本文選題：腰椎小關節(jié) + 動力學��； 參考：《南方醫(yī)科大學》2017年博士論文

【摘要】：背景當今社會,腰椎退變性疾病帶給人們的困擾越來越大;因而相關的研究及治療方案也在不斷革新。在手術治療方面,減壓融合固定手術被看作當前治療腰椎椎管狹窄、椎間盤退變性疾病等疾病時應用最為廣泛的手術方式。但是,根據(jù)近期長期隨訪觀察結果顯示,融合手術會出現(xiàn)加速鄰近腰椎節(jié)段退變等不足。針對這些臨床問題,相關學者提出了保留腰椎活動的手術方式,即非融合手術的觀點。此類手術的目的是保留病人腰椎的活動度,減少融合手術帶來的鄰近節(jié)段病的發(fā)生。在相對應的手術中,腰椎人工小關節(jié)置換術能夠處理較多的臨床問題,受到學者們的關注。但是,現(xiàn)有的小關節(jié)假體并未普及;究其原因主要是現(xiàn)在的小關節(jié)假體型號單一,不適合我國人群;或者結構不理想,會出現(xiàn)器械破損等臨床問題。因此需要根據(jù)國人正常腰椎解剖參數(shù),設計一種適合國人的新型腰椎小關節(jié)假體。方法1.利用自制生物力學實驗裝置模擬腰椎在6Nm力偶矩作用下的運動并行CT掃描,同時驗證該實驗方法的精確性與可重復性。2.應用三維重建技術獲得腰椎不同位置的3D模型;測量腰椎不同節(jié)段椎間高度在屈伸、側彎過程中的變化特點。3.設計腰椎小關節(jié)假體模型,利用有限元分析法對小關節(jié)假體進行相關生物力學分析,并根據(jù)分析結果進一步優(yōu)化假體結構,同時申請專利保護。4.生產出小關節(jié)假體,并利用人腰椎尸體標本對假體進行生物力學體外實驗。結果1.成功制作出了可用于CT掃描的腰椎力學加載裝置,并且具有較高的精確性與可重復性。2.在腰椎中立位-前屈位活動時,所有節(jié)段椎間盤的前高變化幅度均隨著節(jié)段增加而增加(L3/4:1.56 ± 0.30mm,L4/5:2.06 ± 0.62mm,L5/S1:2.50 ± 0.93mm);在中立位-后伸位時,L4/5節(jié)段椎間盤前后高的變化幅度相近,但是在L3/4、L5/S1節(jié)段,此過程中其前高的變化要比后高的變化大;而在側彎時,側彎方向的椎間盤側方高度變化值明顯比對側的椎間盤側方高度大,而人字嵴間距呈現(xiàn)與之相反的趨勢。3.建立了正常人腰椎(L2-L5)有限元分析模型。椎間ROM比較顯示:腰椎小關節(jié)假體組的活動范圍比釘棒固定組大,但接近于正常腰椎組;假體組應力主要集中關節(jié)假體的上半部分與椎弓根螺釘連接處。4.體外實驗顯示小關節(jié)假體組的腰椎剛度與正常組的接近,而小于釘棒組的腰椎剛度。結論1.腰椎的椎間盤高度和人字嵴間距在屈伸、側彎運動時呈現(xiàn)節(jié)段特異性的變化。2.有限元分析顯示:腰椎小關節(jié)假體可以為腰椎提供一定的生物力學穩(wěn)定性。3.離體標本實驗顯示腰椎小關節(jié)假體作為一種新型的非融合內固定技術,融合后整體結構穩(wěn)定性接近于正常腰椎。
[Abstract]:Background in today's society, lumbar degenerative disease brings more and more problems to people; therefore, related research and treatment programs are constantly innovating. In the aspect of surgical treatment decompression fusion fixation is regarded as the most widely used surgical method in the treatment of lumbar spinal stenosis disc degeneration and other diseases. However, according to the recent long-term follow-up results, fusion surgery may lead to accelerated adjacent lumbar segment degeneration and other deficiencies. In order to solve these clinical problems, some scholars put forward the idea of non-fusion surgery, which is the method of preserving lumbar vertebrae activity. The aim of these operations is to preserve the patient's lumbar mobility and to reduce the incidence of adjacent segmental diseases associated with fusion surgery. In the corresponding surgery, lumbar artificial facet arthroplasty can deal with more clinical problems, which has attracted the attention of scholars. However, the existing facet joint prosthesis is not popularized; the main reason is that the current small joint prosthesis model is single, which is not suitable for the Chinese population; or the structure is not ideal, there will be clinical problems such as device breakage and so on. Therefore, it is necessary to design a new lumbar facet joint prosthesis based on normal lumbar vertebrae anatomical parameters. Method 1. The self-made biomechanical experimental device was used to simulate the motion of lumbar vertebrae under the action of 6Nm force couple moment and CT scan. The accuracy and repeatability of the experimental method were also verified. Three-dimensional reconstruction technique was used to obtain 3D models of lumbar vertebrae in different positions and to measure the changes of lumbar intervertebral height during flexion extension and lateral bending. The model of lumbar facet joint prosthesis was designed, and the biomechanical analysis of facet joint prosthesis was carried out by using finite element analysis, and the structure of the prosthesis was further optimized according to the analysis results, and the patent protection was applied for. Facet joint prostheses were produced and biomechanical experiments were carried out on human lumbar vertebrae cadavers in vitro. Result 1. A mechanical loading device for lumbar vertebrae which can be used for CT scanning is successfully fabricated, and it has high accuracy and repeatability. In neutral position and anterior flexion of lumbar vertebrae, the changes of anterior height of all segments of intervertebral disc increased with the increase of segments, and the changes of L 3 / 4: 4: 4: 56 鹵0.30 mm and L / 4: 5: 0. 62 mm / L 5 / S 1: 1: 1: 2. 50 鹵0. 93 mm of lumbar intervertebral disc were similar in neutral position and extension position, and the height of L4 / 5 segment of intervertebral disc was similar in neutral position and extension position, and the change of L4 / 5 segment height was similar to that of L4 / 5 segment in neutral position and extension position. But in the L3 / 4 / L5 / S1 segment, the change in the front height is greater than that in the posterior segment, and in the lateral bend, the lateral height of the disc in the lateral bending direction is significantly larger than the lateral height of the contralateral intervertebral disc. The spacing of herringbone cristae showed the opposite trend. 3. A finite element model of L 2-L 5) for normal lumbar vertebrae was established. The results showed that the range of motion in the lumbar facet joint prosthesis group was larger than that in the pedicle fixation group, but close to that in the normal lumbar vertebrae group, and the stress in the prosthesis group mainly concentrated on the upper half of the joint prosthesis and the pedicle screw junction. 4. In vitro experiments showed that the lumbar stiffness of the facet joint prosthesis group was similar to that of the normal group, but less than that of the screw rod group. Conclusion 1. Lumbar disc height and herringbone crest spacing showed segmental specific changes during flexion and lateral bending. Finite element analysis shows that the lumbar facet joint prosthesis can provide certain biomechanical stability. As a new non-fusion internal fixation technique, the whole structure stability of lumbar facet joint prosthesis is similar to that of normal lumbar vertebra.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R687.3

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