation of a C2-C7 cervical spine finite element model using specimen-specific flexibility data. Med Eng Phys, 2010, 32(5): 482-489.
12. 李家顺, 贾连顺. 颈椎外科学. 上海: 上海科学技术出版社, 2004: 294-298.
13. 陈春, 赵卫东, 孙培栋, 等. 钉道强化对颈椎前路椎间融合术式稳定性影响的生物力学研究. 中国修复重建外科杂志, 2010, 24(10): 1174-1179.
14. Hussain M, Natarajan RN, An HS, et al. Progressive disc degeneration at C5-C6 segment affects the mechanics between disc heights and posterior facets above and below the degenerated segment: A flexion-extension investigation using a poroelastic C3-T1 finite element model. Med Eng Phys, 2012, 34(5): 552-558.
15. Fice JB, Cronin DS, Panzer MB. Cervical spine model to predict capsular ligament response in rear impact. Ann Biomed Eng, 2011, 39(8): 2152-2162.
16. Lau D, Song Y, Guan Z, et al. Radiological outcomes of static vs expandable titanium cages after corpectomy: a retrospective cohort analysis of subsidence. Neurosurgery, 2013, 72(4): 529-539.
17. Kim HW, Ryu JI, Bak KH. The safety and efficacy of cadaveric allografts and titanium cage as a fusion substitutes in pyogenic osteomyelitis. J Korean Neurosurg Soc, 2011, 50(4): 348-356.

《中国修复重建外科杂志》

下颈椎前路椎弓根螺钉人工椎体系统的有限元研究

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《中国修复重建外科杂志》

下颈椎前路椎弓根螺钉人工椎体系统的有限元研究

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