CAJ | 학술논문

背景：目前脊柱胸腰段内固定方法均有优缺点，希望探索一种新的内固定方案，使脊柱有效固定的同时，可更安全、方便的进行其他操作。 　　目的：建立脊柱胸腰段(T12-L2)三维有限元模型，观察钉棒系统后外侧前后一体内固定对胸腰段稳定性的影响。方法：基于人正常T12-L2节段的 CT 扫描数据，利用 Geomagic 11.0、Ug 7.0、Hypermesh 10.0、Abaqus 6.9.1软件建立T12-L2节段三维有限元模型，并在此基础上分别建立钉棒系统后路固定、前路固定、后外侧前后一体内固定模型，在T12上表面施加500 N预载荷，再施加7.5 N?m的力矩，模拟胸腰段前屈、后伸、左右侧屈及左右旋转等生理活动，观察不同工况下内固定节段的平均刚度。 　　结果与结论：3种内固定模型在不同工况下的平均刚度均较正常模型的平均刚度高。在前屈、左右侧屈、左右扭转等不同工况下，后外侧钉棒系统前后一体固定的平均刚度均高于单纯后路固定，平均刚度分别较后路固定高13%，28%，11%，17%和9%，后伸时平均刚度低于后路固定，比后路固定低6%。但与前路相比，后外侧钉棒系统前后一体内固定在前屈、左右侧弯3种工况下的平均刚度低于前路固定，平均刚度分别比固定低15%，10%和14%，而在后伸、左右扭转情况下平均刚度高于前路固定，分别比前路固定高5%，12%和2%。提示后外侧钉棒系统前后一体内固定能够明显提高固定节段的稳定性，在抗后伸及左右扭转方面的稳定性略好于前路固定，而在抗前屈、左右侧弯、左右扭转方面略好于后路固定，因此可作为一种可选的内固定方法。
배경：목전척주흉요단내고정방법균유우결점，희망탐색일충신적내고정방안，사척주유효고정적동시，가경안전、방편적진행기타조작。 　　목적：건립척주흉요단(T12-L2)삼유유한원모형，관찰정봉계통후외측전후일체내고정대흉요단은정성적영향。방법：기우인정상T12-L2절단적 CT 소묘수거，이용 Geomagic 11.0、Ug 7.0、Hypermesh 10.0、Abaqus 6.9.1연건건립T12-L2절단삼유유한원모형，병재차기출상분별건립정봉계통후로고정、전로고정、후외측전후일체내고정모형，재T12상표면시가500 N예재하，재시가7.5 N?m적력구，모의흉요단전굴、후신、좌우측굴급좌우선전등생리활동，관찰불동공황하내고정절단적평균강도。 　　결과여결론：3충내고정모형재불동공황하적평균강도균교정상모형적평균강도고。재전굴、좌우측굴、좌우뉴전등불동공황하，후외측정봉계통전후일체고정적평균강도균고우단순후로고정，평균강도분별교후로고정고13%，28%，11%，17%화9%，후신시평균강도저우후로고정，비후로고정저6%。단여전로상비，후외측정봉계통전후일체내고정재전굴、좌우측만3충공황하적평균강도저우전로고정，평균강도분별비고정저15%，10%화14%，이재후신、좌우뉴전정황하평균강도고우전로고정，분별비전로고정고5%，12%화2%。제시후외측정봉계통전후일체내고정능구명현제고고정절단적은정성，재항후신급좌우뉴전방면적은정성략호우전로고정，이재항전굴、좌우측만、좌우뉴전방면략호우후로고정，인차가작위일충가선적내고정방법。
BACKGROUND:Currently thoracolumbar fixation techniques have its advantages and disadvantages, it is necessary to explore a new internal fixation to fix the spine effectively and conveniently. OBJECTIVE:To establish thoracolumbar (T12-L2) three-dimensional finite element model and observe the effect of anteroposterior integration fixation by posterolateral nail-stick system on thoracolumbar stability. METHODBased on the CT scan data of normal human T12-L2 segments, we used Geomagic 11.0, Ug 7.0, Hypermesh 10.0, Abaqus 6.9.1 software to establish a three-dimensional finite element model of T12-L2 segments. Subsequently we established nail-stick system posterior fixation, anterior fixation, posterolateral anteroposterior integration fixation model. T12 segment was given 500 N preload and 7.5 N·m torque, to simulate thoracolumbar flexion, extension, lateral bending and rotation. The average rigidity of fixed segments under different conditions were observed. RESULTS AND CONCLUSION:Three fixation models showed a higher average rigidity than normal model under different conditions. The average rigidity in anteroposterior integration fixation by posterolateral nail-stick system was increased by 13%, 28%, 11%, 17%and 9%, compared with simple posterior fixation under the conditions such as anterior flexion, lateral bending and lateral rotation, respectively. Under the posterior extension, the average rigidity was reduced by 6%than the posterior fixation. Compared with the anterior fixation, the average rigidity in anteroposterior integration fixation by posterolateral nail-stick system was reduced by 15%, 10%, and 14%under the conditions of anterior flexion and lateral bending. While the average rigidity was higher than anterior flexion under the posterior extension and lateral rotation, increasing 5%, 12%and 2%. The anteroposterior integration fixation by posterolateral nail-stick system can improve the stability of fixed segments, and the stability is higher than anterior fixation at posterior extension and lateral rotation, while higher than posterior fixation in anterior flexion, lateral bending and lateral rotation. So it is a potential fixation method.