新型后路寰枢椎板间融合器生物力学特征的有限元分析
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摘要
背景:随着寰枢椎手术量的增加,寰枢椎植骨融合的问题也一直备受重视,无论寰枢椎前路或者后路融合器,虽然对寰枢椎融合器的研究从未停止,但由于手术技术难度、手术风险、设计不成熟等诸多原因,目前仍未有相关的寰枢椎融合器可应用于临床。后路寰枢椎板间融合器是一种可配合后路钉棒内固定系统使用的新型融合器类型,但其生物力学性能仍需进一步研究。目的:通过建立寰枢椎板间融合器联合后路钉棒内固定系统的三维有限元模型,评估新型后路寰枢椎板间融合器的生物力学特性。方法:通过CT扫描获取1名健康成年人枕骨、寰枢椎图像信息,应用有限元分析软件创建寰枢椎板间融合器联合后路钉棒内固定系统的三维有限元分析模型,分析不同运动状态下寰枢椎板间融合器的应力变化及应力云图。结果与结论:(1)建立的有限元模型几何相似性好,包含206 745个单元及72 496个节点;(2)寰枢椎板间融合器的最大应力均集中在微型钛钉置入骨质部位,左右旋转工况下的最大应力值较其他工况下高;(3)后路钉棒系统应力均主要集中在螺钉的钉-骨交界处及钉棒连接处,最大的应力均产生在螺钉置入骨质部分的根部周围;(4)提示新型后路寰枢椎板间融合器的力学稳定性可,寰枢椎板间融合器是一种简单、安全的寰枢椎融合器类型,对后路钉棒系统应力无影响,值得进一步研究。
BACKGROUND: With the increase of surgical amount in atlantoaxial spine, the problem of bone graft fusion has also been respected.Regardless of atlantoaxial anterior or posterior fusion cage, although the study of atlantoaxial fusion cage has never stopped, but because of the surgical technical difficulties, surgical risk, immature design, and many other reasons, there is still no related atlant oaxial fusion cage can be applied to clinic. Posterior atlantoaxial interlamina fusion cage is a new type that can be used with posterior screw-rod internal fixation system, but its biomechanical properties still need to be further studied.OBJECTIVE: To evaluate the biomechanical characteristics of a new posterior atlantoaxial interlamina fusion cage by establishing a three-dimensional finite element model of the atlantoaxial interlamina fusion cage combined with posterior screw-rod internal fixation system.METHODS: CT scan was used to obtain the image information of occipital and atlantoaxial of a healthy adult. Finite element analysis software was used to create a three-dimensional finite element analysis model of atlantoaxial interlaminar fusion cage combined with posterior screw-rod internal fixation system, and stress changes and stress nephogram of atlantoaxial interlaminar fusion cage under different motion states were analyzed.RESULTS AND CONCLUSION:(1) The finite element model had good geometric similarity, including 206 745 elements and 72 496 nodes.(2) The maximum stress of atlantoaxial interlaminar fusion cage device was concentrated at the bone implant site of micro-titanium nail, and the maximum stress value under the condition of left and right rotation was higher than that under other conditions.(3) The stress of the posterior screw-rod system was mainly concentrated at the screw-bone junction and the screw-rod junction of the screw, and the maximum stress was generated around the root of the screw into the bone.(4) These results suggest that the mechanical stability of the new posterior atlantoaxial interlaminar fusion cage device is good, and it is a simple and safe type of atlantoaxial fusion cage device, which makes no influence on the stress of the posterior screw-rod system and is worthy of further investigation.
