CAJ | 학술논문

目的通过有限元法比较前、后路不同手术方式治疗载荷分享评分≥6分的严重胸腰椎爆裂性骨折的优缺点,以期为临床治疗提供参考.方法选取1名30岁男性健康志愿者的胸腰段脊柱CT扫描图像和有限元软件建立T12至L2脊柱三维有限元模型.验证有效后,模拟L1爆裂性骨折,建立前路内固定治疗模型、后路椎弓根螺钉内固定加间接减压治疗模型及后路椎弓根螺钉内固定加直接减压治疗模型.比较术后即刻及术后2个月时每种模型在不同工况下内固定最大位移及最大承载应力分布. 结果最大位移:术后即刻及术后2个月时,前路手术模型最小,其次为后路间接减压模型及后路直接减压模型;最大承载应力分布:术后即刻,前路手术模型最小,其次为后路直接减压模型及后路间接减压模型,术后2个月时,3种模型最大承载应力分布相当. 结论术后即刻前路手术在3种手术方案中稳定性最好,最不容易发生内固定治疗失败,但会丢失部分脊柱活动度.术后2个月时后路两种手术模型稳定性已达到正常生理状态,3种手术模型内固定应力分布相当,后路手术亦为治疗严重胸腰椎爆裂性骨折的有效方法之一.
목적 통과유한원법비교전、후로불동수술방식치료재하분향평분≥6분적엄중흉요추폭렬성골절적우결점,이기위림상치료제공삼고.방법 선취1명30세남성건강지원자적흉요단척주CT소묘도상화유한원연건건립T12지L2척주삼유유한원모형.험증유효후,모의L1폭렬성골절,건립전로내고정치료모형、후로추궁근라정내고정가간접감압치료모형급후로추궁근라정내고정가직접감압치료모형.비교술후즉각급술후2개월시매충모형재불동공황하내고정최대위이급최대승재응력분포. 결과 최대위이:술후즉각급술후2개월시,전로수술모형최소,기차위후로간접감압모형급후로직접감압모형;최대승재응력분포:술후즉각,전로수술모형최소,기차위후로직접감압모형급후로간접감압모형,술후2개월시,3충모형최대승재응력분포상당. 결론 술후즉각전로수술재3충수술방안중은정성최호,최불용역발생내고정치료실패,단회주실부분척주활동도.술후2개월시후로량충수술모형은정성이체도정상생리상태,3충수술모형내고정응력분포상당,후로수술역위치료엄중흉요추폭렬성골절적유효방법지일.
Objective To characterize anterior internal fixation,posterior pedicle screwing + indirect decompression,and posterior pedicle screwing + direct decompression in treatment of severe thoracolumbar burst fractures (load-sharing classification ≥ 6 points) through finite element analysis.Methods Helical CT scan images of the thoracolumbar spine from a 30 year-old male volunteer were obtained for establishment of three dimensional finite element models of T12-L2 spine.Mter authentication,severe burst fracture of L1 and corresponding 3 treatments (anterior internal fixation,posterior pedicle screwing + indirect decompression,and posterior pedicle screwing + direct decompression) were simulated in the finite element models.The maximum displacements of and stress distributions on the internal fixation were compared under axial load 500 N and 15 N · m torque between the 3 different working conditions at immediate and 2 months postoperation respectively.Results At immediate and 2 months postoperation,the anterior approach model exhibited the least maximum displacement,followed by the posterior indirect decompression model and the posterior direct decompression model.At immediate postoperation,the anterior approach model presented the least stress distribution,followed by the posterior direct decompression model and the posterior indirect decompression model.At 2 months postoperation,the stress distribution was similar between the 3 models.Conclusions At immediate postoperation,the anterior approach yields the best stability and the least probability of internal fixation failure,but may cost partial loss of the mobility of the treated segment.At 2 months postoperation when the stability of the 2 posterior treatments has reached a normal physiological status,the stress distribution shows no significant difference between the 3 treatments,indicating the posterior pedicle screwing is also an efficient treatment of severe thoracolumbar burst fractures.