不同固定方式治疗急性脊柱创伤的脊柱生物力学指标分析

Analysis of spinal biomechanical indexes in acute spinal trauma treated by different fixation methods

目的用脊柱力学指标分析和比较前路内固定术和后路切开椎弓根内固定治疗急性脊柱创伤的疗效,以期得到更好的治疗急性脊柱创伤的方法。方法基于正常胸腰椎有限元模型的基础上构建创伤模型,在创伤模型中对比不同固定模式载荷下模型整体的变形和Von Mises应力。结果在中立位及前屈、左弯及右弯载荷下,前路内固定术的位移均小于后路切开椎弓根内固定术;在后伸载荷下,后路切开椎弓根内固定术的位移均小于前路内固定术。在中立位及前屈、后伸、左弯及右弯载荷下,前路固定术的椎体应力均大于后路切开椎弓根内固定术。结论前路内固定在增加椎体刚度方面有较好的效果,活动更加接近于正常;后路切开椎弓根内固定承受的应力较大,出现内固定断裂的概率也较大。

Objective To analyze and compare the efficacy of anterior internal fixation and posterior incisional internal fixation in the treatment of acute spinal trauma using spinal mechanics,in order to obtain a better method for the treatment of acute spinal trauma.Methods The trauma model was established based on the normal thoracolumbar finite element model.The deformation and Von Mises stress of the model under different fixed loading modes were compared in the trauma model.Results The displacement of anterior internal fixation was smaller than that of posterior incisional internal fixation in neutral position and under anterior flexion,left bending and right bending loads;the displacement of posterior incisional internal fixation was smaller than that of anterior internal fixation under posterior extension loads.In neutral position and under anterior flexion,posterior extension,left bending and right bending loads,the stresses on the vertebral body were greater with anterior fixation than with posterior incisional pedicle internal fixation.Conclusions Anterior internal fixation is more effective in increasing the stiffness of the vertebral body,and the activity is closer to normal;posterior incisional internal fixation is subjected to higher stresses and has a higher probability of internal fixation fracture.