CAJ | 학술논문

目的：通过建立正常、L4~5和L4~S1的腰椎后路减压椎间融合内固定模型，分析模型在不同载荷下的应力变化情况。方法：采用有限元分析软件对1名志愿者的98张图像节点、划分单元建立正常腰椎运动节段(L1~S1)有限元模型及L4~5、L4~S1节段腰椎后路减压椎间融合内固定模型，分别对三种模型加载五个方向的负荷，计算邻近节段椎间盘的应力变化，并对结果进行统计分析。结果：双节段较单节段融合的上位邻近节段椎间盘平均有效应力，在前屈、后伸、侧屈、旋转加载时比较差异有统计学意义(P<0.05)，垂直压缩加载时差异无统计学意义(P>0.05)。不管是单节段L4~5还是双节段L4~S1固定后，邻近L3~4椎间盘有效应力在前屈、后伸、垂直压缩、侧屈、旋转时均大于未融合固定，差异有统计学意义(P<0.05)，各加载方式两两比较，加载平均应力由大到小依次为旋转、侧屈、后伸、前屈和垂直压缩，且两两之间比较差异有统计学意义(P<0.05)。结论：腰椎后路椎间融合术后，节段融合固定的应力要明显大于非融合固定临近椎间盘的应力，而且更容易加快邻近椎间盘的退变，双节段腰椎融合内固定比单节段在大部分活动状态下更易加快邻近椎间盘退变，尤其是旋转活动。
목적：통과건립정상、L4~5화L4~S1적요추후로감압추간융합내고정모형，분석모형재불동재하하적응력변화정황。방법：채용유한원분석연건대1명지원자적98장도상절점、화분단원건립정상요추운동절단(L1~S1)유한원모형급L4~5、L4~S1절단요추후로감압추간융합내고정모형，분별대삼충모형가재오개방향적부하，계산린근절단추간반적응력변화，병대결과진행통계분석。결과：쌍절단교단절단융합적상위린근절단추간반평균유효응력，재전굴、후신、측굴、선전가재시비교차이유통계학의의(P<0.05)，수직압축가재시차이무통계학의의(P>0.05)。불관시단절단L4~5환시쌍절단L4~S1고정후，린근L3~4추간반유효응력재전굴、후신、수직압축、측굴、선전시균대우미융합고정，차이유통계학의의(P<0.05)，각가재방식량량비교，가재평균응력유대도소의차위선전、측굴、후신、전굴화수직압축，차량량지간비교차이유통계학의의(P<0.05)。결론：요추후로추간융합술후，절단융합고정적응력요명현대우비융합고정림근추간반적응력，이차경용역가쾌린근추간반적퇴변，쌍절단요추융합내고정비단절단재대부분활동상태하경역가쾌린근추간반퇴변，우기시선전활동。
Objective:To analysis model under different loads and stress changes by posterior lumbar discectomy through the establishment of normal, L4-5 and L4-S1 fusion and internal fixation model.Method: Analyzed 98 image nodes from 1 volunteers what were divided unit to establish the normal lumbar motion segment (L1-S1) finite element model and L4-5, L4-S1 segment of posterior lumbar interbody fusion and internal fixation model, the three models with five direction load, calculation of adjacent segment disc shall be stress variation, and the results were statistically analyzed.Result: The research showed that the upper two segments adjacent segment than the single disc fusion segment average effective stress in flexion, extension , lateral flexion , rotation load difference was statistically significant(P<0.05), vertical compression load no statistically significant difference(P>0.05), whether it was single or double segment L4-5 segment L4-S1 was fixed , the neighboring L3~4 disc effective stress in flexion, extension , vertical compression , lateral flexion, rotation were greater than unfused fixed, the difference was statistically significant(P<0.05), for each pairwise comparison loading , load average stress decreasing order of rotation, lateral flexion , extension, flexion and vertical compression, and the difference between any two distinct , with statistical significance(P<0.05).Conclusion: After posterior lumbar interbody fusion, segmental fixation stress is much higher than that of non stress fusion adjacent intervertebral disc, and easier to speed up the adjacent intervertebral disc degeneration, 2-level lumbar fusion and internal fixation is better than that of single segment in the most active state to accelerate the adjacent intervertebral disc degeneration, especially the rotary activities.