中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (9): 1365-1370.doi: 10.12307/2022.803

• 数字化骨科 digital orthopedics • 上一篇    下一篇

青少年胸椎经关节螺钉固定的有限元分析

和雨洁1,康志杰2,薛明明3,金  凤4,李志军1,王  星1,许阳阳5,高明杰1,李佳伟2,李筱贺1,王海燕1   

  1. 内蒙古医科大学,1基础医学院人体解剖学教研室,2研究生院,3基础医学院生理学教研室,4附属医院影像科,内蒙古自治区呼和浩特市   010010;5长治市人民医院康复科,山西省长治市   046000
  • 收稿日期:2021-08-30 接受日期:2022-01-07 出版日期:2023-03-28 发布日期:2022-07-01
  • 通讯作者: 王海燕,教授,硕士生导师,内蒙古医科大学基础医学院人体解剖学教研室,内蒙古自治区呼和浩特市 010010 李筱贺,教授,硕士生导师,内蒙古医科大学基础医学院人体解剖学教研室,内蒙古自治区呼和浩特市 010010
  • 作者简介:和雨洁,女,1988年生,内蒙古自治区呼和浩特市人,汉族,讲师,主要从事脊柱数字解剖研究。 康志杰,男,1993年生,内蒙古自治区赤峰市人,蒙古族,内蒙古医科大学在读硕士,主要从事数字医学方面的研究。
  • 基金资助:
    国家自然科学基金资助项目(81860383),项目负责人:李志军;国家自然科学基金资助项目(81860558) ,项目负责人:金凤;内蒙古自然科学基金资助项目(2021MS08086),项目负责人:王海燕;内蒙古医科大学2020年大学生科技创新“英才培育”项目(YCPY20200015),项目负责人:王海燕;内蒙古医科大学2020年大学生科技创新“英才培育”项目(YCPY20200018),项目负责人:和雨洁;内蒙古医科大学第一临床医学院 2020年大学生“启蒙计划”项目(FYQMJH2020033),项目负责人:王海燕;内蒙古医科大学2020年“三位一体”大学生创新创业培育项目(SWYT2020025),项目负责人:王海燕;内蒙古医科大学2020年“三位一体”大学生创新创业培育项目(SWYT2020021),项目负责人:和雨洁;内蒙古医科大学 2020 年度校级科研项目“成果转化”项目(YKD2020CGZH009),项目负责人:王海燕;内蒙古自治区级大学生创新创业训练计划项目(201910132019),项目负责人:王海燕;内蒙古自治区科技发展计划项目(2019GG115),项目负责人:李志军

Finite element analysis of transarticular screw fixation of adolescent thoracic vertebra

He Yujie1, Kang Zhijie2, Xue Mingming3, Jin Feng4, Li Zhijun1, Wang Xing1, Xu Yangyang5, Gao Mingjie1, Li Jiawei2, Li Xiaohe1, Wang Haiyan1   

  1. 1Department of Human Anatomy of School of Basic Medicine, 2Graduate School, 3Department of Physiology of School of Basic Medicine, 4Department of Imaging of Affiliated Hospital, Inner Mongolia Medical University, Hohhot 010010, Inner Mongolia Autonomous Region, China; 5Department of Rehabilitation, Changzhi People’s Hospital, Changzhi 046000, Shanxi Province, China
  • Received:2021-08-30 Accepted:2022-01-07 Online:2023-03-28 Published:2022-07-01
  • Contact: Wang Haiyan, Professor, Master’s supervisor, Department of Human Anatomy of School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010010, Inner Mongolia Autonomous Region, China Li Xiaohe, Professor, Master’s supervisor, Department of Human Anatomy of School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010010, Inner Mongolia Autonomous Region, China
  • About author:He Yujie, Lecturer, Department of Human Anatomy of School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010010, Inner Mongolia Autonomous Region, China Kang Zhijie, Master candidate, Graduate School, Inner Mongolia Medical University, Hohhot 010010, Inner Mongolia Autonomous Region, China He Yujie and Kang Zhijie contributed equally to this article.
  • Supported by:
    National Natural Science Foundation of China, No. 81860383 (to LZJ); the National Natural Science Foundation of China, No. 81860558 (to JF); the Natural Science Foundation of Inner Mongolia Autonomous Region, No. 2021MS08086 (to WHY); Undergraduate Scientific and Technological Innovation “Elite Cultivation” Project of Inner Mongolia Medical University in 2020, No. YCPY20200015 (to WHY); Undergraduate Scientific and Technological Innovation “Elite Cultivation” Project of Inner Mongolia Medical University in 2020, No. YCPY20200018 (to HYJ); “Enlightenment Program” Project of the First Clinical Medical College of Inner Mongolia Medical University in 2020, No. FYQMJH2020033 (to WHY); “Trinity” Innovation and Entrepreneurship Cultivation Project of Inner Mongolia Medical University in 2020, No. SWYT2020025 (to WHY); “Trinity” Innovation and Entrepreneurship Cultivation Project for College Students of Inner Mongolia Medical University in 2020, No. SWYT2020021 (to HYJ); School-level Scientific Research Project “Achievement Transformation” Project of Inner Mongolia Medical University in 2020, No. YKD2020CGZH009 (to WHY); College Students Innovation and Entrepreneurship Training Program of Inner Mongolia Autonomous Region, No. 201910132019 (to WHY); Science and Technology Development Plan Project of Inner Mongolia Autonomous Region, No. 2019GG115 (to LZJ)

摘要:

