本文選題：樞椎 + 頸椎��； 參考：《中國組織工程研究》2017年03期

【摘要】：背景:寰樞椎融合是目前治療寰樞椎脫位的主要修復(fù)方式,但是其前提是犧牲寰樞椎活動為代價,特別是旋轉(zhuǎn)功能。限制性非融合內(nèi)固定是一種既可以維持寰樞椎穩(wěn)定性,又可保留寰樞椎活動功能的方法,其生物力學(xué)特點與傳統(tǒng)融合術(shù)之間的差異有待進一步研究。目的:通過建立寰樞椎不穩(wěn)的三維有限元模型并模擬后路寰樞椎限制性非融合內(nèi)固定系統(tǒng)和后路寰樞椎釘棒內(nèi)固定系統(tǒng),驗證該新型內(nèi)固定系統(tǒng)的生物力學(xué)特性。方法:選擇1名31歲成年健康男性志愿者,采集從枕骨底到第3頸椎(C0-C3)的CT數(shù)據(jù),應(yīng)用Simpleware3.0、Geomagic 8.0、Hypermesh 10.0、Abaqus 6.9、Rhino 4.0軟件構(gòu)建有限元模型。施加1.5 N·m的純力偶矩,使模型在屈伸、側(cè)彎、旋轉(zhuǎn)方向上運動,將模型的椎間活動度與文獻報道的體外生物力學(xué)實驗數(shù)據(jù)相比進行驗證。建立后路寰樞椎限制性非融合內(nèi)固定系統(tǒng)模型和后路寰樞椎釘棒內(nèi)固定系統(tǒng)模型,對比兩種模型在前屈、后伸、側(cè)彎、旋轉(zhuǎn)等工況下的椎間活動度,記錄下限制性非融合內(nèi)固定系統(tǒng)模型的SMise應(yīng)力云圖。結(jié)果與結(jié)論:(1)實驗建立了健康人的上頸椎(C0-C3)三維非線性有限元模型,模型包括206 747單元,72 500個節(jié)點,其外形逼真,椎間活動度與文獻報道的體外生物力學(xué)實驗結(jié)果吻合;(2)限制性非融合內(nèi)固定系統(tǒng)模型C1-C2節(jié)段前屈、后伸工況的活動度與傳統(tǒng)釘棒內(nèi)固定系統(tǒng)模型相似;(3)在左右側(cè)屈工況下,傳統(tǒng)釘棒內(nèi)固定系統(tǒng)模型C1-2間的側(cè)屈活動度明顯受限,而限制性非融合內(nèi)固定系統(tǒng)模型的活動度比寰樞椎脫位模型有所增加,與正常寰樞椎模型基本相同;(4)在左右旋轉(zhuǎn)工況下,傳統(tǒng)釘棒內(nèi)固定系統(tǒng)模型寰樞椎之間的旋轉(zhuǎn)活動度基本消失,而限制性非融合內(nèi)固定系統(tǒng)模型其活動度雖有所減少,但仍保留大部分旋轉(zhuǎn)活動度;(5)限制性非融合內(nèi)固定系統(tǒng)模型在螺釘與連接棒、連接桿接觸部位出現(xiàn)應(yīng)力集中;(6)結(jié)果表明,后路寰樞椎限制性非融合內(nèi)固定系統(tǒng)是一種實用、有效的寰樞椎內(nèi)固定方式,該限制性非融合內(nèi)固定裝置具有限制屈伸活動,并且有效保留寰樞椎軸向旋轉(zhuǎn)和側(cè)彎活動功能的特點。
[Abstract]:Background: atlantoaxial fusion is the main repair method for atlantoaxial dislocation at present, but its premise is to sacrifice atlantoaxial activity, especially rotational function.Restrictive non-fusion internal fixation is a method which can maintain the stability of atlantoaxial vertebra and preserve the function of atlantoaxial movement. The difference between its biomechanical characteristics and traditional fusion needs to be further studied.Objective: to verify the biomechanical characteristics of the new internal fixation system by establishing a three-dimensional finite element model of atlantoaxial instability and simulating the posterior atlantoaxial limited non-fusion internal fixation system and the posterior atlantoaxial screw rod internal fixation system.Methods: Ct data from occipital floor to C0-C3 of the third cervical vertebra were collected from a 31-year-old adult male volunteer. The finite element model was constructed with Simpleware 3.0 Geomagic 8.0 HyperMesh 10.0 Abaqus 6.9 Rhino 4.0 software.The pure force couple moment of 1.5 N m was applied to make the model move in the direction of flexion, extension, lateral bending and rotation. The intervertebral activity of the model was compared with the biomechanical data reported in the literature in vitro.The posterior atlantoaxial limited non-fusion internal fixation system model and the posterior atlantoaxial screw rod internal fixation system model were established to compare the intervertebral mobility of the two models under the conditions of anterior flexion, extension, lateral bending and rotation.The SMise stress cloud of the restricted nonfused internal fixation system model was recorded.Results and conclusion\\\The results of in vitro biomechanical experiments were in agreement with the results of in vitro biomechanical experiments reported in the literature. (2) the model of C1-C2 segment anterior flexion and extension were similar to those of the traditional screw rod internal fixation system model under the condition of left and right flexion.The lateral flexion activity of the traditional screw rod internal fixation system model C1-2 is obviously limited, while that of the restricted non-fusion internal fixation system model is higher than that of the atlantoaxial dislocation model, which is basically the same as that of the normal atlantoaxial system model.The rotation activity between atlantoaxial vertebrae of the traditional screw rod internal fixation system model was basically disappeared, but the limited non-fusion internal fixation system model had a decrease in the range of motion.The results showed that the posterior atlantoaxial limited non-fusion internal fixation system was practical.Effective atlantoaxial internal fixation, the limited non-fusion internal fixation device has the characteristics of limiting flexion and extension activities, and effectively preserving the atlantoaxial rotation and lateral bending functions.
【作者單位】： 解放軍第二軍醫(yī)大學(xué)附屬長征醫(yī)院骨科;解放軍第451醫(yī)院創(chuàng)傷顯微外科;上海交通大學(xué)附屬瑞金醫(yī)院傷骨科研究所;解放軍福州軍區(qū)總醫(yī)院骨科;
【分類號】：R318
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本文編號：1774113