有限元分析胸腰段脊柱骨折经伤椎置钉的固定

Transpedicular screw fixation for thoracolumbar fracture based on finite element analysis

背景:胸腰段脊柱骨折是临床上常见的脊柱损伤,骨折破坏脊柱的稳定性,轻者压迫脊髓、神经,重者可造成畸形、瘫痪。临床上对于胸腰段脊柱骨折的诊断和治疗尚存在部分争议。目的:对胸腰段脊柱骨折损伤机制的有限元分析、分型发展现状、经伤椎置钉固定应用等方面进行概括。方法:由第一作者应用计算机检索中国期刊全文数据库(CNKI)、Pub Med数据库2000年1月至2016年12月相关文献,在标题、摘要、关键词中以"有限元分析、胸腰段脊柱骨折、经伤椎固定"或"finite element method、thoracolumbar spine fracture、transpedicular screw fixation"为检索词进行检索。结果与结论:(1)有限元分析法可以很好地模拟胸腰段脊柱骨折的发生机制,为临床研究胸腰段脊柱骨折的发生发展及治疗提供参考;(2)胸腰段脊柱骨折的分型有利于临床治疗方法的选择和预后的判断;(3)经伤椎置钉固定相较于跨伤椎置钉固定无论在生物力学稳定性方面,还是在维持术后矫正效果方面,均具有优势;(4)现实中胸腰段脊柱骨折的分型较多、程度差异、软组织损伤程度不同,目前条件下完全模拟实际情况尚难以做到;(5)有限元分析法学习曲线长、建模耗时长、分析数据运算量大,因此临床应用受到一定的限制。

BACKGROUND： Thoracolumbar fracture is commonly seen in spinal injuries, which causes loss of stability of thespine, as well as spinal cord and nerve compression, even deformity and paralysis. The diagnosis and treatmentof thoracolumbar fracture remain controversial.OBJECTIVE： To summarize the mechanism of thoracolumbar fracture based on finite element method, itsclassification and transpedicular screw fixation.METHODS： The first author retrieved CNKI and PubMed databases for the relevant literature published betweenJanuary 2000 and December 2016. The keywords were “finite element method, thoracolumbar spine fracture,transpedicular screw fixation” in Chinese and English, respectively.RESULTS AND CONCLUSION： （1） The finite element analysis method can simulate the mechanism of thoracolumbarfracture and provides a reference for the studies on the occurrence, development and treatment of thoracolumbarfracture. （2） The classification of thoracolumbar fracture is beneficial for planning a rational treatment strategy andevaluating prognosis. （3） Compared with the traditional screw fixation, the transpedicular screw fixation holdsadvantages in biomechanical stability and postoperative correction effect. （4） There are various classifications forthoracolumbar fracture; differences in severity and cartilage injury are difficult to simulate completely. （5） The finiteelement analysis method shows certain application limitations due to long learning curve and modeling time as well ascomplicated calculations.