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枕骨髁螺钉治疗上颈椎不稳的有限元分析

Finite element analysis of occipital condylar screw in treatment of occipitocervical instability

摘要:

目的 探讨后路枕骨髁螺钉相较于常见枕颈融合装置的生物力学性能差异及其对舌下神经管的应力影响. 方法 选择1名28岁健康男性志愿者的枕颈部CT数据建立有限元模型:正常模型、不稳模型、枕骨髁螺钉内固定模型、枕骨钢板螺钉内固定模型、经寰枕关节螺钉内固定模型,在枕骨上表面施加50 N载荷和1.5N·m的扭矩,使模型产生侧弯、屈伸及旋转运动.比较各模型在不同工况下的椎体间活动度、内固定物的应力分布情况及枕骨髁螺钉对舌下神经管的影响. 结果 相较于不稳模型,在侧弯、屈、伸、旋转工况下枕骨髁螺钉内固定模型的活动度分别减少96.8%、95.6%、95.0%、98.5%;枕骨钢板螺钉内固定模型活动度减少96.3%、95.7%、98.4%、99.6%;经寰枕关节螺钉内固定模型活动度减少95.7%、94.0%、94.3%、98.9%.在侧弯、屈伸、旋转工况下,枕骨髁螺钉内固定的应力峰值为192.4 MPa、201.6 MPa、187.6 MPa;枕骨钢板螺钉内固定的应力峰值为279.6 MPa、213.7 MPa、154.1 MPa;经寰枕关节螺钉内固定的应力峰值为232.4 MPa、220.9 MPa、224.5 MPa.枕骨髁螺钉对舌下神经管壁的应力影响峰值为12.96 MPa,舌下神经管内容物形变为0.64%. 结论 枕骨髁螺钉内固定与枕骨钢板螺钉和经寰枕关节螺钉内固定相比具有相似的稳定性,但其应力分布更均匀,并且对舌下神经管的影响较小,因此枕骨髁螺钉作为枕颈融合的颅侧固定点是安全可靠的.

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abstracts:

Objective To explore the biomechanical properties of posterior occipital condyle screws compared with common occipitocervical fusion internal fixation and it's impacts upon stress of hypoglossal canals.Methods Finite element models based on the occipitocervical CT data of one 28-year-old male healthy volunteer were built,including normal model,instability model,internal fixation model by occipital condyle screws,internal fixation model by occipital plate screws,and internal fixation model by transarticular screws.Fifty N gravity and 1.5 N · m torque were exerted upon the surface of occipital bone so that the models could perform lateral bending,flexion,extension,and rotational motions.The motion range and stress distribution of internal fixation were compared under varying conditions among different occipitocervical fusion models.In addition,the impact of occipital condyle screw upon hypoglossal canals was examined.Results Compared with instability model,the motion range in the internal fixation model by occipital condyle screws declined by 96.8%,95.6%,95.0% and 98.5% respectively in lateral bending,flexion,extension and rotation.In the internal fixation by occipital plate screws,the motion range decreased by 96.3%,95.7%,98.4% and 99.6% respectively.In the internal fixation by transarticular screws,the motion range exhibited a decline of 95.7%,94.0%,94.3% and 98.9%,respectively.The stress peaks in the occipital condyle screw were 192.4 MPa,201.6 MPa and 187.6 MPa under lateral bending,flexion,and rotation conditions,respectively.The stress peaks in the occipital plate screw were 279.6 MPa,213.7 MPa,and 154.1 MPa,respectively.The stress peaks in the transarticular screw were 232.4 MPa,220.9 MPa,and 224.5 MPa,respectively.The stress impact peak of occipital condyle screw on the hypoglossal canals wall was 12.96 MPa,and the content deformationunder the hypoglossal canal was 0.64%.Conclusions The occipital condyle screw internal fixation has similar stability with common occipitocervical fusion fixations.The occipital condyle screw has more uniform stress distribution and less effect on the hypoglossal canals,and hence is safe and reliable as anchor point on the cranial side in occipitocervical fusion.

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作者: 马维虎 [1] 王扬 [2] 娄桢祺 [2] 徐顶立 [2] 李国庆 [1] 阮超越 [1] 赵华国 [1]
期刊: 《中华创伤杂志》2018年34卷4期 305-311页 ISTICPKUCSCD
栏目名称: 脊柱脊髓损伤
DOI: 10.3760/cma.j.issn.1001-8050.2018.04.004
发布时间: 2018-05-15
基金项目:
国家自然科学基金 浙江省医药卫生科技项目 宁波市创新团队项目(2015B11050)National Natural Science Foundation of China Zhejiang Medical and Health Science and Technology Project Ningbo Innovation Team Project
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