中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (30): 4777-4782.doi: 10.12307/2024.636

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

有限元法预测颈椎前路椎间盘切除融合螺钉置入位置对内固定稳定性的影响

季兴华1，魏金政2，3，郝  帅1，邢泽军1   

  1. 1山西白求恩医院(山西医学科学院同济山西医院)，山西医科大学第三医院，山西省太原市   030032；2山西医科大学第一医院，山西省太原市   030001；3山西医科大学第一临床医学院，山西省太原市   030001
  • 收稿日期:2023-07-05 接受日期:2023-08-21 出版日期:2024-10-28 发布日期:2023-12-25
  • 通讯作者: 邢泽军，博士，主任医师，山西白求恩医院(山西医学科学院同济山西医院)，山西医科大学第三医院，山西省太原市 030032
  • 作者简介:季兴华，男，1985年生，内蒙古自治区通辽市人，硕士，主治医师，主要从事脊柱疾病的相关研究。 魏金政，男，1997年生，山东省淄博市人，山西医科大学第一临床医学院在读硕士，主要从事脊柱脊髓及周围神经病变相关研究。
  • 基金资助:
    山西省卫生健康委员会科研课题(2020011)，项目负责人：季兴华

Finite element method predicts the effect of screw placement position in anterior cervical discectomy and fusion on stability of internal fixation

Ji Xinghua1, Wei Jinzheng2, 3, Hao Shuai1, Xing Zejun1   

  1. 1Shanxi Bethune Hospital (Tongji Shanxi Hospital of Shanxi Academy of Medical Sciences), Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China; 2First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; 3First Clinical Medicine College of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • Received:2023-07-05 Accepted:2023-08-21 Online:2024-10-28 Published:2023-12-25
  • Contact: Xing Zejun, MD, Chief physician, Shanxi Bethune Hospital (Tongji Shanxi Hospital of Shanxi Academy of Medical Sciences), Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China
  • About author:Ji Xinghua, Master, Attending physician, Shanxi Bethune Hospital (Tongji Shanxi Hospital of Shanxi Academy of Medical Sciences), Third Hospital of Shanxi Medical University, Taiyuan 030032, Shanxi Province, China Wei Jinzheng, Master candidate, First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; First Clinical Medicine College of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • Supported by:
    Scientific Research Project of Shanxi Provincial Health Committee, No. 2020011 (to JXH)

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摘要：


文题释义：

有限元法：是随着电子计算机的发展而迅速发展起来的一种弹性力学问题的数值求解方法。
颈椎前路椎间盘切除融合：是治疗颈椎病的经典术式，包括切除病变节段的椎间盘组织和上、下软骨板、突入椎管的髓核组织和骨赘，椎体间植骨并置入内固定系统重建椎体间的稳定性。


背景：在颈椎前路椎间盘切除融合过程中，螺钉放置角度会影响内固定系统的稳定性。

目的：有限元分析法预测不同螺钉放置角度对颈椎前路椎间盘切除融合过程中内固定系统应力的影响，寻找螺钉最佳放置角度。
方法：采用三维重建法建立颈椎力学模型，模拟颈椎侧弯、直立和前屈等3种不同的工况。在SolidWorks 2017软件中，建立颈椎前路钢板和螺钉模型，根据螺钉的不同放置角度建模，a为内侧偏移，b为理想位置，c为外侧偏移，d为向下偏移，e为向上偏移。观察不同螺钉放置角度下内固定的应力分布，并记录其应力和位移。

结果与结论：①构建全颈椎及前路钢板置入后的有限元模型，在相同工况下，钢板上螺钉的不同置入角度对脊柱生物力学改变无明显差别；②但微观数值显示，在侧弯工况下，向外偏移(c)螺钉位置的抗侧弯性能最好；在直立工况下，向下偏移(d)螺钉承载效果最好；在反屈工况下，向外偏移(c)螺钉抗屈效果最好；③在不同的运动工况下，内固定装置的固定效果是相对稳定的；当螺钉向内侧、外侧、向下或向上放置时，3种工况下的内固定效果相差10%，但位移变化较小；这说明在临床实际操作中同时满足承重、抗弯、抗屈的最佳螺钉位置是不存在的；④提示颈椎前路间盘切除融合术中钢板螺钉的置入方向对颈椎的力学稳定性影响不大；在颈椎侧屈、直立、前屈运动时，不同方向的螺钉角度对颈椎内固定装置的稳定性影响不大；因此在临床手术中无需刻意追求螺钉的置入方向。

https://orcid.org/0000-0002-8659-2427 (季兴华)

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: 颈椎前路, 椎体融合, 生物力学, 有限元法, 内固定, 螺钉放置

Abstract: BACKGROUND: The angle of screw placement in anterior cervical discectomy and fusion plays a crucial role in determining the stability of the internal fixation system. 
OBJECTIVE: To predict the impact of different screw placement angles on the stress experienced by the internal fixation system in anterior cervical discectomy and fusion utilizing finite element analysis, with the ultimate goal of identifying the optimal screw placement angle. 
METHODS: A three-dimensional reconstruction method was employed to establish a mechanical model of the cervical spine, enabling the simulation of three distinct working conditions: scoliosis, uprightness, and forward flexion. In SolidWorks 2017, the anterior cervical plate and screw models were built according to different placement angles of the screws, with a as the inward offset, b as the ideal position, c as the outward offset, d as the downward offset, and e as the upward offset. The stress distribution of internal fixation system at different screw placement angles was observed, and the stress and displacement were recorded.
RESULTS AND CONCLUSION: (1) By constructing a finite element model of the entire cervical spine and incorporating an anterior titanium plate, it was found that the biomechanical changes in the spine did not significantly differ based on the various angles of screw insertion on the titanium plate under the same working conditions. (2) However, microscopic analysis revealed that the outward offset (c) screw position exhibited the most effective resistance against side bending, while the downward offset (d) screw demonstrated optimal load-bearing capacity in the upright condition. Additionally, the outward deviation (c) screw displayed superior anti-bending effects in the reverse buckling condition. (3) The fixation effect of the internal fixation device remained relatively stable across different motion conditions. Although there was a 10% variation in the internal fixation effect under the three working conditions when the screw was placed inward, outward, downward, or upward, the displacement changes were minimal. These findings suggest that the requirements of load bearing, bending resistance, and flexion resistance could be simultaneously met without a specific optimal screw location in clinical practice. (4) The placement direction of titanium plate screw in anterior cervical disc-resection and fusion has little effect on the mechanical stability of the cervical spine. The screw angles in different directions have little influence on the stability of the internal fixation device in the lateral, upright, and forward flexion movements of the cervical spine. There is no need to pursue the direction of screw placement in clinical operations.

Key words: anterior cervical approach, vertebral body fusion, biomechanics, finite element method, internal fixation, screw placement

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