CAJ | 학술논문

目的比较下颈椎前路椎弓根螺钉内固定系统(ACTPS)和颈椎前路椎体螺钉钛板系统(ACLP)重建两节椎体次全切后的生物力学特性.方法选择一名28岁成年健康男性志愿者,采集颈椎(C1 ～T1)的CT数据,应用Mimics 10.0、Rapidform XOR3、Hypermesh10.0、CATIA5 V19、ANSYS14.0软件建立下颈椎三维非线性的(C3～C7)完整模型.在C3上分别施加75 N的轴向压力和1N·m的纯力偶矩,使模型在屈伸、侧弯、旋转方向上运动.将模型的椎间活动度与文献报道的体外生物力学实验数据相比进行验证.建立ACTPS模型和ACLP模型,利用ANSYS计算两种模型在前屈、后伸、侧弯、旋转等工况下的椎间活动度.记录下ACTPS模型组和ACLP模型组的Von Mises应力云图及最大应力值,将ACTPS固定模型、ACLP固定模型的椎间活动度与完整模型进行比较.结果本次实验建立了健康人的下颈椎(C3～C7)三维非线性有限元模型,模型包括85 832个单元,23 612个节点,其外形逼真,椎间活动度与文献报道的体外生物力学实验结果吻合.ACTPS模型组应力分布的相对比较均匀,ACLP模型组在螺钉与钛板接触部位出现应力集中.两组模型的最大应力值相比差异较明显.ACTPS组固定节段与ACLP组相比,椎间活动度更小,邻近节段椎间活动度相比差异不明显;与完整组比较,ACTPS组和ACLP组整体椎间活动度在屈伸、侧屈、旋转方向上分别减小约25°、20°和8°,相应的邻近C3～4节段的椎间活动度代偿性的变化约0.3°、3°和0.1°.结论 ACTPS的生物力学稳定性优于ACLP,适用于2节段及以上颈椎前路减压后稳定性重建.与ACLP相比,ACTPS的断裂风险更低.
목적 비교하경추전로추궁근라정내고정계통(ACTPS)화경추전로추체라정태판계통(ACLP)중건량절추체차전절후적생물역학특성.방법 선택일명28세성년건강남성지원자,채집경추(C1 ～T1)적CT수거,응용Mimics 10.0、Rapidform XOR3、Hypermesh10.0、CATIA5 V19、ANSYS14.0연건건립하경추삼유비선성적(C3～C7)완정모형.재C3상분별시가75 N적축향압력화1N·m적순력우구,사모형재굴신、측만、선전방향상운동.장모형적추간활동도여문헌보도적체외생물역학실험수거상비진행험증.건립ACTPS모형화ACLP모형,이용ANSYS계산량충모형재전굴、후신、측만、선전등공황하적추간활동도.기록하ACTPS모형조화ACLP모형조적Von Mises응력운도급최대응력치,장ACTPS고정모형、ACLP고정모형적추간활동도여완정모형진행비교.결과 본차실험건립료건강인적하경추(C3～C7)삼유비선성유한원모형,모형포괄85 832개단원,23 612개절점,기외형핍진,추간활동도여문헌보도적체외생물역학실험결과문합.ACTPS모형조응력분포적상대비교균균,ACLP모형조재라정여태판접촉부위출현응력집중.량조모형적최대응력치상비차이교명현.ACTPS조고정절단여ACLP조상비,추간활동도경소,린근절단추간활동도상비차이불명현;여완정조비교,ACTPS조화ACLP조정체추간활동도재굴신、측굴、선전방향상분별감소약25°、20°화8°,상응적린근C3～4절단적추간활동도대상성적변화약0.3°、3°화0.1°.결론 ACTPS적생물역학은정성우우ACLP,괄용우2절단급이상경추전로감압후은정성중건.여ACLP상비,ACTPS적단렬풍험경저.
Objeetive To evaluate the biomechanical effects of the anterior cervical transpedicularscrew system (ACTPS), compared to the anterior cervical screw plate system (ACLP), in the subaxial cervical spine after 2-level corpectomy.Methods A verified intact finite element subaxial cervical (C3-C7) model was established and analyzed by Mimics 10.0, Rapidform XOR3, Hypermesh 10.0, CATIA5V19, ANSYS 14.0 softwares based on the CT data(C1-T1) was collected from a 28 years old male volunteer.The axial force of 75 N and moment couple of 1N · m was loaded on the upper surface of C3 , which made the model movement in flexion extension, lateral bending, rotating direction, respectively.Then, recorded the range of motion, and compared the results with the in vitro biomechanical experimental data to verify the effectiveness of the model.The ACTPS model and the ACLP model were analyzed using the finite element method.The range of motion at the operation segments (C4-C7) , the range of motion at the adjacent segment (C3-C4) and stress distribution under flexion, extension, lateral bending, and axial rotation were calculated, and compared the range of motion with intact model.Results There were 85 832 elements and 23 612 nodes in the intact model of subaxial cervical spine(C3-C7) in this experiment, and the range of motion of intact model validated with the reported cadaveric experimental data.In ACTPS group the stress was been well-distributed, but the stress concentrated on the interface between screw and the titanium plate in ACLP group.There were obvious differences of the maximum stress value between the two groups.The range of motion of fixed segments in ACTPS group was smaller than ACLP group, however adjacent segment range of motion showed no significant difference.Compared with the intact group, the range of motion in flexion extension, lateral flexion, rotation direction was decreased respectively about 25°, 20° and 8°, the range of motion at adjacent segment (C3-C4)was correspondingly compensated about 0.3°, 3° and 0.1°.Conclusions ACTPS is better than ACLP in terms of biomechanical properties.It offers rigid stability, and may be more suitable for reconstruction stability of 2-level and more than 2 levels corpectomy in the subaxial cervical spine.Meanwhile, the risk of fracture of ACTPS system is lower than that of the ACLP system.