BACKGROUND: With the increase of surgical amount in atlantoaxial spine, the problem of bone graft fusion has also been respected.Regardless of atlantoaxial anterior or posterior fusion cage, although the study of atlantoaxial fusion cage has never stopped, but because of the surgical technical difficulties, surgical risk, immature design, and many other reasons, there is still no related atlant oaxial fusion cage can be applied to clinic. Posterior atlantoaxial interlamina fusion cage is a new type that can be used with posterior screw-rod internal fixation system, but its biomechanical properties still need to be further studied.OBJECTIVE: To evaluate the biomechanical characteristics of a new posterior atlantoaxial interlamina fusion cage by establishing a three-dimensional finite element model of the atlantoaxial interlamina fusion cage combined with posterior screw-rod internal fixation system.METHODS: CT scan was used to obtain the image information of occipital and atlantoaxial of a healthy adult. Finite element analysis software was used to create a three-dimensional finite element analysis model of atlantoaxial interlaminar fusion cage combined with posterior screw-rod internal fixation system, and stress changes and stress nephogram of atlantoaxial interlaminar fusion cage under different motion states were analyzed.RESULTS AND CONCLUSION:(1) The finite element model had good geometric similarity, including 206 745 elements and 72 496 nodes.(2) The maximum stress of atlantoaxial interlaminar fusion cage device was concentrated at the bone implant site of micro-titanium nail, and the maximum stress value under the condition of left and right rotation was higher than that under other conditions.(3) The stress of the posterior screw-rod system was mainly concentrated at the screw-bone junction and the screw-rod junction of the screw, and the maximum stress was generated around the root of the screw into the bone.(4) These results suggest that the mechanical stability of the new posterior atlantoaxial interlaminar fusion cage device is good, and it is a simple and safe type of atlantoaxial fusion cage device, which makes no influence on the stress of the posterior screw-rod system and is worthy of further investigation.
引文
[1]Yin QS,Wang JH.Current Trends in Management of Atlantoaxial Dislocation.Orthop Surg,2015;7(3):189-199.
[2]尹庆水,艾福志,夏虹,等.寰枢椎前路复位钢板系统的研制及其生物力学[J].中华创伤骨科杂志,2004,1(2):54-57.
[3]Wei G,Wang Z,Ai F,et al.Treatment of basilar invagination with klippel-feil syndrome:atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate.Neurosurgery.2016;78(4):492-498.
[4]Richter M,Schmidt R,Claes L,et al.Posterior atlantoaxial fixation:biomechanical in vitro comparison of six different techniques.Spine(Phila Pa 1976).2002;27(16):1724-1732.
[5]Yin QS,Ai FZ,Zhang K,et al.Transoral atlantoaxial reduction plate internal fixation for the treatment of irreducible atlantoaxial dislocation:a 2-to 4-year follow-up.Orthop Surg.2010;2(2):149-155.
[6]Xia H,Yin Q,Ai F,et al.Treatment of basilar invagination with atlantoaxial dislocation:atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate(TARP)without odontoidectomy.Eur Spine J.2014;23(8):1648-1655.
[7]Yi QS,Li XS,Bai ZH,et al.An 11-Year Review of the TARPProcedure in the Treatment of Atlantoaxial Dislocation.Spine(Phila Pa 1976).2016;41(19):E1151-E1158.
[8]Yin Q,Ai F,Zhang K,et al.Irreducible anterior atlantoaxial dislocation:one-stage treatment with a transoral atlantoaxial reduction plate fixation and fusion.Report of 5 cases and review of the literature.Spine(Phila Pa 1976).2005;30(13):E375-E381.
[9]Sim HB,Lee JW,Park JT,et al.Biomechanical evaluations of various c1-c2 posterior fixation techniques.Spine(Phila Pa 1976).2011;36(6):E401-E407.
[10]Park J,Scheer JK,Lim TJ,et al.Biomechanical analysis of Goel technique for C1-2 fusion.J Neurosurg Spine.2011;14(5):639-646.
[11]Melcher RP,Puttlitz CM,Kleinstueck FS,et al.Biomechanical testing of posterior atlantoaxial fixation techniques.Spine(Phila Pa 1976).2002;27(22):2435-2440.
[12]马向阳,尹庆水,吴增晖,等.寰枢椎后路四种钉棒固定方法的三维稳定性评价[J].中国脊柱脊髓杂志,2008,18(6):464-468.
[13]Claybrooks R,Kayanja M,Milks R,et al.Atlantoaxial fusion:a biomechanical analysis of two C1-C2 fusion techniques.Spine J.2007;7(6):682-688.
