Dynesys系統(tǒng)單節(jié)段固定腰椎模型的建立與有限元分析
發(fā)布時間：2018-08-27 17:30
【摘要】：退變性腰椎疾病是腰腿痛常見的病因，保守治療效果欠佳的患者，往往需要接受手術進一步治療。而應用的釘-棒內(nèi)固定系統(tǒng)的脊柱融合手術，是目前手術治療腰椎退變性疾病的金標準。這種內(nèi)固定系統(tǒng)可保證椎骨間的融合，及橋接節(jié)段的穩(wěn)定。然而，脊柱融合手術被發(fā)現(xiàn)可造成鄰近節(jié)段反常的壓力。這種高剛度的椎弓根釘-棒系統(tǒng)，可能在脊柱手術鄰近節(jié)段，起到了加速退行性病變進程的作用。非融合技術隨之被提出，現(xiàn)階段最近最具代表性的內(nèi)固定裝置為Dynesys動態(tài)中和系統(tǒng)。其將釘-棒系統(tǒng)連接同側(cè)椎弓根螺釘?shù)拟伆魮Q成了更柔韌的套管及繩索。其設計理念上的先進性，能否帶來實際應用中令人滿意的效果，且其在國外初步應用的療效，能否在國內(nèi)得到復制，一直受到廣泛的關注。 目的：1.建立腰椎（L2-L5）有限元模型，并對其有效性進行驗證；2.建立Dynesys植入腰椎、及傳統(tǒng)釘棒系統(tǒng)植入腰椎有限元模型；3.模型間比較：在3種模型上施加相同的前屈、后伸、側(cè)向彎曲、旋轉(zhuǎn)扭矩，通過有限元分析軟件計算，比較標準腰椎模型、堅強內(nèi)固定模型、Dynesys動態(tài)內(nèi)固定模型，三種模型在前屈、后伸、側(cè)向彎曲、旋轉(zhuǎn)狀態(tài)下，固定節(jié)段（L3-L4）及上位鄰近節(jié)段（L2-L3）的椎間活動度及椎間盤應力；4.方法間比較：將本研究結果與以往病例回顧研究及體外實驗研究結果進行初步比較。 方法：1.建立并驗證L2-L5腰椎有限元模型。對健康男性患者腰椎CT數(shù)據(jù)，應用Mimics軟件進行分割，提取骨骼及椎間盤斷層圖像，建立幾何三維模型。應用HyperMesh軟件對三維模型進行網(wǎng)格劃分、賦予材料屬性等有限元前處理。并通過Abaqus軟件進行有限元運算。通過“距離——應力”的應力分布曲線，及“壓縮力——位移”曲線，驗證有限元模型的有效性。2.Dynesys及釘-棒系統(tǒng)固定腰椎模型的建立及有限元分析。通過Pro/Engineer軟件制作內(nèi)固定裝置模型，在mimics軟件下，模擬手術于L3-L4植入兩種內(nèi)固定器械。在前屈、后伸側(cè)向彎曲、旋轉(zhuǎn)四種工況下，比較未置釘腰椎模型、Dynesys系統(tǒng)固定腰椎模型及釘棒系統(tǒng)固定腰椎模型的L2-L3、L3-L4椎間活動度，椎間盤應力及小關節(jié)應力。 結果：1.建立包括椎骨、椎間盤、韌帶的L2-L5腰椎有限元模型，并驗證了其有效性。2.建立了Dynesys系統(tǒng)及釘棒系統(tǒng)固定腰椎的有限元模型。3.Dynesys系統(tǒng)固定腰椎模型在內(nèi)固定植入節(jié)段，與未置釘模型相比椎間活動度降低67%，頭側(cè)鄰近節(jié)段椎間活動度增加11%；而傳統(tǒng)堅強內(nèi)固定降低手術節(jié)段椎間活動度81.6%，增加頭側(cè)鄰近節(jié)段活動度21.3%。動態(tài)固定在手術節(jié)段卸載了大部分應力，而對上位鄰近節(jié)段造成的影響較釘-棒系統(tǒng)小。動態(tài)固定對于間盤及小關節(jié)應力的影響，，介于無固定與堅強固定之間。4.本研究通過有限元分析得到的椎間活動度的結果，與本科室以往病例回顧研究及他人體外測試結果相一致。 結論：1.基于腰椎CT斷層掃描圖像，建立了標準化的、通過驗證的、可用于進一步分析的腰椎有限元模型；2.Dynesys系統(tǒng)固定腰椎模型有限元分析，在椎間活動度方面的結果，與以往病例回顧分析的結果相似，即Dynesys系統(tǒng)可為固定節(jié)段提供穩(wěn)定，并對上位鄰近節(jié)段活動度造成較小的影響；Dynesys系統(tǒng)對腰椎應力方面的影響與堅強固定相比，對上位臨近節(jié)段椎間盤應力及小關節(jié)應力的影響較小。
[Abstract]:Degenerative lumbar spine disease is a common cause of low back and leg pain, and patients with poor conservative treatment often need further surgery. Spinal fusion with a screw-rod system is the gold standard for surgical treatment of lumbar degenerative diseases. This system ensures intervertebral fusion and bridging of segments. Stability. However, spinal fusion has been found to cause abnormal pressures in adjacent segments. This high stiffness pedicle screw-rod system may play a role in accelerating the progression of degenerative lesions in adjacent segments of spinal surgery. Non-fusion techniques have been proposed, with Dynesys being the most recent representative instrumentation at this stage. Neutralization system. It replaces the titanium rod of the screw-rod system with the flexible cannula and rope of the ipsilateral pedicle screw. Whether the advanced design concept can bring satisfactory results in practical application, and whether the curative effect of the preliminary application abroad can be replicated in China, has been widely concerned.
