本文關(guān)鍵詞： 融合器 椎弓根螺釘 有限元仿真 生物力學(xué)特性 活動(dòng)度　出處：《上海交通大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：腰椎間融合器(Cage)植入配合椎弓根螺釘-連接棒固定,已發(fā)展成為了治療腰椎退行性病變的主要融合和固定方式。經(jīng)椎間孔入路腰椎間融合術(shù)(TLIF)作為一種相對(duì)較新的脊椎融合術(shù)式,由于其具有較大程度保留椎體的完整性,減輕神經(jīng)損傷,融合率高,術(shù)后并發(fā)癥少等優(yōu)點(diǎn),目前已經(jīng)廣泛地應(yīng)用于臨床中,然而手術(shù)中Cage的植入位置角度僅憑醫(yī)生的主觀經(jīng)驗(yàn),缺乏系統(tǒng)性的研究。因此,本文利用有限元仿真和離體實(shí)驗(yàn)相結(jié)合的研究方法,旨在探究TLIF術(shù)后Cage和椎弓根螺釘-連接棒固定系統(tǒng)對(duì)于椎體節(jié)段的穩(wěn)定性和生物力學(xué)特性影響規(guī)律,并確定出相對(duì)較好的TLIF術(shù)融合方式。考慮到椎間盤(pán)纖維環(huán)材料的高度非線(xiàn)彈性,基于連續(xù)介質(zhì)力學(xué),建立了纖維環(huán)各向異性纖維增強(qiáng)超彈性本構(gòu)模型,并利用ABAQUS/Standard中用戶(hù)自定義材料子程序UANISOHYPER_INV,編譯實(shí)現(xiàn)應(yīng)用于腰椎TLIF融合數(shù)值模擬�；诮】党赡曛驹刚哐礐T掃描薄層數(shù)據(jù),利用醫(yī)學(xué)圖像處理軟件Mimics重建了腰椎幾何模型,再導(dǎo)入有限元軟件HyperMesh中建立了正常腰椎L4-L5節(jié)段模型以及按不同角度(30,45°,60°)植入Cage的椎弓根螺釘單/雙邊固定的TLIF融合模型,比較了術(shù)后在四種生理活動(dòng)下融合節(jié)段活動(dòng)度ROM大小,融合器與椎間盤(pán)上下終板接觸界面、融合器、纖維環(huán)和椎弓根螺釘上的von Mises應(yīng)力峰值和應(yīng)力分布等生物力學(xué)特性。模擬結(jié)果表明,在相同的生理活動(dòng)下,單/雙側(cè)固定時(shí)L4-L5融合節(jié)段術(shù)后穩(wěn)定性大幅提升,而Cage植入角度對(duì)節(jié)段穩(wěn)定性有一定影響,表現(xiàn)為與腰椎矢狀面夾角越小,前屈、后伸時(shí)椎體穩(wěn)定性越高,而側(cè)彎、軸向旋轉(zhuǎn)時(shí)穩(wěn)定性則越低;融合器、接觸界面、椎間盤(pán)纖維環(huán)、單/雙椎弓根螺釘?shù)膽?yīng)力分布隨著生理活動(dòng)和Cage植入角度不同存在差異,雙側(cè)固定時(shí)容易導(dǎo)致其中一側(cè)椎弓根螺釘-連接棒受力集中,而且Cage對(duì)于軸向載荷分擔(dān)能力也下降,因此最終確定最佳融合方式為Cage斜向45°植入椎間盤(pán)并且配合單側(cè)椎弓根螺釘棒-連接棒系統(tǒng)內(nèi)固定。最后,本文設(shè)計(jì)了動(dòng)物生物力學(xué)離體實(shí)驗(yàn),以豬腰椎標(biāo)本作為實(shí)驗(yàn)對(duì)象,對(duì)比分析了TLIF融合對(duì)腰椎融合節(jié)段和鄰近節(jié)段穩(wěn)定性的影響。實(shí)驗(yàn)結(jié)果表明,單純固定時(shí)融合節(jié)段在各生理活動(dòng)下ROM值大幅降低,而TLIF術(shù)前屈/后伸和側(cè)彎時(shí)ROM數(shù)值進(jìn)一步降低,但軸向旋轉(zhuǎn)時(shí)反而有所升高;TLIF術(shù)對(duì)于鄰近節(jié)段穩(wěn)定性影響表現(xiàn)為上鄰近節(jié)段的各個(gè)方向的ROM值均較大幅度降低,而對(duì)下鄰近節(jié)段的影響較小,僅在側(cè)彎時(shí)其ROM值有一定降低。
[Abstract]:Lumbar interbody fusion cage (Cage) was implanted with pedicle screw and connective rod fixation. Transforaminal lumbar interbody fusion (TLIFs) is a relatively new spinal fusion method for the treatment of lumbar degenerative diseases. Because of its advantages of preserving the integrity of vertebral body, reducing nerve injury, high fusion rate and less postoperative complications, it has been widely used in clinical practice. However, the placement of Cage in surgery is only based on the doctor's subjective experience, lack of systematic research. Therefore, this paper uses finite element simulation and in vitro experiments. The purpose of this study was to investigate the effects of Cage and pedicle screw-rod fixation system on the stability and biomechanical characteristics of vertebral segment after TLIF. Considering the high non-linear elasticity of disc annular material, the anisotropic fiber reinforced hyperelastic constitutive model is established based on continuum mechanics. And the use of ABAQUS/Standard user-defined material subprogram UANISOHYPER_INV. Based on the data of lumbar spine CT scanning thin layer of healthy adult volunteers, the geometry model of lumbar vertebrae was reconstructed by medical image processing software Mimics. The L4-L5 segment model of normal lumbar vertebrae was established by introducing the finite element software HyperMesh and 30 擄45 擄according to different angles. 60 擄Cage was implanted into the pedicle screw single / bilateral fixed TLIF fusion model, and the ROM size of fusion segment was compared under four physiological activities after operation. The biomechanical characteristics of von Mises stress peak and stress distribution on the interface between the fusion cage and the upper and lower endplate of the disc, the fusion cage, the fibrous ring and the pedicle screw were obtained. Under the same physiological activity, the stability of L4-L5 fusion segment was significantly improved after unilateral / bilateral fixation, and the Cage implantation angle had a certain effect on the stability of L4-L5 fusion segment. The lower the sagittal angle with the lumbar vertebrae, the higher the stability of the vertebral body when it is extended, but the lower the stability is when the lateral bend and axial rotation. The stress distribution of fusion cage, contact interface, intervertebral disc fiber ring and single / double pedicle screw varied with physiological activity and Cage implantation angle. Bilateral fixation is easy to lead to one side of the pedicle screw-connecting rod force concentration, and Cage for axial load sharing ability also decreased. Therefore, the best fusion method is Cage oblique 45 擄intervertebral disc implantation and internal fixation of unilateral pedicle screw rod system. Finally, animal biomechanical in vitro experiment was designed. The effects of TLIF fusion on the stability of lumbar fusion segment and adjacent segment of lumbar vertebrae were compared and analyzed with porcine lumbar vertebrae specimen as the experimental object. The ROM value of fusion segment decreased significantly under various physiological activities while the ROM value decreased further during flexion / extension and lateral bending of TLIF before operation but increased at axial rotation. The effect of TLIF on the stability of adjacent segments was as follows: the ROM values of all directions of upper adjacent segments were significantly lower than those of lower adjacent segments. Only in the lateral bending, its ROM value has a certain decrease.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3

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本文編號(hào)：1456600