[14]马向阳,尹庆水,吴增晖,等.多种寰枢椎后路钉棒固定技术的临床组合应用[J].中国骨科临床与基础研究杂志,2010,2(1):12-16.
[15]Bhowmick DA,Benzel EC.Posterior atlantoaxial fixation with screw-rod constructs:safety,advantages,and shortcomings.World Neurosurg.2014;81(2):288-289.
[16]Hwang IC,Kang DH,Han JW,et al.Clinical experiences and usefulness of cervical posterior stabilization with polyaxial screw-rod system.J Korean Neurosurg Soc.2007;42(4):311-316.
[17]Meyer B,Kuhlen D.Atlantoaxial fusion:transarticular screws versus screw-rod constructs.World Neurosurg.2013;80(5):516-517.
[18]Elliott RE,Tanweer O,Boah A,et al.Outcome comparison of atlantoaxial fusion with transarticular screws and screw-rod constructs:meta-analysis and review of literature.J Spinal Disord Tech.2014;27(1):11-28.
[19]Harms J,Melcher RP.Posterior C1-C2 fusion with polyaxial screw and rod fixation.Spine(Phila Pa 1976).2001;26(22):2467-2471.
[20]Stulik J,Vyskocil T,Sebesta P,et al.Atlantoaxial fixation using the polyaxial screw-rod system.Eur Spine J.2007;16(4):479-484.
[21]Guo SL,Zhou DB,Yu XG,et al.Posterior C1-C2 screw and rod instrument for reduction and fixation of basilar invagination with atlantoaxial dislocation.Eur Spine J.2014;23(8):1666-1672.
[22]Qi L,Li M,Zhang S,et al.C1-c2 pedicle screw fixation for treatment of old odontoid fractures.Orthopedics.2015;38(2):94-100.
[23]马向阳,杨进城,邱锋,等.寰枢椎脱位后路植骨材料的选择与融合效果评价[J].中国骨科临床与基础研究杂志,2015,7(1):5-9.
[24]He X,Meng Y,Zhang J,et al.Bone grafting of atlantoaxial joints and occipitocervical or atlantoaxial fusion for the reduction and fixation of basilar invagination with atlantoaxial dislocation by a posterior approach:a preliminary study.World Neurosurg.2017.
[25]张皓南,尹庆水,刘桂英,等.经口前路寰枢椎侧块关节融合器的力学稳定性评价[J].中国临床解剖学杂志,2014,3(3):348-350.
[26]Zhang BC,Liu HB,Cai XH,et al.Biomechanical comparison of a novel transoral atlantoaxial anchored cage with established fixation technique-a finite element analysis.BMC Musculoskelet Disord.2015;16:261.
[27]陈树金,马向阳,杨进城,等.有限元法分析寰-枢椎椎弓根螺钉内固定的生物力学变化[J].中国组织工程研究,2018,22(31):4970-4974.
[28]Faizan A,Goel VK,Garfin SR,et al.Do design variations in the artificial disc influence cervical spine biomechanics?A finite element investigation.Eur Spine J.2012;21 Suppl 5:S653-662.
[29]关哲,马迅,梁凯恒,等.上颈椎有限元模型的建立及寰椎生物力学有限元分析[J].中国脊柱脊髓杂志,2009,19(7):530-534.
[30]Zhang H,Bai J.Development and validation of a finite element model of the occipito-atlantoaxial complex under physiologic loads.Spine(Phila Pa 1976).2007;32(9):968-974.
[31]杨敏,马向阳,杨进城,等.自行防旋转寰枢椎钉棒内固定系统的生物力学有限元分析[J].中国组织工程研究,2017,21(19):3031-3037.
[32]Ma X,Peng X,Xiang H,et al.A finite element modeling of posterior atlantoaxial fixation and biomechanical analysis of C2intralaminar screw fixation.Chin Med J(Engl).2014;127(7):1266-1271.
[33]Lapsiwala SB,Anderson PA,Oza A,et al.Biomechanical comparison of four C1 to C2 rigid fixative techniques:anterior transarticular,posterior transarticular,C1 to C2 pedicle,and C1 to C2 intralaminar screws.Neurosurgery.2006;58(3):516-521.