Objective: 1. To establish a finite element model of the lumbar spine (L2-L5) and verify its effectiveness; 2. To establish a finite element model of the lumbar spine with Dynesys implantation and traditional screw-rod system implantation; 3. Comparison between models: the same forward flexion, backward extension, lateral bending and rotational torque were applied to the three models, and the standard lumbar was compared by finite element analysis software. Vertebral model, rigid internal fixation model, Dynesys dynamic internal fixation model, three models in flexion, extension, lateral bending, rotation state, fixed segment (L3-L4) and upper adjacent segment (L2-L3) intervertebral mobility and disc stress; 4. Method comparison: The results of this study and previous case review and in vitro experimental results. Make a preliminary comparison.
Methods: 1. Establish and validate the L2-L5 finite element model of lumbar vertebrae. Segment the CT data of lumbar vertebrae of healthy male patients with Mimics software, extract the tomographic images of bone and intervertebral disc, and establish the geometric three-dimensional model. Finite element calculation is carried out. The validity of the finite element model is verified by the stress distribution curve of "distance-stress" and the curve of "compressive force-displacement". 2. The establishment and finite element analysis of the model of the fixed lumbar vertebrae with Dynesys and the screw-rod system. The model of the internal fixation device is made by Pro/Engineer software, and the operation is simulated by MICs software. The L2-L3, L3-L4 intervertebral mobility, intervertebral disc stress and facet joint stress were compared under four conditions: flexion, lateral flexion and rotation.
The finite element models of L2-L5 lumbar spine including vertebrae, intervertebral disc and ligament were established and validated. 2. The finite element models of Dynesys system and screw-rod system were established. 3. Dynesys system was used to fix the lumbar spine in the implanted segment. Compared with the model without screw fixation, the intervertebral mobility was reduced by 67% and the adjacent segment was reduced. Dynamic fixation unloaded most of the stress in the operative segment, but had little effect on the upper adjacent segment. Dynamic fixation had no effect on the stress in the disc and facet joints. Between fixation and rigid fixation. 4. The results of intervertebral mobility obtained by finite element analysis in this study are consistent with the results of previous retrospective studies of undergraduate cases and other in vitro tests.
