北京生物医学工程

不同入路椎间融合术中腰椎融合器的生物力学性能

Biomechanical property of lumbar fusion cages in different approaches of interbody fusion

作者：陈政宇李学林晏怡果

单位：南华大学附属第一医院脊柱外科（湖南衡阳 421001） 通信作者：晏怡果。E-mail：yan_yiguo@qq.com

分类号：R318.01

出版年·卷·期（页码）：2021·40·5（521-525）

摘要：

目的探讨不同入路椎间融合术中腰椎融合器的生物力学性能，为临床上合理选择手术方式提供理论支持。方法基于正常人L3~4节段的CT扫描数据，采用3D打印技术进行钛合金椎间融合器制作，设备为EOSINT M280（EOS GmbH公司，德国）。建立完整的腰椎三维有限元模型，通过实验模型进行不同入路的生物力学性能测定并进行对比研究。手术入路包括前路腰椎间融合术（anterior lumbar interbody fusion ，ALIF）、后路腰椎间融合术（posterior lumbar interbody fusion ，PLIF）、直接外侧腰椎间融合术（direct lateral lumbar interbody fusion ，DLIF）和经椎间孔入路腰椎间融合术（transforaminal lumbar interbody fusion ，TLIF）。在L3椎体表面施加500 N的人体重力和10 N·m力矩，模拟腰椎前屈、后伸、左侧弯、右侧弯、左旋转、右旋转6种生理活动，观察力学性能差异。结果行不同入路腰椎融合术后，ALIF以及DLIF模型的预测活动度（range of motion，ROM）和椎间融合器应力显著低于PLIF和TLIF模型；ALIF、DLIF以及TLIF模型的终板应力较PLIF显著降低。结论在4种不同入路的选择中，ALIF、DLIF术后模型的ROM、融合器应力、终板应力均有良好表现。结合临床ALIF的局限性在于前路手术操作相对复杂，容错率较低，而DLIF入路效果与ALIF相似，且具有更好的综合性优势，同时在临床操作过程中更适合于微创手术。

Objective To investigate the biomechanical properties of lumbar interbody fusion cage in different approaches, and to provide theoretical support for the reasonable choice of surgical methods in clinic. Methods Based on the CT scan data of L3~4 segments of normal people, the porous titanium alloy models were made by 3D printing technology through four different approaches. The equipment was eosint M280 (EOS GmbH, Germany). A complete three-dimensional finite element model of lumbar spine was established. The biomechanical properties of different approaches were measured and compared through the experimental model. The surgical approaches included anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), direct lateral lumbar interbody fusion (DLIF) and transforaminal lumbar interbody fusion (TLIF). Five hundred n human gravity and 10 N · m torque were applied on the L3 surface to simulate six physiological activities, including flexion, extension, left bending, right bending, left rotation and right rotation . Results After lumbar fusion, the range of motion (ROM) and cage stress of ALIF and DLIF models were significantly lower than those of PLIF and TLIF models, and the endplate stress of ALIF, DLIF and TLIF models was significantly lower than that of PLIF. Conclusions Among the four different approaches, the ROM, fuser stress and endplate stress of ALIF and DLIF have good results. However, the disadvantage of ALIF is that the anterior approach is complicated and the fault tolerance rate is low, while the DLIF only takes the lateral approach, and the effect is similar to that of ALIF. Therefore, DLIF can be recommended for clinical practice.

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