[34]邹小宝,马向阳,杨进城,等.寰枢椎脱位不同植骨材料及内固定方式对植骨后融合时间的影响[J].中国组织工程研究,2017,21(11):1688-1694.
[35]廖文胜,刘玉峰,鲍恒,等.经口前路寰枢椎侧块关节间固定融合器的研制及生物力学分析[J].郑州大学学报(医学版),2013,48(5):658-661.
[36]Zhang B,Liu H,Cai X,et al.Biomechanical comparison of modified tarp technique versus modified goel technique for the treatment of basilar invagination:a finite element analysis.Spine(Phila Pa 1976).2016;41(8):E459-466.
[37]邹小宝,马向阳,杨进城,等.经口咽前路减压侧块关节融合器植骨融合联合颈椎压力固定器治疗难复性寰枢椎脱位[J].中国脊柱脊髓杂志,2016,26(11):961-966.
[38]Matsumoto M,Chiba K,Tsuji T,et al.Use of a titanium mesh cage for posterior atlantoaxial arthrodesis.Technical note.J Neurosurg.2002;96(1 Suppl):127-130.
[39]Chun HJ,Oh SH,Yi HJ,et al.Efficacy and durability of the titanium mesh cage spacer combined with transarticular screw fixation for atlantoaxial instability in rheumatoid arthritis patients.Spine(Phila Pa 1976).2009;34(22):2384-2388.
[40]Ryu JI,Bak KH,Yi HJ,et al.Evaluation of the Efficacy of Titanium Mesh Cages with Posterior C1 Lateral Mass and C2 Pedicle Screw Fixation in Patients with Atlantoaxial Instability.World Neurosurg.2016;90:103-108.
[41]Goel A,Kulkarni AQ,Sharma P.Reduction of fixed atlantoaxial dislocation in 24 cases:technical note.J Neurosurg Spine.2005;2(4):505-509.
[42]Li S,Ni B,Xie N,et al.Biomechanical evaluation of an atlantoaxial lateral mass fusion cage with C1-C2 pedicle fixation.Spine(Phila Pa 1976).2010;35(14):E624-E632.
[43]李胜华,汪康,夏良政,等.后路寰枢椎侧块关节融合器置入的临床应用解剖[J].中国骨与关节损伤杂志,2012,27(5):385-388.
[44]Yoshizumi T,Murata H,Ikenishi Y,et al.Occipitocervical fusion with relief of odontoid invagination:atlantoaxial distraction method using cylindrical titanium cage for basilar invagination--case report.Neurosurg Rev.2014;37(3):519-525.
[45]Lee JY,Im SB,Jeong JH.Use of a c1-c2 facet spacer to treat atlantoaxial instability and basilar invagination associated with rheumatoid arthritis.World Neurosurg.2017;98:874.e13-874.
[2]尹庆水,艾福志,夏虹,等.寰枢椎前路复位钢板系统的研制及其生物力学[J].中华创伤骨科杂志,2004,1(2):54-57.
[3]Wei G,Wang Z,Ai F,et al.Treatment of basilar invagination with klippel-feil syndrome:atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate.Neurosurgery.2016;78(4):492-498.
[4]Richter M,Schmidt R,Claes L,et al.Posterior atlantoaxial fixation:biomechanical in vitro comparison of six different techniques.Spine(Phila Pa 1976).2002;27(16):1724-1732.
[5]Yin QS,Ai FZ,Zhang K,et al.Transoral atlantoaxial reduction plate internal fixation for the treatment of irreducible atlantoaxial dislocation:a 2-to 4-year follow-up.Orthop Surg.2010;2(2):149-155.
[6]Xia H,Yin Q,Ai F,et al.Treatment of basilar invagination with atlantoaxial dislocation:atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate(TARP)without odontoidectomy.Eur Spine J.2014;23(8):1648-1655.
[7]Yi QS,Li XS,Bai ZH,et al.An 11-Year Review of the TARPProcedure in the Treatment of Atlantoaxial Dislocation.Spine(Phila Pa 1976).2016;41(19):E1151-E1158.
