刘峰;彭文;浣溢帆;王文军;晏怡果;王麓山;邹炜民;王程;

• 1:南华大学附属第一医院脊柱外科
• 2:湖南华翔增量制造股份有限公司

摘要(Abstract)：

[目的]通过三维有限元分析新型颈椎多孔型(金属)网式融合器应力的分布特点,为临床应用提供理论依据。[方法]建立传统钛网融合器以及新型颈椎多孔型(金属)网式融合器的颈椎前路椎体次全切减压融合内固定术的三维有限元模型。在前屈后伸、左右侧屈、左右旋转等六种工况下施加73.6 N的预载荷,1.5 Nm的附加运动力矩,观察并分析融合器自身、钛板及融合器与上下终板接触面的Von-Mises应力分布情况以及椎体位移情况。[结果]与传统钛网相比,在六种工况下新型颈椎多孔型(金属)网式融合器自身最大应力减少了84%～98%,C6上终板的最大应力减少了29%～83%,C4下终板的最大应力减少了8%～55%。在大部分工况下,新型颈椎多孔型(金属)网式融合器组的钛板最大应力值较传统钛网融合器组低。在大部分工况下,两种钛网融合器组的终板应力最大值均位于上终板后缘,但新型颈椎多孔型(金属)网式融合器的终板后缘最大应力值要小于传统钛网。[结论]与传统钛网融合器比较,新型颈椎多孔型(金属)网式融合器在颈椎前路椎体次全切减压融合内固定术后具有较强的即刻稳定性,能减少应力集中,减少钛板的应力遮挡,显著降低上下终板的最大应力,更好的预防融合器下沉。

关键词(KeyWords)： 新型颈椎多孔型(金属)网式融合器,;颈前路椎体次全切减压植骨融合术;三维有限元分析

Abstract:

Keywords:

基金项目(Foundation): 湖南省重点研发计划项目(编号：2017SK2104);; 湖南省卫生计生委科研计划课题重点项目(编号：A2017016);; 湖南省脊柱微创临床医学研究中心项目(编号：2017SK4004);; 湖南省卫生健康委员会科研计划课题项目(编号：2019120);; 衡阳市科学技术发展计划项目(编号：2018KJ115)

作者(Author): 刘峰;彭文;浣溢帆;王文军;晏怡果;王麓山;邹炜民;王程;

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DOI:

参考文献(References)：

• [1]潘孟骁.颈椎前路椎体次全切除后钛网下沉原因及对颈神经功能的影响[J].中国组织工程研究, 2017, 21(15):2355-2360.
• [2] Eck KR, Bridwell KH, Ungacta FF, et al. Analysis of titanium mesh cages in adults with minimum two-year follow-up[J]. Spine,2000, 25(18):2407-2415.
• [3] Chuang HC, Cho DY, Chang CS, et al. Efficacy and safety of the use of titanium mesh cages and anterior cervical plates for interbody fusion after anterior cervical corpectomy[J]. Surg Neurol,2006, 65(5):46-71.
• [4] Riew KD, Rhee JM. The use of titanium mesh cages in the cervical spine[J]. Clin Orthop, 2002, 394:47-54.
• [5] Masahiro K, Tomoyuki H, Keiichi S, et al. Pitfalls of anterior cervical fusion using titanium mesh and local autograft[J]. J Spine Surg, 2003, 16(6):513-518
• [6] Weber MH, Fortin M, Shen J, et al. Graft subsidence and revision rates following anterior cervical corpectomy:a clinical study comparing different interbody cages[J]. Clin Spine Surg, 2017, 30(9):E1239-e45.
• [7] Wu JX. Anatomy-related risk factors for the subsidence of titanium mesh cage in cervical reconstruction after one-level corpectomy[J]. Int J Clin Exp Med, 2015, 8(5):7405-7411
• [8] Yu FB, Miao JH, Liao XY, et al. Evaluation of a new type of titanium mesh cage versus the traditional titanium mesh cage for singlelevel, anterior cervical corpectomy and fusion[J]. Eur Spine J,2013, 22(12):2891-2896
• [9] Lu T, Liang H, Liu C, et al. Effects of titanium mesh cage end structures on the compressive load at the endplate interface:a cadaveric biomechanical study[J]. Med Sci Monitor, 2017, 23:2863-2870.
• [10] Norberto A, Mario Z, Charles K. Long-term follow-up of cervical radiographic sagittal spinal alignment after 1-and 2-level cervical corpectomy for the treatment of spondylosis of the subaxial cervical spine causing radiculomyelopathy or myelopathy:a retrospective study[J]. J Neurosurg, 2012, 16(1):2-7
• [11] Xu H, Ren X, Wang D, et al. Clinical use of the nanohydroxyapatite/polyamide mesh cage in anterior cervical corpectomy and fusion surgery[J]. J Nanomaterials, 2015, 2015:1.
• [12]陈宇.一种新型植骨重建钛网的三维有限元研究[J].脊柱外科杂志, 2010, 5(8):290-294.
• [13] Lee SH, Im YJ, Kim KT, et al. Comparison of cervical spine biomechanics after fixed-and mobile-core artificial disc replacement:a finite element analysis[J]. Spine, 2011, 36(9):700-708.
• [14]郭永飞,陈德玉,徐建伟,等.颈前路钛网植骨融合术后钛网沉陷的原因分析[J].中国脊柱脊髓杂志, 2005, 15(7):409-413.
• [15]马永刚,刘世清,李亚明,等.颈椎前路减压融合术后钛笼下沉临床分析[J].中国脊柱脊髓杂志, 2011, 21(1):21-23.
• [16]苏再发,贾连顺,陈雄生,等.大、小直径钛网对终板-钛网界面应力分布影响的比较[J].颈腰痛杂志, 2011, 32(5):323-327.
• [17] Jonbergen W, Spruit M, Anderson PG, et al. Anterior cervical interbody fusion with a titanium box cage:early radiological assessment of fusion and subsidence[J]. Spine J, 2005, 5(6):645-649.