Coflex动态固定联合腰椎融合手术的三维有限元分析

作者	单位	邮编
董奥坤^*	长江大学附属荆州医院骨科,湖北荆州,434020	434020
马亮	长江大学附属荆州医院骨科,湖北荆州,434020	434020
许永涛^*	长江大学附属荆州医院骨科,湖北荆州,434020	434020

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中文摘要:

目的采用三维有限元分析的方法分析Coflex动态固定联合后路腰椎椎间融合术（posterior lumbar interbody fusion, PLIF）及经椎间孔腰椎椎间融合术（transforaminal lumbar interbody fusion, TLIF）的生物力学的比较。方法将来自64排螺旋CT的L₁-骨盆扫描的数据用Mimics软件处理，初步建立出L₁-S₁的脊柱模型，再用Geomagic Studio软件进行优化。用Pro/E软件将模型实体化，构建正常模型、L_4-5双侧后路腰椎椎体间融合术+Cage+L_3-4棘突间植入Coflex动态固定模型（双侧PLIF+Coflex模型）及L_4-5单侧经椎间孔入路腰椎椎体间融合术+Cage+L_3-4棘突间植入Coflex动态固定模型（单侧TLIF+Coflex模型），用Hypermesh和MSC.Patran/Nastran软件网格划分模型，对模型进行赋值后模拟腰椎6种体位得到数据进行分析。结果在加载6种体位载荷时，TLIF+Coflex模型及PLIF+Coflex模型与正常模型的弯曲刚度差别较小。与正常模型比较，PLIF+Coflex模型比TLIF+Coflex模型更显著降低了L_3-4椎间盘应力，但TLIF+Coflex模型的L₅-S₁椎间盘应力增加更显著。两种手术模型L_3-4和L₅-S₁椎间盘活动度较正常模型明显增加。两种手术方式模型的应力在钉棒系统上较为集中。结论 PLIF+Coflex和TLIF+Coflex两种手术方式不仅能保持术后腰椎的稳定性，还能有效降低融合上一节段的椎间盘应力，但是会增加融合下一节段的椎间应力和融合邻近节段椎间盘的活动度。两种手术方式生物力学效应存在差异，PLIF+Coflex手术方案在保护上位邻近节段方面更具优势。

英文摘要:

Objective To use the three-dimensional finite element analysis method to compare the biomechanics of Colfex dynamic fixation combined with PLIF and TLIF.Methods Data from L₁ pelvic scans acquired by 64 slice spiral CT were processed using Mimics software to establish a preliminary spinal model of L₁-S₁, and optimize it using Geomagic Studio software. Pro/E software was used to materialize the model and construct a normal model, an L_4-5 bilateral posterior lumbar interbody fusion + Cage + L_3-4 spinous process-implanted Coflex dynamic fixation model (bilateral PLIF+Coflex model), and an L_4-5 unilateral transforaminal lumbar interbody fusion + Cage + L_3-4 spinous process-implanted Coflex dynamic fixation model (unilateral TLIF+Coflex model). Hypermesh and MSC Patran/Nastran were used for meshing and assigning material properties to the model and simulate six different positions of the lumbar spine to obtain data. Finally, the results and conclusions were analyzed.Results When loading 6 postures, the bending stiffness of the TLIF+Coflex model and PLIF+Coflex model showed minimal differences compared to the normal model. Compared to the normal model, the PLIF+Coflex model significantly reduced the stress on the L_3-4 intervertebral disc more than the TLIF+Coflex model, while the TLIF+Coflex model exhibited a more pronounced increase in stress on the L₅-S₁ intervertebral disc. Both surgical models demonstrated significantly increased disc mobility at L_3-4 and L₅-S₁ compared to the normal model. The stress distribution in both surgical models was more concentrated on the rod-screw system.Conclusion Both PLIF+Coflex and TLIF+Coflex surgical approaches can not only maintain postoperative lumbar stability but also effectively reduce intervertebral disc stress in the upper fused segment. However, they may increase intervertebral stress in the lower fused segment and the mobility of the adjacent segment disc. There are biomechanical differences between the two surgical methods, with the PLIF+Coflex approach offering greater advantages in protecting the superior adjacent segment.

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