中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (12): 1842-1848.doi: 10.12307/2024.012

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

有限元仿真分析强直性脊柱炎后路“Y”型截骨固定的生物力学特征

张  乐1，2，曹振华3，4，张云凤3，许阳阳4，金  凤5，苏宝科6，王利东7，王  星1，仝  玲1，刘清华1，方  源1，沙丽蓉1，王海燕1，李筱贺1，李志军1   

  1. 1内蒙古医科大学基础医学院人体解剖教研室(内蒙古自治区数字转化医学工程技术研究中心)，内蒙古自治区呼和浩特市   010000；2巴彦淖尔市医院，内蒙古自治区巴彦淖尔市   015000；3内蒙古医科大学第二附属医院影像科，内蒙古自治区呼和浩特市   010000；4北京航空航天大学生物与医学工程学院，北京市   100083；5内蒙古医科大学附属医院影像科，内蒙古自治区呼和浩特市   010000；6内蒙古自治区中医医院，内蒙古自治区呼和浩特市   010000；7内蒙古自治区国际蒙医医院影像科，内蒙古自治区呼和浩特市   010000
  • 收稿日期:2022-12-01 接受日期:2023-03-09 出版日期:2024-04-28 发布日期:2023-08-22
  • 通讯作者: 张云凤，副主任医师，内蒙古医科大学第二附属医院影像科，内蒙古自治区呼和浩特市 010010 李筱贺，教授，博士生导师，内蒙古医科大学基础医学院人体解剖教研室(内蒙古自治区数字转化医学工程技术研究中心)，内蒙古自治区呼和浩特市 010010
  • 作者简介:张乐，女，1986年生，汉族，内蒙古医科大学在读硕士，主要从事骨科生物力学方面的研究。 曹振华，男，1980年生，汉族，博士，博士后，副主任医师，主要从事脊柱外科研究。
  • 基金资助:
    内蒙古自治区自然科学基金项目(2021MS08086)，项目负责人：王海燕；2022年度内蒙古自治区卫生健康科技计划项目(202201188)，项目负责人：王海燕；内蒙古医科大学2020年度“成果转化”项目(YKD2020CGZH009)，项目负责人：王海燕；内蒙古自然科学基金(2020MS08124)，项目负责人：李筱贺；内蒙古自治区“草原英才”工程青年创新创业人才项目(2020)，项目负责人：李筱贺；内蒙古医科大学后续科研项目(2020)，项目负责人：李筱贺；内蒙古科技计划项目(2019GG115)，项目负责人：李志军；2021年内蒙古自治区蒙医药协同创新中心科学研究项目，项目负责人：李筱贺；2021年内蒙古医科大学致远人才项目，项目负责人：李筱贺；内蒙古医科大学2021年度校级科研重点项目(YKD2021ZD001)，项目负责人：李筱贺；内蒙古教育厅高等学校创新团队发展计划(NMGIRT2227)，项目负责人：李筱贺

Biomechanical features of posterior “Y” osteotomy and fixation in treatment of ankylosing spondylitis based on finite element simulation analysis

Zhang Le1, 2, Cao Zhenhua3, 4, Zhang Yunfeng3, Xu Yangyang4, Jin Feng5, Su Baoke6, Wang Lidong7, Wang Xing1, Tong Ling1, Liu Qinghua1, Fang Yuan1, Sha Lirong1, Wang Haiyan1, Li Xiaohe1, Li Zhijun1   

  1. 1Department of Human Anatomy, School of Basic Medicine, Inner Mongolia Medical University (Inner Mongolia Digital Transformation Medical Engineering Technology Research Center), Hohhot 010000, Inner Mongolia Autonomous Region, China; 2Bayannur City Hospital, Bayannur 015000, Inner Mongolia Autonomous Region, China; 3Department of Imaging, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China; 
  • Received:2022-12-01 Accepted:2023-03-09 Online:2024-04-28 Published:2023-08-22
  • Contact: Zhang Yunfeng, Associate chief physician, Department of Imaging, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China Li Xiaohe, Professor, Doctoral supervisor, Department of Human Anatomy, School of Basic Medicine, Inner Mongolia Medical University (Inner Mongolia Digital Transformation Medical Engineering Technology Research Center), Hohhot 010000, Inner Mongolia Autonomous Region, China
  • About author:Zhang Le, Master candidate, Department of Human Anatomy, School of Basic Medicine, Inner Mongolia Medical University (Inner Mongolia Digital Transformation Medical Engineering Technology Research Center), Hohhot 010000, Inner Mongolia Autonomous Region, China; Bayannur City Hospital, Bayannur 015000, Inner Mongolia Autonomous Region, China Cao Zhenhua, MD, Associate chief physician, Department of Imaging, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China; School of Biological and Medical Engineering, Beihang University, Beijing 100083, China
  • Supported by:
    Natural Science Foundation of Inner Mongolia Autonomous Region, No. 2021MS08086 (to WHY); 2022 Inner Mongolia Autonomous Region Health Science and Technology Plan Project, No. 202201188 (to WHY); “Achievement Transformation” Project of Inner Mongolia Medical University in 2020, No. YKD2020CGZH009 (to WHY); Inner Mongolia Natural Science Foundation, No. 2020MS08124 (to LXH); “Grassland Talents” Project Youth Innovation and Entrepreneurship Talent Program of Inner Mongolia Autonomous Region, No. 2020 (to LXH); Follow-Up Scientific Research Project of Inner Mongolia Medical University, No. 2020 (to LXH); Inner Mongolia Science and Technology Plan Project, No. 2019GG115 (to LZJ); 2021 Mongolian Medicine Collaborative Innovation Center Scientific Research Project of Inner Mongolia Autonomous Region (to LXH); 2021 Zhiyuan Talent Project of Inner Mongolia Medical University (to LXH); 2021 School-Level Key Scientific Research Project of Inner Mongolia Medical University, No. YKD2021ZD001 (to LXH); Higher Education Innovation Team Development Plan of Inner Mongolia Education Department, No. NMGIRT2227 (to LXH)

