CAJ | 학술논문

背景:目前国内外尚未成功建立双足直立的灵长类的特发性脊柱侧凸实验动物模型.随着计算机和影像学的飞速发展,现在可以做到通过计算机软件来虚拟人类特发性脊柱侧凸模型,并进行相关的生物力学分析,为临床手术操作提供指导.目的:利用有限元模型验证PUMC Ⅱd_2型特发性脊柱侧凸脊柱融合治疗的最佳融合节段.设计、时间及地点:对比观察,于2007-05/2008-05在北京协和医院骨科完成.对象:PUMCⅡd_2脊柱侧凸女性患者1例,为双弯畸形.方法:利用PUMC Ⅱd_2型特发性脊柱侧凸有限元模型(T_5-S),分别模拟上胸弯融合、下腰弯融合和双弯融合方式,在侧弯凹侧端椎椎弓根内分别赋予50,100,150 N载荷,比较上弯端椎T_5和下弯端椎T_(11)在矢状面向上的位移(Z轴正值为矢状面向上的位移,负值为矢状面向下的位移)以及二者之间的差值,以T5位移代表双弯矫形效果,以T_(11)位移代表下腰弯矫形效果,二者差值(T_5～T_(11))代表上胸弯矫形效果.主要观察指标:不同融合节段、不同矫形力下的T_5和T_(11)位移.结果:对于PUMCⅡd_2型侧弯,T_5在Z轴的位移:双弯矫型较单纯上弯或者下弯矫形融合位移大(P<0.01).T_5～T_(11)位移差:双弯矫形>单纯上胸弯矫形>单纯下腰弯矫形(P<0.01).T_(11)在Z轴的位移:双弯矫形>单纯下腰弯矫形>单纯上胸弯矫形(P<0.01).结论:对于PUMCⅡd_2型侧弯,双弯矫型内固定较单纯上弯或者下弯矫形融合内固定效果好;3种载荷对于上胸弯的矫正效果:双弯矫形>单纯上胸弯矫形>单纯下腰弯矫形;3种载荷对于下腰弯的矫正效果:双弯矫形>单纯下腰弯矫形>单纯上胸弯矫形.三维有限元分析法可以作为一种有效的方法应用于脊柱侧弯畸形矫正的生物力学分析,为临床开创了一种虚拟、无创的验证方式,可以优化手术方案.
배경:목전국내외상미성공건립쌍족직립적령장류적특발성척주측철실험동물모형.수착계산궤화영상학적비속발전,현재가이주도통과계산궤연건래허의인류특발성척주측철모형,병진행상관적생물역학분석,위림상수술조작제공지도.목적:이용유한원모형험증PUMC Ⅱd_2형특발성척주측철척주융합치료적최가융합절단.설계、시간급지점:대비관찰,우2007-05/2008-05재북경협화의원골과완성.대상:PUMCⅡd_2척주측철녀성환자1례,위쌍만기형.방법:이용PUMC Ⅱd_2형특발성척주측철유한원모형(T_5-S),분별모의상흉만융합、하요만융합화쌍만융합방식,재측만요측단추추궁근내분별부여50,100,150 N재하,비교상만단추T_5화하만단추T_(11)재시상면향상적위이(Z축정치위시상면향상적위이,부치위시상면향하적위이)이급이자지간적차치,이T5위이대표쌍만교형효과,이T_(11)위이대표하요만교형효과,이자차치(T_5～T_(11))대표상흉만교형효과.주요관찰지표:불동융합절단、불동교형력하적T_5화T_(11)위이.결과:대우PUMCⅡd_2형측만,T_5재Z축적위이:쌍만교형교단순상만혹자하만교형융합위이대(P<0.01).T_5～T_(11)위이차:쌍만교형>단순상흉만교형>단순하요만교형(P<0.01).T_(11)재Z축적위이:쌍만교형>단순하요만교형>단순상흉만교형(P<0.01).결론:대우PUMCⅡd_2형측만,쌍만교형내고정교단순상만혹자하만교형융합내고정효과호;3충재하대우상흉만적교정효과:쌍만교형>단순상흉만교형>단순하요만교형;3충재하대우하요만적교정효과:쌍만교형>단순하요만교형>단순상흉만교형.삼유유한원분석법가이작위일충유효적방법응용우척주측만기형교정적생물역학분석,위림상개창료일충허의、무창적험증방식,가이우화수술방안.
BACKGROUND:At present,experimental animal models of primate idiopathic scoliosis with erect feet have not been established.With rapid development of computer and imaging,we can use computer software to simulate models of human idiopathic scoliosis,and do relevant biomechanical analysis and provide instructions for clinical surgery operation.OBJECTIVE:To research the best surgical fusion level for the adolescent idiopathic scoliosis (AIS) of PUMC Ⅱ d_2 with the finite element model (FEM).DESIGN,TIME AND SETTING:The compadson observation was performed at the Department of Orthopedics,Beijing Union Hospital from May 2007 to May 2008.PARTICIPANTS:One female patient with PUMC Ⅱ d_2 scoliosis (double curve malformation) was included.METHODS:FEM (T5-S) of PUMC Ⅱ d_2 idiopathic scoliosis was used to simulate upper thoracic curve,lower lumbar curve and double curve fusion manners.Hollow lateral curvature pedicle of vertebral arch received 50,100,150 N load.Displacement of T_5 and T_(11) on upper sagittal plane (displacement of Z axis positive value on upper sagittal plane,displacement of negative value on lower sagittal plane) and their difference value were compared.T_5 displacement represented outcomes of double curve orthopaedics.T_(11) displacement represented outcomes of lower lumbar curve orthopaedics.Their difference value (T5-T11) represented outcomes of upper thoracic curve orthopaedics.MAIN OUTCOME MEASURES:Different fusion segments and displacement of T_5 and T_(11) under different orthopedic forces were measured.RESULTS:In PUMC Ⅱ d_2 lateral curvature,T_5 displacement on Z axis:fusion displacement of double curves was greater compared with upper curve alone or lower curve alone (P < 0.01 ).Difference of T_5-T_(11) displacement:double curves orthopaedics > upper thoracic curve orthopaedics alone > lower lumbar curve orthopaedics alone (P < 0.01).Displacement of T_(11) on Z axis:double curves orthopaedics > lower lumbar curve orthopaedics alone > upper thoracic curve orthopaedics alone (P < 0.01).CONCLUSION:Fusing two curves would get the best effect on the AIS of PUMC Ⅱ d_2 compared with upper curve alone or lower curve fusion alone.Effects of 3 kinds of load on correction of upper thoracic curve:double curve orthopaedics < upper thoracic curve orthopaedics alone > lower lumbar curve orthopaedics alone.Effect of 3 kinds of load on correction of lower lumbar curve orthopaedics alone:double curve orthopaedics > lower lumbar curve orthopaedics alone > upper thoracic curve orthopaedics alone.Three-dimensional finite element analysis is an effective method to analyze biomechanics of scoliosis deformity correction and provides a virtual non-invasive verification manner,and can optimize surgery scheme.