研究生: |
廖經凱 Jing-Kai Liao |
---|---|
論文名稱: |
不同椎間骨融合固定器於腰椎椎間盤切除術之生物力學分析 Biomechanical Analyses of Different Interbody Fusion Devices after a Lumbar Discectomy Surgery |
指導教授: |
趙振綱
Ching-Kong Chao 徐慶琪 Ching-Chi Hsu |
口試委員: |
釋高上
Kao-Shang Shih |
學位類別: |
碩士 Master |
系所名稱: |
工程學院 - 機械工程系 Department of Mechanical Engineering |
論文出版年: | 2012 |
畢業學年度: | 100 |
語文別: | 中文 |
論文頁數: | 81 |
中文關鍵詞: | 錨型椎籠 、鄰近節骨折 、鄰近節疾病 、腰椎 、前方固定術 、後方固定術 、運動活動度 |
外文關鍵詞: | Anchored Spacer, Adjacent Fracture, Adjacent Segment Disease, Lumbar Spine, ALIF, PLIF, Range Of Motion. |
相關次數: | 點閱:391 下載:7 |
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當脊椎的椎間盤受損時,骨科醫師進行椎間空間的重建手術,常會用椎籠加上外加的輔助固定,並配合骨融合做為穩定脊椎之功能,常用的外加固定方法有前方板型固定器和後方椎弓根骨螺絲系統。目前很多研究多著重在植入物的螺絲破壞強度研究,這些研究成果改善植入物失效的可能性,但是臨床上椎骨與椎間盤的損壞情況少有研究探討。
本研究主要針對一種獨立椎籠(Anchored spacer)與常見的脊椎前後方固定方法(ALIF、PLIF),此三種固定方法使用於L4/L5椎間盤切除術,對於鄰近節脊椎的影響,經由四種三維模型包含:完整腰椎、獨立固定、ALIF、PLIF,並使用常見的前彎、後彎、側彎、旋轉運動進行分析,找出脊椎固定後可能的損壞部位。
分析結果顯示,在同樣的力量負載情況下,PLIF的固定穩定度最佳,但是會增加L3/L4椎間盤和下節L5椎骨的額外負擔;ALIF的固定穩定度最差,且會增加上下節L4、L5椎骨的負擔,但是椎間盤的總應能與完整腰椎最接近;Anchored spacer的固定穩定度介於ALIF與PLIF之間,特性與ALIF比較接近,對下L5椎骨的負擔比ALIF小。在相同的運動活動度下,PLIF會使椎體與椎間盤有最大的應變能增加量,增加量最多的部位在L5椎體與L3/L4椎間盤;ALIF的椎體與椎間盤應變能增加量,是三種固定器中最小者,負擔主要集中在L5椎體與L5/S1椎間盤;Anchored spacer則是介於ALIF與PLIF之間。因此同時考慮穩定度與鄰近節的應變能變化情況,Anchored spacer是一個可以考慮的手術選擇。
The discectomy and interbody fusion surgery are used to treat degenerative disc disease. The surgical operations usually use cages and additional fixation devices to stablize the fusion vertebrae. The common fixation devices were applied including anterior plates or posterior pedicle screw system. There are many studies to improve implants’ strength recently. Those studies reduced the possibility of implant failure, but little studies mention the adjacent disc disease or the adjacent vertebral fracture.
Our study developed finite element models of L1-S1 multi-level lumbar spine to investigate the biomechanical performances of the spine with three types of lumbar fusion devices at L4/L5 disc. Those devices included PLIF(cages plus posterior pedicle screw system), ALIF(cages plus anterior plate), and stand-alone cage (Anchored spacer). Four types of loading conditions were applied to investigate the biomechanical performances of each fusion devices including flexion, extension, lateral bending, and torsion.
The results showed that, PLIF is the most stable fusion type, but it would increase the strain energy on L3/L4 disc and L5 vertebra; ALIF is the most instable fusion type, and it would increase the strain energy on L5/S1 disc and L5 vertebra. The stability of Anchored spacer was between PLIF and ALIF. The increment of strain energy was also between PLIF and ALIF, and the strain energy occurred on L5/S1 disc and L5 vertebra.
In conclusion, if we consider stability and increment of strain energy of fusion type at the same time, the Anchored spacer may be a suggested option for lumbar interbody fusion.
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