不同補骨來源及固定方式 之前位胸腰椎融合手術的生物力學評估

Biomechanical Evaluation of Different Bone Grafts Combined with Instrumentations in Anterior Thoracolumbar Fusion

余俊文(Jun-Wen Yu)

指導教授 ： 陳文斌 ； 黃聰仁

中原大學/工學院/醫學工程研究所/碩士(2003年)

https://doi.org/10.6840/cycu200300709

摘要

當脊椎損傷位置發生在脊柱前側和中間時，一般先施以前位手術切除損傷部位，再重建脊椎的穩定性是必要的，然而長時間脊椎的穩定性仍需依賴健全的骨融合，而在脊椎穩定過程中最重要的不是固定器本身，而是得到結實的骨融合，使用內固定器可提供脊椎暫時的穩定度且提高骨融合率。而在骨融合手術中，腸骨是最常被採用的自體移植骨，在前位胸腰椎手術時，肋骨常需被切除，因此可做為補骨來源的另一選擇，因此本研究目的為以有限元素法探討在前位椎體間融合手術，以腸骨及肋骨為不同補骨來源合併前後位不同鋼釘固定方式之生物力學效應。從分析結果顯示，施力為軸向壓力或彎曲力矩情況下，二段肋骨用於前位骨融合術結果和腸骨相當，一段肋骨則有應力集中現象，因此建議在骨融合手術時，可採用二段肋骨作為補骨材料。在固定器方面，不管是植入前位或後位固定器皆可減少移植骨的壓力，在骨融合初期提供脊椎穩定度，在施行胸腰椎之前位補骨融合手術時，固定器中同一節的兩支螺絲在椎體中有夾角或螺絲能穿透對側皮質骨，在降低移植骨上應力的效果較佳，而固定器加入橫連結桿可增加軸向扭轉時的穩定性。

關鍵字

補骨融合術 ； 脊椎內固定器 ； 補骨 ； 腸骨 ； 肋骨 ； 有限元素法

並列摘要

For lesion involved in the anterior and/or middle column of the spine, an anterior approach is adequate for curetting the lesion and restoring spinal stability. Long-term spinal stability still relies on the integrity of the bone fusion. The most important thing in spinal stabilization procedure is not instrumentation itself but finally solid fusion of bone graft. In spinal fusion surgery, bone grafts and instrumentations are commonly used to enhance bone fusion and to provide stability. In practice, autologous bone graft, such as, iliac bone crest is most often adopted. In anterior approach of thoracolumbar vertebral surgery, the ribs are often dissected and may be an alternative choice for bone graft besides iliac bone. The purpose of this study was to use a validated finite element model to evaluate the effects of using iliac bone, one rib or two-rib bone graft combined with anterior or posterior instrumentations in thoracolumbar interbody fusion surgery, under the condition of axial compression, lateral bending, flexion, extension and rotation. According to the analysis results, under the conditions of axial compression or flexion moment, the results of the two-rib and iliac bone graft conditions were similar. There was stress concentration on the one-rib graft. We suggest that under the condition of solid fusion, two-rib bone graft could be an alternative choice. For the results of instrumentations, both anterior and posterior instrumentations could reduce the stress on the interbody bone graft. They could provide initial support right after operation and prevent early collapse of bone graft. The constructs of the instrumentations were stronger if the screws penetrate the opposite side cortex of the vertebral body. Also the two screws were better when positioned triangulated than parallel. The cross link between the rods could strengthen the constructs of the instrumentations under axial rotation.

並列關鍵字

bone graft ； spinal instrumentation ； spinal fusion ； iliac bone ； rib bone ； finite element method

參考文獻

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