中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
6期
686-691
,共6页
李全%孙伟%刘俊健%蔡郑东
李全%孫偉%劉俊健%蔡鄭東
리전%손위%류준건%채정동
骶骨%骨肿瘤%有限元分析%内固定器
骶骨%骨腫瘤%有限元分析%內固定器
저골%골종류%유한원분석%내고정기
Sacrum%Bone neoplasms%Finite element analysis%Internal fixators
目的 分析骶骨切除术后四棒内固定方式重建腰骶部的生物力学特点.方法 利用CT图像建立骶骨次全切除和全骶骨切除有限元模型.在次全切除模型上比较四棒内固定方式与改良Galveston技术重建时L3椎体在垂直压缩、前屈、后伸、左侧弯和右旋工况下的活动范围及内固定器械最大应力值.在全切除模型上比较两种重建方式在垂直压缩工况下L3椎体的活动范围和内固定器械最大应力值.结果 (1)在次全切除模型上,四棒内固定后L3椎体在各种工况下的活动范围分别为4.2mm、0.49°、0.49°、0.24°和0.26°,改良Galveston技术重建后分别为5.5 mm、0.74°、0.74°、0.27°和0.30°.四棒内固定后各种工况下器械最大应力值分别为810.7、148.0、148.0、134.6、14.4 Mpa,改良Galveston技术重建后分别为655.0、109.9、109.9、119.1、11.4 MPa.(2)在全切除模型上,四棒内固定后垂直压力下L3椎体位移和器械最大应力值分别为10.9 mm和2172 MPa,改良Galveston技术重建后分别为49.1 mm和4325 MPa.结论 与改良Galveston技术相比,四棒内固定方式重建腰骶部具有较强的刚度.在全骶骨切除且不行腰骶部植骨时,四棒内固定方式具有较小的最大应力值,可降低内固定器械早期失败的风险.但在骶骨次全切除或行腰骶部植骨时,其应力遮挡效应明显增加.
目的 分析骶骨切除術後四棒內固定方式重建腰骶部的生物力學特點.方法 利用CT圖像建立骶骨次全切除和全骶骨切除有限元模型.在次全切除模型上比較四棒內固定方式與改良Galveston技術重建時L3椎體在垂直壓縮、前屈、後伸、左側彎和右鏇工況下的活動範圍及內固定器械最大應力值.在全切除模型上比較兩種重建方式在垂直壓縮工況下L3椎體的活動範圍和內固定器械最大應力值.結果 (1)在次全切除模型上,四棒內固定後L3椎體在各種工況下的活動範圍分彆為4.2mm、0.49°、0.49°、0.24°和0.26°,改良Galveston技術重建後分彆為5.5 mm、0.74°、0.74°、0.27°和0.30°.四棒內固定後各種工況下器械最大應力值分彆為810.7、148.0、148.0、134.6、14.4 Mpa,改良Galveston技術重建後分彆為655.0、109.9、109.9、119.1、11.4 MPa.(2)在全切除模型上,四棒內固定後垂直壓力下L3椎體位移和器械最大應力值分彆為10.9 mm和2172 MPa,改良Galveston技術重建後分彆為49.1 mm和4325 MPa.結論 與改良Galveston技術相比,四棒內固定方式重建腰骶部具有較彊的剛度.在全骶骨切除且不行腰骶部植骨時,四棒內固定方式具有較小的最大應力值,可降低內固定器械早期失敗的風險.但在骶骨次全切除或行腰骶部植骨時,其應力遮擋效應明顯增加.
목적 분석저골절제술후사봉내고정방식중건요저부적생물역학특점.방법 이용CT도상건립저골차전절제화전저골절제유한원모형.재차전절제모형상비교사봉내고정방식여개량Galveston기술중건시L3추체재수직압축、전굴、후신、좌측만화우선공황하적활동범위급내고정기계최대응력치.재전절제모형상비교량충중건방식재수직압축공황하L3추체적활동범위화내고정기계최대응력치.결과 (1)재차전절제모형상,사봉내고정후L3추체재각충공황하적활동범위분별위4.2mm、0.49°、0.49°、0.24°화0.26°,개량Galveston기술중건후분별위5.5 mm、0.74°、0.74°、0.27°화0.30°.사봉내고정후각충공황하기계최대응력치분별위810.7、148.0、148.0、134.6、14.4 Mpa,개량Galveston기술중건후분별위655.0、109.9、109.9、119.1、11.4 MPa.(2)재전절제모형상,사봉내고정후수직압력하L3추체위이화기계최대응력치분별위10.9 mm화2172 MPa,개량Galveston기술중건후분별위49.1 mm화4325 MPa.결론 여개량Galveston기술상비,사봉내고정방식중건요저부구유교강적강도.재전저골절제차불행요저부식골시,사봉내고정방식구유교소적최대응력치,가강저내고정기계조기실패적풍험.단재저골차전절제혹행요저부식골시,기응력차당효응명현증가.
Objective To analysis the biomechanical properties of four-rod fixation system for lumbosacral reconstruction after sacrectomy.Methods Two finite element models of lumbosacral area were established according to pelvic CT images:a subtotal saerectomy model and a total sacrectomy model.The range of motion of L3 vertebral body and max yon Mise stress of instruments of a novel four-rod fixation system were evaluated and compared with those of modified Galveston technique(MGT)under conditions of veaebral body and max von Mise stress of instruments of the four-rod fixation system were evaluated and compared with those of MGT under vertical compression.Results In subtotal sacreetomy model,the range of motion of L3 vertebral body in the four-rod fixation system were 4.2 mm,0.49°,0.49°,0.24°and 0.26°compared to 5.5 mm.0.74°,0.74°,0.27°and 0.30°in the MGT.The max von Mise stress of instruments in the four-rod fixation system were 810.7,148.0,148.0,134.6 and 14.4 MPa,compared to 655.0,109.9,109.9,119.1 and 11.4 MPa in the MGT.In total sacrectomy model under veaical compression,the range of motion of L3 vertebral body and max van Mise stress of instruments in the four-rod fixation system were 10.9mm and 2172 MPa compared to 49.1 mm and 4325 MPa in the MGT.Conclnsion Comparing with the MGT.the four-rod fixation system was stiffer and showed a significant increase in the stability of lumbosacral area.When total sacrectomy without bone graft were performed,the max stress of the four-rod fixation system was much lower than that of the MGT,which means smaller risk of instrument failure.When subtotal sacrectomy or bone graft were performed,despite better stability,the higher stress shielding-effect of the four-rod fixation svstem might be unfavorable for bone fusion,which still need to be evaluated by clinical trials.
