不同矫形力矫正特发性脊柱侧凸的三维有限元分析(英文)

Three-dimensional finite element analysis of adolescent idiopathic scoliosis correction by different correction methods

获得1例PUMCIID2脊柱侧11女性患者的CT资料，导入医学建模软件mimics 11.11，得到医学仿真模型。仿真模型导入有限元分析软件abaqus6．7，建立特发性脊柱侧凸患者有限元分析模型（T1-S）。取短节段胸弯（T）有限元模型，分别以单纯凹侧撑开、单纯凸侧加压、同时凹侧撑开凸侧加压、先凹侧撑开后凸侧加压、先凸例加压后凹侧撑开5种矫形方法，利用计算机软件abaqus模拟椎弓根螺钉矫形，于端椎椎弓根内分别赋予50，100，200N载荷，比较T6椎体的Y轴（矢状面）、Z轴（冠状向）位移变化，分别代表后凸和侧凸的矫正效果。T6住Z轴位移：单纯凹侧撑开优于单纯凸侧加压、同时凹侧撑开凸侧加压、先凹侧撑开后凸侧加压及先凸侧加压后凹侧撑开（P〈0．01）：同时凹侧撑开凸侧加压、先凹侧撑开后凸侧加坻及先凸侧加压后凹侧撑开三者T6在Z轴位移相同，且都优于单纯凸侧加压（P〈0.01）。T6在Y轴位移：单纯凸侧加压优于单纯凹侧撑开、同时凹侧撑开凸侧加压、先凹侧撑开后凸侧加压和先凸侧加压后凹侧撑开（P〈0．01）；同时凹侧撑开凸侧加压、先凹侧撑开后凸侧加压和先凸侧加压后凹侧撑开王者T6在Y轴位移相同，且部优于单纯凹侧撑开（P〈0.01）。结果提示，对侧弯冠状面的矫正，单纯凹侧撑开〉同时凹侧撑开凸侧加压=先凹侧撑开后凸侧加压=先凸侧加压后凹侧撑开〉单纯凸侧加压。对矢状面后凸的矫正，单纯凸侧加压〉同时凹侧撑开凸侧加压=先凹侧撑开后凸侧加压=先凸侧加压后凹侧撑开〉单纯凹侧撑开。单纯凹侧撑开无明显的后凸矫正作用，相反一定程度上可以导致后凸增大。单纯凸侧加压无明显的前凸矫正作用，相反一定程度上可以导致前凸增大。

CT data regarding PUMC Ⅱ d2 adolescent idiopathic scoliosis obtained from one female patient were input into modeling software minics 11.11 to obtain medical simulation model. Then finite element analysis models of AIS patients （T1 S） were created by introducing simulation models into software abaqus 6.7. Finite element models of T611 segments were corrected by 5 different correction methods： simple concave bracing, simple convex pressurization, concave distraction and convex compression simultaneously, concave distraction prior to convex compression and concave distraction after convex pressurization. Abaqus software was used to simulate correction of scoliosis with vertebral arch pedicle screw by loading 50 N, 100 N, and 200 N distraction forces on the concave side pedlcles of the end vertebrae T6 and T11. The displacement of vertebrae T6 in Y-axis （sagittal plane） and Z-axis （coronal plane）, which respectively represented the correction effects of kyphosis and scoliosis, was compared between prior to and after correction. Simple concave distraction provided better outcomes in terms of displacement of Ts in Z-axis than the remaining four methods （P 〈 0.01 ）. Concave distraction and convex compression simultaneously, concave distraction prior to convex pressurization and concave distraction after convex compression produced identical displacements of T6 in Y-axis, which were all better than simple concave distraction （P 〈 0.01）. The present findings imply that for curative effects of five methods on correction of scoliosis in the coronal plane： simple concave distraction〉 concave distraction and convex compression simultaneously = concave distraction prior to convex compression= concave distraction after convex compression 〉 simple convex pressurization; for curative effects of five methods on correction of kyphosis in the sagittal plane： simple convex compression 〉 concave distraction and convex compression simultaneously = concave distraction prior to convex compression= concave distraction after convex compression〉 simple concave bracing. Simple concave distraction could not produce obvious corrective effects on kyphosis rather than lead to worsened kyphosis to some extent. Simple convex compression could not produce obvious corrective effects on scoliosis rather than result in aggravated scoliosis to some extent.