[8]Yin Q,Ai F,Zhang K,et al.Irreducible anterior atlantoaxial dislocation:one-stage treatment with a transoral atlantoaxial reduction plate fixation and fusion.Report of 5 cases and review of the literature.Spine(Phila Pa 1976).2005;30(13):E375-E381.
[9]Sim HB,Lee JW,Park JT,et al.Biomechanical evaluations of various c1-c2 posterior fixation techniques.Spine(Phila Pa 1976).2011;36(6):E401-E407.
[10]Park J,Scheer JK,Lim TJ,et al.Biomechanical analysis of Goel technique for C1-2 fusion.J Neurosurg Spine.2011;14(5):639-646.
[11]Melcher RP,Puttlitz CM,Kleinstueck FS,et al.Biomechanical testing of posterior atlantoaxial fixation techniques.Spine(Phila Pa 1976).2002;27(22):2435-2440.
[12]马向阳,尹庆水,吴增晖,等.寰枢椎后路四种钉棒固定方法的三维稳定性评价[J].中国脊柱脊髓杂志,2008,18(6):464-468.
[13]Claybrooks R,Kayanja M,Milks R,et al.Atlantoaxial fusion:a biomechanical analysis of two C1-C2 fusion techniques.Spine J.2007;7(6):682-688.
[14]马向阳,尹庆水,吴增晖,等.多种寰枢椎后路钉棒固定技术的临床组合应用[J].中国骨科临床与基础研究杂志,2010,2(1):12-16.
[15]Bhowmick DA,Benzel EC.Posterior atlantoaxial fixation with screw-rod constructs:safety,advantages,and shortcomings.World Neurosurg.2014;81(2):288-289.
[16]Hwang IC,Kang DH,Han JW,et al.Clinical experiences and usefulness of cervical posterior stabilization with polyaxial screw-rod system.J Korean Neurosurg Soc.2007;42(4):311-316.
[17]Meyer B,Kuhlen D.Atlantoaxial fusion:transarticular screws versus screw-rod constructs.World Neurosurg.2013;80(5):516-517.
[18]Elliott RE,Tanweer O,Boah A,et al.Outcome comparison of atlantoaxial fusion with transarticular screws and screw-rod constructs:meta-analysis and review of literature.J Spinal Disord Tech.2014;27(1):11-28.
[19]Harms J,Melcher RP.Posterior C1-C2 fusion with polyaxial screw and rod fixation.Spine(Phila Pa 1976).2001;26(22):2467-2471.
[20]Stulik J,Vyskocil T,Sebesta P,et al.Atlantoaxial fixation using the polyaxial screw-rod system.Eur Spine J.2007;16(4):479-484.
[21]Guo SL,Zhou DB,Yu XG,et al.Posterior C1-C2 screw and rod instrument for reduction and fixation of basilar invagination with atlantoaxial dislocation.Eur Spine J.2014;23(8):1666-1672.
[22]Qi L,Li M,Zhang S,et al.C1-c2 pedicle screw fixation for treatment of old odontoid fractures.Orthopedics.2015;38(2):94-100.
[23]马向阳,杨进城,邱锋,等.寰枢椎脱位后路植骨材料的选择与融合效果评价[J].中国骨科临床与基础研究杂志,2015,7(1):5-9.
[24]He X,Meng Y,Zhang J,et al.Bone grafting of atlantoaxial joints and occipitocervical or atlantoaxial fusion for the reduction and fixation of basilar invagination with atlantoaxial dislocation by a posterior approach:a preliminary study.World Neurosurg.2017.
[25]张皓南,尹庆水,刘桂英,等.经口前路寰枢椎侧块关节融合器的力学稳定性评价[J].中国临床解剖学杂志,2014,3(3):348-350.
[26]Zhang BC,Liu HB,Cai XH,et al.Biomechanical comparison of a novel transoral atlantoaxial anchored cage with established fixation technique-a finite element analysis.BMC Musculoskelet Disord.2015;16:261.
[27]陈树金,马向阳,杨进城,等.有限元法分析寰-枢椎椎弓根螺钉内固定的生物力学变化[J].中国组织工程研究,2018,22(31):4970-4974.
