CAJ | 학술논문

目的：通过有限元分析方法将经椎弓根皮质骨通道(cortical bone trajectory, CBT)置钉技术应用于胸腰段爆裂性骨折，进行生物力学模拟分析，验证CBT技术应用的可行性。方法：模拟1例成年男性：(A)脊柱完整状态；(B)爆裂性骨折；(C)骨折化之后的4种固定组合：(1)4椎弓根钉2棒(P4组)；(2)4 CBT 2棒(C4组)；(3)6椎弓根钉2棒(P6组)；(4)6 CBT 2棒(C6组)。比较上述组别椎体模型节点的总变形及相应内固定模型节点的等效应力。结果：4组内固定均能使骨折模型获得明显即刻稳定性。P4组各状态时总变形及内固定承受的等效应力普遍较其他模型增大；P6组模型各状态下的模型总位移及内固定所受等效应力较其他模型有明显优势；C6组较C4组各状态下的模型总变形及内固定承受的等效应力均有减少。结论：C4法和C6法固定与P6法相比仍有一定的差距，但两者均能够提供近似甚至高于传统P4法的固定稳定性，并能显著减少应力集中。故CBT置钉法能在理论上成为提供胸腰段爆裂性骨折稳定性的备选方案。
목적：통과유한원분석방법장경추궁근피질골통도(cortical bone trajectory, CBT)치정기술응용우흉요단폭렬성골절，진행생물역학모의분석，험증CBT기술응용적가행성。방법：모의1례성년남성：(A)척주완정상태；(B)폭렬성골절；(C)골절화지후적4충고정조합：(1)4추궁근정2봉(P4조)；(2)4 CBT 2봉(C4조)；(3)6추궁근정2봉(P6조)；(4)6 CBT 2봉(C6조)。비교상술조별추체모형절점적총변형급상응내고정모형절점적등효응력。결과：4조내고정균능사골절모형획득명현즉각은정성。P4조각상태시총변형급내고정승수적등효응력보편교기타모형증대；P6조모형각상태하적모형총위이급내고정소수등효응력교기타모형유명현우세；C6조교C4조각상태하적모형총변형급내고정승수적등효응력균유감소。결론：C4법화C6법고정여P6법상비잉유일정적차거，단량자균능구제공근사심지고우전통P4법적고정은정성，병능현저감소응력집중。고CBT치정법능재이론상성위제공흉요단폭렬성골절은정성적비선방안。
Objective:Cortical bone trajectory (CBT) method was applied to thoracic lumbar burst fracture through finite element analysis for verifing the feasibility of CBT application by simulation of biomechanical analysis. Methods: A case of adult male was simulated:(A) integrity state;(B) burst fracture state;(C) fixed state:(1) 4 pedicle screws cross segment and 2 rods(P4);(2) 4 CBT screws (C4);(3) 6 pedicle screws and 2 rods(P6);(4) 6 CBT screws and 2 rods(C6). Compare the total deformation and the equivalent stress of the corresponding internal fixation of nodes of those models. Results: Fractured model could get obvious immediate stability in four groups of internal fixation. Total deformation of fractured model and equivalent stress of internal fixation under each state generally increased in P4 group compared to the other models. Total deformation of fractured model and equivalent stress of internal fixation under each state of P6 group had obvious advantages than those in other groups. Total deformation of fractured model and equivalent stress of internal fixation under each state of C6 group were less than that in the C4 group. Conclusion: Both fixation of 4 CBT method and 6 CBT method had a certain gap between the P6 method, but could provide approximate even higher stability of fractured model than the traditional four pedicle screws method, and significantly reduced stress concentration of fixation. So, CBT nailing method can theoretically be an alternative to provide stability of thoracic lumbar burst fracture.