Conclusion: 1. A standardized and validated finite element model of the lumbar spine was established based on the CT scan images of the lumbar spine; 2. The results of finite element analysis of the fixed lumbar spine model with Dynesys system were similar to those of the retrospective analysis of the previous cases, that is, Dynesys system could be provided for the fixed segment. Dynesys system has less effect on the stress of lumbar spine than rigid fixation.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R-332;R681.5
本文編號：2207949
[Abstract]:Degenerative lumbar spine disease is a common cause of low back and leg pain, and patients with poor conservative treatment often need further surgery. Spinal fusion with a screw-rod system is the gold standard for surgical treatment of lumbar degenerative diseases. This system ensures intervertebral fusion and bridging of segments. Stability. However, spinal fusion has been found to cause abnormal pressures in adjacent segments. This high stiffness pedicle screw-rod system may play a role in accelerating the progression of degenerative lesions in adjacent segments of spinal surgery. Non-fusion techniques have been proposed, with Dynesys being the most recent representative instrumentation at this stage. Neutralization system. It replaces the titanium rod of the screw-rod system with the flexible cannula and rope of the ipsilateral pedicle screw. Whether the advanced design concept can bring satisfactory results in practical application, and whether the curative effect of the preliminary application abroad can be replicated in China, has been widely concerned.
Objective: 1. To establish a finite element model of the lumbar spine (L2-L5) and verify its effectiveness; 2. To establish a finite element model of the lumbar spine with Dynesys implantation and traditional screw-rod system implantation; 3. Comparison between models: the same forward flexion, backward extension, lateral bending and rotational torque were applied to the three models, and the standard lumbar was compared by finite element analysis software. Vertebral model, rigid internal fixation model, Dynesys dynamic internal fixation model, three models in flexion, extension, lateral bending, rotation state, fixed segment (L3-L4) and upper adjacent segment (L2-L3) intervertebral mobility and disc stress; 4. Method comparison: The results of this study and previous case review and in vitro experimental results. Make a preliminary comparison.
Methods: 1. Establish and validate the L2-L5 finite element model of lumbar vertebrae. Segment the CT data of lumbar vertebrae of healthy male patients with Mimics software, extract the tomographic images of bone and intervertebral disc, and establish the geometric three-dimensional model. Finite element calculation is carried out. The validity of the finite element model is verified by the stress distribution curve of "distance-stress" and the curve of "compressive force-displacement". 2. The establishment and finite element analysis of the model of the fixed lumbar vertebrae with Dynesys and the screw-rod system. The model of the internal fixation device is made by Pro/Engineer software, and the operation is simulated by MICs software. The L2-L3, L3-L4 intervertebral mobility, intervertebral disc stress and facet joint stress were compared under four conditions: flexion, lateral flexion and rotation.
The finite element models of L2-L5 lumbar spine including vertebrae, intervertebral disc and ligament were established and validated. 2. The finite element models of Dynesys system and screw-rod system were established. 3. Dynesys system was used to fix the lumbar spine in the implanted segment. Compared with the model without screw fixation, the intervertebral mobility was reduced by 67% and the adjacent segment was reduced. Dynamic fixation unloaded most of the stress in the operative segment, but had little effect on the upper adjacent segment. Dynamic fixation had no effect on the stress in the disc and facet joints. Between fixation and rigid fixation. 4. The results of intervertebral mobility obtained by finite element analysis in this study are consistent with the results of previous retrospective studies of undergraduate cases and other in vitro tests.
Conclusion: 1. A standardized and validated finite element model of the lumbar spine was established based on the CT scan images of the lumbar spine; 2. The results of finite element analysis of the fixed lumbar spine model with Dynesys system were similar to those of the retrospective analysis of the previous cases, that is, Dynesys system could be provided for the fixed segment. Dynesys system has less effect on the stress of lumbar spine than rigid fixation.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R-332;R681.5
【參考文獻】
相關期刊論文 前2條
1 劉耀升;陳其昕;廖勝輝;唐小君;李方財;吳浩波;余世策;;腰椎L_4~L_5活動節(jié)段有限元模型的建立與驗證[J];第二軍醫(yī)大學學報;2006年06期
2 ;56 Countries & Regions Have Replied to Participate in China 2009 World Stamp Exhibition[J];集郵博覽;2008年03期
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