人工颈椎间盘置换术对邻近节段生物力学影响三维有限元分析.docVIP

人工颈椎间盘置换术对邻近节段生物力学影响三维有限元分析 　 作者：李志远，申勇　张英泽，王林峰，刘艳兵，武刚，张宇宸，任虎 【摘要】 [目的]建立人工颈椎间盘置换术前、术后(C4～7)的三维有限元模型，分析颈椎间盘置换术的特点，并探讨术后对邻近节段生物力学的影响。[方法]选取1名行人工颈椎间盘置换的男性病人的术前、术后CT片，范围为C4～7,(包括椎体、邻近椎体和邻近椎间盘)分别建立术前、术后的三维脊柱功能单元的有限元模型。对模型加载2 N·m的力矩和10 N·m的转矩，分析其在垂直载荷、前屈、后伸、侧屈及旋转的情况下，手术前后的椎体的变化以及椎体皮质骨、松质骨、椎间盘、终板的应力改变，以及活动度的变化。[结果]手术后轴向负荷力线后移,人工间盘邻近椎体上下终板所受应力，以及邻近椎间盘所受应力有所增加，但所受压力、张力不明显。节段活动度的变化减小不明显。[结论]人工颈椎间盘置换术有效的改善了脊柱功能单位的生物力学性能，但需谨慎选择人工椎间盘的大小，并且最大限度保留终板骨性组织，以避免出现术后假体下沉、移位、脱出、节段后凸等不良影响。 【关键词】 人工假体; 颈椎间盘; 生物力学; 有限元分析 　　Abstract: [Objective]To present a validated two-functional spinal unit C4～7 finite element model with simulated placement of a disc prosthesis treatment to predict stresses and strains within adjacent vertebal bodies. [Methods]Two finite element models of C4～7 were generated using the CT scans taken from a male patient following placement of a disc prosthesis treatment, which were included with adjacent bodies, intervertebral discs. Simulations were conducted imposing a compression preload combined to a flexion/extension moment, a pure lateral bending moment and a pure torsion moment, and to quantify the stress levels in intervertebral discs, endplate, cancellous bone, cortical bone and adjacent bodies following placement of a disc prosthesis under clinically relevant loading conditions.[Results]The BryanTM disc prosthesis allows to correctly reproduce a physiological motion at the implanted level, and the changes in stresses and strains in levels adjacent to a placement of a disc prosthesis treatment level were minimal.[Conclusion]The artificial cervical disc prosthesis well restores the biomechanical behavior of the intact spine. Moreover, the selection of surgical indications and proper manipulations shoule bve paid more attehtion to. 　　Key words：cervical disc replacement; biomechanical; finite element analysis 　　随着颈椎的发病率逐年增加，前路减压植骨融合技术广泛应用于颈椎病患者的手术治疗。然而，临床研究显示融合会导致颈椎活动度的减少，加速临近节段的退行性病变。为解决异常应力作用于融合后邻近节段的问题，避免前路减压植骨融合术的诸多并发症，作为“非融合固定技术”的代表—颈椎间盘置换手术在临床上得到广泛应用。然而关于人工颈椎