CAJ | 학술논문

背景:对于不稳定的胸腰段骨折选择合适的内固定方式至关重要.目的:建立胸腰段爆裂骨折以及不同方式内固定有限元模型,进行不同方向加载后比较不同固定方式的生物力学特性.设计、时间及地点:对比观察,于2008/08-10在同济大学力学实验室完成.材料:采用德国西门子公司螺旋CT(64排)扫描一成年健康男性志愿者的T_(11)～L_1节段,间隔0.6 mm.采用布尔操作,去除T_(12)椎体下半部分,保留椎体的后部结构,建立胸腰段爆裂骨折的有限元模型.方法:试验分为5组,模型1为后路4钉2棒固定模型,模型2为后路5钉2棒(单侧伤椎固定)模型,模型3为后路6钉2棒(双伤病椎固定)模型,模型4为前路侧前方双棒固定模型,模型5为前后路联合固定模型.分别对于各模型进行前曲、后伸、左侧曲以及右侧旋转的加载,比较各模型的生物力学特性.主要观察指标:试验模型加载额定载荷后不同运动方向的Von Mises应力以及位移.结果:各种模型的运动状态中,应力从钉尖部至钉棒连接处逐渐增大,近钉棒连接处应力最大;近端螺钉受到的应力大于远端螺钉受到的应力.在试验的每种运动状态中,模型1的螺钉应力高丁模型2,3,高于模型5(P<0.01).模型5的稳定性最好;模型1各个方向位移最大,稳定性最差.结论:建立了不同固定方式的T_(12)椎体爆裂骨折固定模型,验证了在胸腰段骨折内固定治疗中,应用后路短节段固定结合伤椎固定及经椎弓根植骨治疗胸腰段骨折比单纯后路短节段固定具有更良好的生物力学特性.
배경:대우불은정적흉요단골절선택합괄적내고정방식지관중요.목적:건립흉요단폭렬골절이급불동방식내고정유한원모형,진행불동방향가재후비교불동고정방식적생물역학특성.설계、시간급지점:대비관찰,우2008/08-10재동제대학역학실험실완성.재료:채용덕국서문자공사라선CT(64배)소묘일성년건강남성지원자적T_(11)～L_1절단,간격0.6 mm.채용포이조작,거제T_(12)추체하반부분,보류추체적후부결구,건립흉요단폭렬골절적유한원모형.방법:시험분위5조,모형1위후로4정2봉고정모형,모형2위후로5정2봉(단측상추고정)모형,모형3위후로6정2봉(쌍상병추고정)모형,모형4위전로측전방쌍봉고정모형,모형5위전후로연합고정모형.분별대우각모형진행전곡、후신、좌측곡이급우측선전적가재,비교각모형적생물역학특성.주요관찰지표:시험모형가재액정재하후불동운동방향적Von Mises응력이급위이.결과:각충모형적운동상태중,응력종정첨부지정봉련접처축점증대,근정봉련접처응력최대;근단라정수도적응력대우원단라정수도적응력.재시험적매충운동상태중,모형1적라정응력고정모형2,3,고우모형5(P<0.01).모형5적은정성최호;모형1각개방향위이최대,은정성최차.결론:건립료불동고정방식적T_(12)추체폭렬골절고정모형,험증료재흉요단골절내고정치료중,응용후로단절단고정결합상추고정급경추궁근식골치료흉요단골절비단순후로단절단고정구유경량호적생물역학특성.
BACKGROUND:A selection of treatment for thoracolumbar fracture is very important.OBJECTIVE:To develop and validate three-dimensional finite element models of human thoracolumbar fracture using varying fixation methods,and to compare biomechanical characteristics of fixation method.DESIGN TIME AND SETTING:A contrast observation was performed at the Mechanical Experiment Center of Tongji University from August to October 2008.MATERIALS:64-slice spiral CT (Siemens,Germany) was used to scan T_(11)-L_1 segments of an adult male,and the slice thickness was 0.6 mm.based on Boolean operation,the lower half of T_(12) segment was resected,and the structure of posterior part was reserved to establish finite element model of thoracolumbar fracture.METHODS:There were five groups in this study,including 4 pedicle screws+2 rods (group 1),5 pedicle screws+2 rods at one side (group 2),6 pedicle screws+2 rods at both sides (group 3),anterior fixation (group 4),and anterior plus posterior fixation (group 5).Forces of axial compressive,anterior bending,posterior extension,left bending,and right rotation were loaded to compare the biochemical characteristics.MAIN OUTCOM MEASURES:vonMises stress and displacement at different directions.RESULTS:The stresses of all the fixation screws increased from the anterior part to posterior part in all movement tests,and the strongest stress was measured in the joint position.The stress of proximal screw was stronger than that of the distal screw.Additionally,the stress in group 1 was significantly stronger than in groups 2,3,and 5 (P<0.01).The group 5 was the most stable,but the group 1 was the poorest.CONCLUSION:T_(12) bursting fracture models were established using varying fixation methods,and the results verified that short segment plus fracture vertebral segmental fixation has more superior biomechanics.