[28]Faizan A,Goel VK,Garfin SR,et al.Do design variations in the artificial disc influence cervical spine biomechanics?A finite element investigation.Eur Spine J.2012;21 Suppl 5:S653-662.
[29]关哲,马迅,梁凯恒,等.上颈椎有限元模型的建立及寰椎生物力学有限元分析[J].中国脊柱脊髓杂志,2009,19(7):530-534.
[30]Zhang H,Bai J.Development and validation of a finite element model of the occipito-atlantoaxial complex under physiologic loads.Spine(Phila Pa 1976).2007;32(9):968-974.
[31]杨敏,马向阳,杨进城,等.自行防旋转寰枢椎钉棒内固定系统的生物力学有限元分析[J].中国组织工程研究,2017,21(19):3031-3037.
[32]Ma X,Peng X,Xiang H,et al.A finite element modeling of posterior atlantoaxial fixation and biomechanical analysis of C2intralaminar screw fixation.Chin Med J(Engl).2014;127(7):1266-1271.
[33]Lapsiwala SB,Anderson PA,Oza A,et al.Biomechanical comparison of four C1 to C2 rigid fixative techniques:anterior transarticular,posterior transarticular,C1 to C2 pedicle,and C1 to C2 intralaminar screws.Neurosurgery.2006;58(3):516-521.
[34]邹小宝,马向阳,杨进城,等.寰枢椎脱位不同植骨材料及内固定方式对植骨后融合时间的影响[J].中国组织工程研究,2017,21(11):1688-1694.
[35]廖文胜,刘玉峰,鲍恒,等.经口前路寰枢椎侧块关节间固定融合器的研制及生物力学分析[J].郑州大学学报(医学版),2013,48(5):658-661.
[36]Zhang B,Liu H,Cai X,et al.Biomechanical comparison of modified tarp technique versus modified goel technique for the treatment of basilar invagination:a finite element analysis.Spine(Phila Pa 1976).2016;41(8):E459-466.
[37]邹小宝,马向阳,杨进城,等.经口咽前路减压侧块关节融合器植骨融合联合颈椎压力固定器治疗难复性寰枢椎脱位[J].中国脊柱脊髓杂志,2016,26(11):961-966.
[38]Matsumoto M,Chiba K,Tsuji T,et al.Use of a titanium mesh cage for posterior atlantoaxial arthrodesis.Technical note.J Neurosurg.2002;96(1 Suppl):127-130.
[39]Chun HJ,Oh SH,Yi HJ,et al.Efficacy and durability of the titanium mesh cage spacer combined with transarticular screw fixation for atlantoaxial instability in rheumatoid arthritis patients.Spine(Phila Pa 1976).2009;34(22):2384-2388.
[40]Ryu JI,Bak KH,Yi HJ,et al.Evaluation of the Efficacy of Titanium Mesh Cages with Posterior C1 Lateral Mass and C2 Pedicle Screw Fixation in Patients with Atlantoaxial Instability.World Neurosurg.2016;90:103-108.
[41]Goel A,Kulkarni AQ,Sharma P.Reduction of fixed atlantoaxial dislocation in 24 cases:technical note.J Neurosurg Spine.2005;2(4):505-509.
[42]Li S,Ni B,Xie N,et al.Biomechanical evaluation of an atlantoaxial lateral mass fusion cage with C1-C2 pedicle fixation.Spine(Phila Pa 1976).2010;35(14):E624-E632.
[43]李胜华,汪康,夏良政,等.后路寰枢椎侧块关节融合器置入的临床应用解剖[J].中国骨与关节损伤杂志,2012,27(5):385-388.
[44]Yoshizumi T,Murata H,Ikenishi Y,et al.Occipitocervical fusion with relief of odontoid invagination:atlantoaxial distraction method using cylindrical titanium cage for basilar invagination--case report.Neurosurg Rev.2014;37(3):519-525.
[45]Lee JY,Im SB,Jeong JH.Use of a c1-c2 facet spacer to treat atlantoaxial instability and basilar invagination associated with rheumatoid arthritis.World Neurosurg.2017;98:874.e13-874.
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