PDF

66

摘要：


文题释义：

强直性脊柱炎：是一种慢性炎症性疾病，属于风湿免疫病。主要病变部位为骶髂关节、脊柱及外周关节，并伴发不同程度眼、肺、肠道、心血管病变等关节外表现，严重者可发生脊柱畸形和脊柱强直。
Y型截骨：是目前治疗脊柱后凸畸形的有效方法。该方法以前柱为铰链，缩短中柱和后柱以达到对脊柱的大程度矫形，截骨间隙闭合，稳定性较佳，且脊髓神经和大血管损伤的风险明显降低。


背景：强直性脊柱炎是一种因组织骨化和纤维化导致脊柱僵硬畸形的进行性炎症，表现为患者的姿势异常和活动受限，轻微损伤即可引发胸腰椎骨折。传统医学图像观察限制了医生对强直性脊柱炎治疗的术前决策规划和术后疾病预防。

目的：基于强直性脊柱炎患者后路脊柱去松质骨化截骨“Y”型截骨(简称“Y”型截骨)术前和术后的脊柱模型，探究“Y”型截骨固定治疗强直性脊柱炎的生物力学变化。
方法：基于1名在内蒙古医科大学第二附属医院就诊的强直性脊柱炎患者的术前和术后CT图像，于Mimics 19.0软件中重建“Y”型截骨(L3截骨)术前及术后的三维脊柱模型，包括T11-S1节段，于T11椎体顶部施加7.5 Nm力矩，模拟脊柱在前屈、后伸、左弯、右弯、左旋和右旋6个工况下的运动。仿真得到脊柱各椎体的活动度、各椎间盘的应力和钉棒系统的应力。

结果与结论：①“Y”型截骨术后路固定后，脊柱各椎体活动度均下降，且上部椎体活动度损失比例较大(L1：77.95%)；②术前脊柱椎间盘最大应力发生于L1-L2节段(0.55 MPa)，术后脊柱椎间盘最大应力发生于T11-T12节段(0.50 MPa)，且T12以下的椎间盘应力远小于术前；③钉棒系统的最大应力(166.67 MPa)发生于棒体的上中段和椎弓根钉的根部；④提示后路“Y”型截骨固定手术增强了脊柱的稳定性，减小了脊柱活动范围，固定节段的椎体减压良好且下方椎体应力遮挡现象显著，应加强棒体和椎弓根钉应力集中区域的刚度以避免应力疲劳导致的钉棒断裂。

https://orcid.org/0000-0003-2199-3868 (张乐) 

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: 强直性脊柱炎, 后路固定术, 三维重建模型, Y型截骨, 脊柱生物力学

Abstract: BACKGROUND: Ankylosing spondylitis is a progressive inflammation of spinal stiffness deformity caused by tissue ossification and fibrosis. The posture of ankylosing spondylitis patients is abnormal and their activities are limited that minor injuries can lead to thoracolumbar fractures. Traditional medical image observation limits doctors’ preoperative decision planning and postoperative disease prevention for ankylosing spondylitis treatment.
OBJECTIVE: Based on the spinal model of ankylosing spondylitis patients before and after posterior spinal cancellous ossification osteotomy (“Y” osteotomy for short), to explore the biomechanical changes of “Y” osteotomy and fixation in the treatment of ankylosing spondylitis.
METHODS: Based on the preoperative and postoperative CT images of an ankylosing spondylitis patient who went to the Second Affiliated Hospital of Inner Mongolia Medical University, a three-dimensional spine model (T11-S1) before and after “Y” osteotomy (L3 osteotomy) was reconstructed in Mimics 19.0 software. A 7.5 Nm torque was applied to the top of T11 vertebral body to simulate the movement of the spine under six conditions: flexion, extension, left bending, right bending, left rotation and right rotation. Finally, the range of motion of each vertebral body, the stress of each intervertebral disc, and the stress of the screw rod system were simulated. 
RESULTS AND CONCLUSION: (1) After “Y” type osteotomy and posterior fixation, the range of motion of all vertebrae in the spine decreased, and the loss rate of upper vertebrae was large (L1: 77.95%). (2) The maximum stress of the spinal intervertebral disc before operation occurred at the L1-L2 segment (0.55 MPa), and the maximum stress of the spinal intervertebral disc after operation occurred at the T11-T12 segment (0.50 MPa), and the stress of intervertebral disc below T12 was far less than that before operation. (3) The maximum stress of the screw rod system (166.67 MPa) occurred in the upper and middle segments of the rod body and the root of the pedicle screw. (4) In conclusion, the “Y” type posterior fixation operation enhances the stability of the spine and reduces the range of motion of the spine. The vertebral body decompression of the fixed segment is great and the stress-shielding phenomenon of the lower vertebral body is significant. The stiffness of the rod body and the stress concentration area of the pedicle screw should be strengthened to avoid the fracture of the rod caused by stress fatigue. 

Key words: ankylosing spondylitis, posterior fixation surgery, three-dimensional reconstruction model, Y-shaped osteotomy, spinal biomechanics

中图分类号: