有限元分析在椎弓根钉固定治疗胸腰椎骨折中的应用及进展

Application and progress of finite element analysis in the treatment of thoracolumbar fractures with pedicle screw fixation

背景:椎弓根钉固定方法在治疗胸腰椎骨折中因其简单便于操作而在临床广泛应用。寻找一种能术前模拟评估后路椎弓根钉固定治疗胸腰椎骨折安全性的方法一直是研究的热点。而有限元分析目前是评估长节段和短节段椎弓根钉固定模型并分析其安全性的常用方法。目的:对近些年椎弓根钉固定治疗胸腰椎骨折的有限元研究进展进行分析,以期找到一种合适、安全、有效的胸腰椎骨折有限元伤椎模型。方法:在PubMed数据库中以“finite element analysis,pedicle screw,thoracolumbar fractures”为关键词进行相关文献检索,在CNKI数据库中以“有限元分析,椎弓根钉,胸腰椎骨折”为关键词进行相关文献检索,通过快速浏览文章题目及摘要进行筛选,排除与主题关系不密切的文章,最终筛选出57篇文献进行精读并撰写。结果与结论:截至目前为止,通过三维有限元模型来模拟胸腰段骨折尚没有确定的标准。以往相关研究的有限元模型相对简化且与临床实际脱离,对伤椎真实情况不能进行准确地展现,可重复性差。基于脊柱载荷评分系统的中度和重度骨折的有限元模型更符合实际情况,因其进行量化评估的椎体损伤程度、骨折块范围及移位程度、伤椎后凸畸形矫正度都能通过有限元方法很好地模拟出来。因此,基于此种骨折模型进行胸腰椎骨折椎弓根固定的有限元研究也更加接近于临床实际。

BACKGROUND:Pedicle screw fixation is widely used in the treatment of thoracolumbar fractures because of its simplicity and easy operation.It has always been a research hotspot to find a method that can preoperatively simulate and evaluate the safety of posterior pedicle screw fixation in the treatment of thoracolumbar fractures.Finite element analysis is currently a common method for evaluating long-segment and short-segment pedicle screw fixation models and analyzing their safety.OBJECTIVE:It is hoped that a suitable,safe and effective finite element model of thoracolumbar fractures can be found by analyzing the existing finite element studies of pedicle screw fixation for thoracolumbar fractures.METHODS:In the PubMed database,“finite element analysis,pedicle screw,thoracolumbar fractures”were used as the key words to carry out the relevant literature search.In the CNKI database,the relevant literature search was carried out with the key words of“finite element analysis,pedicle screw,thoracolumbar fractures”.The articles that were not closely related to the topic were excluded by quickly browsing the article titles and abstracts.Finally,57 articles were screened out for intensive reading and writing.RESULTS AND CONCLUSION:So far,there is no established standard for simulating thoracolumbar fractures through three-dimensional finite element models.The models of previous related studies are relatively simplified and out of touch with clinical practice,so they cannot accurately display the real situation of injured vertebrae,and the repeatability is poor.The finite element model of moderate and severe fractures based on the load sharing classification scoring system is more in line with the actual situation,because the quantitative assessment of the degree of vertebral body injury,the extent and displacement of the fracture fragments,and the correction of the kyphosis of the injured vertebra can all be determined by the finite element method.The method is well simulated.Therefore,the finite element study of pedicle fixation for thoracolumbar fractures based on this fracture model is also closer to clinical practice.