中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (11): 1723-1729.doi: 10.3969/j.issn.2095-4344.2017.11.015

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

颈椎保留椎体后壁椎体次全切除减压结合钛笼植骨AO钢板内固定的有限元分析

康正阳，王 可，刘百峰   

  1. 哈尔滨医科大学附属第五医院骨科，黑龙江省大庆市   163000
  • 修回日期:2017-01-06 出版日期:2017-04-18 发布日期:2017-05-06
  • 通讯作者: 刘百峰，主任医师，副教授，硕士生导师，哈尔滨医科大学附属第五医院骨科，黑龙江省大庆市 163000
  • 作者简介:康正阳，男，1990年生，汉族，哈尔滨医科大学在读硕士，主要从事脊柱外科方面的研究。
  • 基金资助:

    黑龙江省自然科学基金资助项目(2014/07-17/07)

Cervical vertebra corpectomy decompression with preserving the posterior wall of the corpectomied vertebral body combined with titanium-meshes and AO plate fixation: a finite element analysis

Kang Zheng-yang, Wang Ke, Liu Bai-feng   

  1. Department of Orthopedics, Fifth Affiliated Hospital of Harbin Medical University, Daqing 163000, Heilongjiang Province, China
  • Revised:2017-01-06 Online:2017-04-18 Published:2017-05-06
  • Contact: Liu Bai-feng, Chief physician, Associate professor, Master’s supervisor, Department of Orthopedics, Fifth Affiliated Hospital of Harbin Medical University, Daqing 163000, Heilongjiang Province, China
  • About author:Kang Zheng-yang, Studying for master’s degree, Department of Orthopedics, Fifth Affiliated Hospital of Harbin Medical University, Daqing 163000, Heilongjiang Province, China
  • Supported by:

    the Natural Science Foundation of Heilongjiang Province, No. 2014/07-17/07

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摘要：

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文题释义：
颈椎椎体次全切除减压传统术式：又称颈椎椎体次全切除减压标准术式。经颈前路达椎体前方后，切开需减压椎间隙纤维环，切除与病椎相邻的椎间盘内髓核组织至椎体后缘，刮除上下椎体终板软骨至皮质骨，再将需切除的一或两个椎体沿双侧颈长肌内缘大部咬除至椎体后缘；然后将后缘及残存的椎间盘、骨赘一并切除以彻底减压。
保留椎体后壁的颈椎椎体次全切除减压术：在彻底减压的基础上尽量提高颈椎自身的稳定性，该术式在保留传统椎体次全切除减压术的优点基础上，部分保留椎体后壁，增加了颈椎的稳定性，同时也增加了植骨面，有利于植骨融合；由于椎体后壁的保留，消除了植骨块或钛笼被击入过深伤及脊髓等并发症。
 
摘要
背景：颈椎椎体次全切除减压标准术式是临床常用颈椎前路减压方法之一。近年来在颈椎前路手术治疗原则的指导下有学者提出了颈椎前路保留椎体后壁次全切除减压术，其保留了椎体后壁，不仅增加了颈椎的稳定性，还增加了植骨面积，有利于远期融合；同时椎体后壁的保留，可有效防止骨块及植入物误伤脊髓。
目的：通过羊颈椎CT数据建立有限元模型，评估行颈椎前路保留椎体后壁椎体次全切除减压加钛笼植骨AO钢板内固定的力学稳定性。
方法：选取实验用成年羊颈椎标本进行CT平扫，运用有限元软件将CT数据构建有限元模型(未行手术组)。保留椎体后壁组行C4保留后壁椎体次全切除及钛笼植骨、AO钢板内固定术；不保留椎体后壁组进行传统术式，即不保留后壁的椎体次全切除及钛笼植骨加AO钢板内固定术。通过有限元软件测试分析颈椎标本各状态下的应力、位移变化。
结果与结论：①虽然保留后壁组颈椎模型较未行手术组以及不保留后壁组位移略小，术后即刻稳定性较好；但保留后壁组与不保留后壁组位移及应力相比差异并无显著性意义；②综上，与传统椎体次全切除减压术相比，保留椎体后壁椎体次全切除减压加钛笼植骨AO钢板内固定具有较好的术后即刻稳定性。

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
ORCID: 0000-0001-6789-5708(刘百峰)

关键词: 骨科植入物, 脊柱植入物, 颈椎手术, 保留椎体后壁, 稳定性, 有限元分析, 黑龙江省自然科学基金

Abstract:

BACKGROUND: Cervical vertebra corpectomy decompression is one of the commonly used methods of anterior cervical decompression. In recent years, under the guidance of the principle of anterior cervical surgery, scholars propose the anterior cervical vertebra corpectomy decompression with preserving the posterior wall of the corpectomied vertebral body. It retains the posterior wall of the vertebral body, not only increases the stability of the cervical spine, but also increases the area of bone graft, which is conducive to the long-term fusion. At the same time, retaining posterior wall of the vertebral body can effectively prevent bone- and implant-induced spinal cord injury.

OBJECTIVE: To evaluate the biomechanical stability of anterior cervical vertebra corpectomy decompression with preserving the posterior wall of the corpectomied vertebral body procedure on sheep by the establishment of finite element model with CT data.
METHODS: Cervical vertebra specimens of adult sheep were selected, and scanned to capture its CT data. The geometrical model captured by CT was then transformed into finite element model through finite element software (without surgery). In the posterior wall preserving group, C4 corpectomy decompression was conducted while preserving its posterior wall followed by titanium-meshes and AO plate fixation. On the basis of posterior wall preserving group, corpectomy decompression was operated without preserving the posterior wall in another group; titanium mesh and plate were fixed. Finite element software was used to test and analyze the changes in stress and displacement of cervical vertebra under different conditions.
RESULTS AND CONCLUSION: (1) The displacement was slightly small, and immediate postoperative stability was good in the posterior wall preserving group. However, the displacement and stress were not significantly different between posterior wall preserving group and posterior wall non-preserving group. (2) To sum up, a procedure preserving posterior wall of the vertebra body gains better immediate postoperative stability compared with conventional method.

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

Key words: Cervical Vertebrae, Finite Element Analysis, Internal Fixators, Tissue Engineering

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