文题释义:
胸椎:胸椎位于脊柱胸段,一共12块。 上位胸椎形似颈椎,下位胸椎形似腰椎,具有生理弯曲。在椎体侧面上下缘有上肋凹和下肋凹与肋头相关节,T1椎体有上肋凹和半圆形下肋凹;T9和T10椎体只有一个上肋凹;T11和T12椎体只有一个圆形的肋凹。
有限元分析:是利用数学的方法对真实物理几何和载荷工况进行模拟。采用简单而相互作用的单元,就可以用有限数量的未知量去逼近无限未知量的真实系统的一种测量方法。

背景:关节突关节螺钉内固定作为一种被接受的内固定方法,目前已在颈椎和腰椎中进行了广泛的研究和应用。
目的:拟通过有限元法定量分析比较青少年胸椎经关节螺钉内固定和传统椎弓根螺钉内固定的生物力学特性,探索前者在胸椎内固定术中应用的可行性。
方法:建立14岁青少年全胸椎经关节螺钉固定(B组模型)和传统椎弓根螺钉固定(A组模型)的有限元模型。将连续扫描的胸椎断层影像原始数据以DICOM格式导入Mimics 21.0,分别重建T1-T12,再导入到3-Matic,建立椎间盘、关节突关节、螺钉和钛棒的初步几何模型,再进行去噪、铺面、平滑等处理,完善后的模型导入Hypermesh软件进行网格划分,对材料进行属性赋值后导入ANSYS 19.2中显示有限元模型,设定边界和载荷条件。观测椎弓根、椎间盘、螺钉和钛棒等结构的活动度和应力情况;分析二者是否具有相同的受力情况和生物力学稳定性。
结果与结论:①椎弓根螺钉各节段关节突关节的活动度在6种工况(前屈、后伸、左旋转、右旋转、左侧屈、右侧屈)下均大于小关节螺钉,最大值均位于左侧屈状态下的T11/12节段(A组模型0.691°;B组模型0.563°);②前屈、后伸、侧屈和左旋转运动状态时,A、B两组模型椎弓根的应力值组间比较差异均无显著性意义(P > 0.05);右旋转状态时,差异有显著性(P < 0.05)的节段分别位于T3、T6-T9,A组模型应力值均大于B组模型;③前屈、后伸和侧屈运动状态时,A、B两组模型上关节突的应力值组间比较差异均无显著性意义(P > 0.05);左旋转、右旋转状态时,差异有显著性(P < 0.05)的节段分别位于T10和T8,且B组模型上关节突关节面应力值均大于A组;④B组模型仅在前屈、右侧屈和右旋转工况下T1-2节段椎间盘平均应力值大于A组,其余情况下应力值均小于A组,钛钉和钛棒的整体应力云图中,A组模型平均应力值均大于B组模型;⑤结论:小关节螺钉具有同传统椎弓根螺钉一样的生物力学特性,胸椎后路经关节螺钉内固定可作为一种固定方式的选择。

https://orcid.org/0000-0002-1977-3180 (和雨洁) ;https://orcid.org/0000-0001-6025-7535 (康志杰)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 胸椎, 小关节螺钉, 椎弓根, 青少年, 有限元分析

Abstract: BACKGROUND: Facet screw fixation is currently accepted as an internal fixation method. It has been extensively studied and applied in the cervical spine and lumbar spine. 
OBJECTIVE: To quantitatively analyze and compare biomechanical properties of transarticular screw fixation and traditional pedicle screw fixation in adolescents using finite element method to explore the feasibility of the former in thoracic internal fixation.
METHODS: The finite element models of total thoracic vertebral pedicle screw fixation (Model A) and transarticular screw fixation (Model B) were established in 14-year-old adolescents. The original data of continuous scan thoracic vertebral tomography images were imported into Mimics 21.0 in DICOM format. T1-T12 were reconstructed and then imported into 3-Matic to establish preliminary geometric models of discs, facet joints, screws and titanium rods, and then processed with denoising, surfacing, smoothing and so on. The models were imported into Hypermesh software to carry on the grid. After attribute assignment, materials were imported into Ansys 19.2 to show the finite element model. Boundary and load condition were set. The motion range and stress of pedicles, intervertebral discs, screws, and titanium rods were observed, and whether the two had the same force and biomechanical stability were analyzed.
RESULTS AND CONCLUSION: (1) The range of motion of facet joints in all segments of pedicle screws was greater than that of facet screws in all six working conditions (flexion, extension, left rotation, right rotation, left flexion, right flexion). The maximum motion was located at T11/12 segment in the left flexion state (Model A: 0.691°; Model B: 0.563°). (2) There was no significant difference in the stress value of the pedicle between the two groups in flexion, extension, lateral flexion and left rotation (P > 0.05). In right-rotation state, the segments with significant differences (P < 0.05) were located at T3 and T6-T9, respectively, and the stress values of the model in Model A were higher than those in Model B. (3) There was no significant difference in the stress value of the superior articular process between Model A and B in flexion, extension, and lateral flexion motion (P > 0.05). In left-rotation and right-rotation states, the segments with significant differences (P < 0.05) were located at T10 and T8, respectively, and the stress values of the superior facet in Model B were higher than those in Model A. (4) The average stress value of T1-2 intervertebral disc in Model B was greater than that in Model A only in flexion forward, flexion right and rotation right, but was smaller than that in Model A under other conditions. In the overall stress cloud of titanium screw and rod, the average stress value of Model A was greater than that in Model B. (5) It is concluded that the biomechanical properties of small articular screws are similar to those of traditional pedicle screws, and posterior transarticular screw fixation in the thoracic spine can be used as an alternative fixation method.

Key words: thoracic, facet screw, pedicle, teenager, finite element analysis

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