前方腰椎椎間骨融合術(ALIF)已被廣泛的使用於治療椎間盤的疾病，其常用的手術方式為以一對椎籠替代退化的椎間盤，若僅使用椎籠時易發生手術環節的不穩定，需要加入後方固定結構予以增加強度，而後方固定技術也慢慢的由傷害性較大的椎弓根螺絲固定術發展到手術容易且傷害性小的小面關節固定術，但小面關節固定術的穩定度一直備受爭議，有鑑於此，在單層ALIF中，本研究嘗試找出最佳的椎籠擺放位置，以增加前方支撐結構的強度，提高小面關節固定術的可用性，而在雙層ALIF中，本研究則針對五種後方固定結構進行分析與討論，評估四種固定器是否可以替代椎弓根螺絲的可能性。
本研究建立三維的腰椎有限元素模型，將其應用於單層(L4/L5)與雙層(L3/L4，L4/L5)ALIF的模擬，在分析椎籠最佳位置的研究中，田口方法被用來規劃有限元素分析模型的組合，其中考慮三個三水準的控制因子:椎籠前後位置、椎籠間距離與兩椎籠間的角夾型式，兩個兩水準的雜訊因子: 軸向壓力的大小與鬆質骨的強度，因此L9直角表被使用於實驗設計，ANOVA分析則使用於求得各因子的貢獻度，而最佳的椎籠位置定義為能夠提供手術環節最大的穩定度，最後利用求得的最佳的椎籠位置，進行生物力學實驗的評估。在雙層ALIF中比較五種後方固定結構在六種負載下的力學特性，因此本研究建立三種椎弓根螺絲加圓桿的固定結構與兩種小面關節固定結構的有限元素模型，以軸向位移、角位移、L4椎體的前位移量、後方固定器總應變能與L4椎體的總應變能作為評估後方固定結構強度的依據。
根據有限元素分析與生物力學實驗的結果，本研究發現椎籠放置的位置會明顯的影響ALIF的穩定性，而最好的椎籠擺放方式為:(a)椎籠置於前方的椎間區域;(b)增大兩椎籠間的距離;(c)兩椎籠間以發散角度擺放，而且以(a)點為優先考量。本研究所建議的椎籠放置方式可以避開端板上最脆弱的中間區域、可放置大量的移植骨於易骨融合的中間與後方區域、椎籠不易後退至椎孔中、在四種力矩負載下具有良好的穩定度與減少後方固定器失效的可能性。
在雙層ALIF中，本研究不建議省略在中間椎體的椎弓根螺絲的手術方式，因為就算加入後方橫桿也無助於抵抗中間椎體可能的移動。兩種小面關節固定結構在側曲負載時，不但手術環節有大的角位移，而且螺絲也可能有較大的變形發生，此提高了固定結構失效的可能性，因此本研究不建議小面關節固定術應用於雙層ALIF中，在五種後方固定結構中，三節椎體皆使用椎弓根螺絲加桿的固定方式能夠提供最佳的穩定度。
本論文之研究成果可提供骨科醫師在骨融合手術時植入椎籠位置的參考，也提供在多層ALIF時選用後方固定器的依據。

Anterior Lumbar Interbody Fusion (ALIF) has been widely used to treat internal disc degeneration. Several biomechanical studies, however, have demonstrated that stand-alone ALIF cages could not provide enough stability for the fusion segment. Therefore, additional posterior instrumentation has been used to increase the stability for the stand-alone ALIF. The development of the posterior fixation, from traditional pedicle screw fixation (PSR) and translaminar facet screw fixation (TLFS) to transfacet pedicle screw fixation (TFPS), has achieved less injury and a simpler procedure. However, the stability of the low-profile fixation is still questionable, especially during cyclic loading. The purpose of the present study, for single-level ALIF, is to investigate the optimum cage position and orientation to increase the strength of anterior support and this may enable the TFPS to be used with greater confidence. For two-level ALIF, the aim of this research was to assess the biomechanical behavior of each fixation construct immediately after surgery and to discuss the relationship between out finite element results and the current literature.
A three –dimensional finite element models have been developed to simulate the single (L4/l5) and two-level (L3/L4 and L4/L5) ALIF. Taguchi method and the FEM of the single-level ALIF were used to evaluate the optimized placement of the cages, after that those results were verified by the biomechanical testing. The FEM of two-level ALIF was used to evaluate the initial biomechanical behavior of five types of posterior fixation devices under six loading conditions. These fixation constructs included a three-level pedicle screw and rod, a two-level translaminar facet screw, a two-level transfacet pedicle screw, a bisegmental pedicle screw and rod, and a bisegmental pedicle screw and rod with cross-linking.
From the results of the FEA and Taguchi method, we suggest that the optimal cage positioning has anterior and widely bilateral placement and a diverging angle between the two cages. The results show that the optimum cage position simultaneously contributes to a stronger support of the anterior column and lowers the risk of TFPS loosening and these findings were similar to the results of biomechanical testing. After biomechanical testing, the more anterior placement of the cages shows to provid more stability than the other setting.
The results of this study demonstrate that the three-level pedicle screw and rod provide the best biomechanical stability compared to the other four types of posterior fixation constructs. Both two-level facet screw fixation constructs showed unfavorable loading in lateral bending. For the construct of the three-level pedicle screw and rod, the middle-segment pedicle screw should not be omitted even though a cross-link is used. The two-level ALIF models with cages and posterior fixation constructs that we developed can be used to evaluate the initial biomechanical performance of a wide variety of posterior fixation devices prior to surgery.
The results of this dissertation could be use to guide surgical technique for placement of interbody cage devices in ALIF surgery and help surgeons in selecting posterior instrumentation for multisegment ALIF fusion.

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