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研究生： 王智緯
Chih-wei Wang
論文名稱： 腰椎動靜態組合式內固定器的生物力學研究
Biomechanical study about rigid and semi-rigid design for lumbar fixator
指導教授： 林上智
Shang-chih Lin
口試委員: 陳世豪
Shih-hao Chen
許維君
Wei-jyun Syu
學位類別： 碩士
Master
系所名稱： 應用科技學院 - 醫學工程研究所
Graduate Institute of Biomedical Engineering
論文出版年： 2012
畢業學年度： 100
語文別： 中文
論文頁數： 183
中文關鍵詞： 腰椎 、有限元素分析 、後方固定器 、動態固定器
外文關鍵詞： lumbar, pedicle screw fixator
相關次數： 點閱：157  下載：16 
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  •  上一筆

    • 目前臨床上利用穿椎弓根靜態固定器治療腰椎退化已被廣泛接受，但是此手術方式常會引起手術區域鄰近節的加速退化問題，許多文獻報告亦證明出固定區域的運動學以及力學的限制，是此類手術區域鄰近節加速退化的主要原因。雖然近年來已設計出許多強調動態效果；或者是可以與傳統靜態進行搭配的固定器，但是其使用方式及效果在臨床上仍然不明確，並且被廣泛討論。本研究利用電腦斷層掃瞄(CT)掃瞄出成年人L1至S1脊椎並建立長節有限元素腰椎模型。並且為了更真實模擬出手術情形，建立了三種不同的退化等級，並利用三種不同型態之動靜態混和式後方固定器給予治療，希望由分析結果了解不同植入物之生物力學情形，並且建立出後方固定器剛性與不同退化等級的平衡區間。
    由研究結果可以發現關節螺絲頭型態後方固定器之動態螺絲並無明顯的旋轉，並且在四種運動情形下皆可觀察到明顯的手術鄰近節補償問題，本研究認為主要是因為固定器骨螺絲植入方向與腰椎運動方向不同所造成。關節連接桿型態後方固定器在不同退化等級也發現手術鄰近節有明顯的退化加速問題，其主要原因為軟性墊片材質剛性較強，並且最大軸向位移量受到限制，然而本研究認為由於此種設計具有良好的椎間盤高度維持能力，並且提供些微的動態效果，因此使用於動態骨融合手術為較好的選擇。由研究結果可以發現饒性連接桿固定器在四種運動情形下腰椎運動能力較植入另外兩種固定器佳，然而固定器方姓仍舊過大。因此本研究建立一平衡區間，並且發現隨著退化等級提升，植入物所需的剛性則越強。

    Lumbar fusion with a rigid fixator has been the widely accepted treatment of degenerative disc disease. However, the previous studies report that the junctional problem is the common complications at the adjacent levels. However, there is still no extensively study to investigate the kinematic and mechanical behavior of fixed and transition levels.This study aims to evaluate stress distribution, facet contact force and motion pattern of instrumented lumbar with the rigid (titanium), and 3 diffenent type of dynamic fixators (joint, hinge and spacer type). The CT-based lumbar from L1 vertebra to L5/S1 disc is developed. The behavior of seven ligaments and five muscles are modeled, and the geometric and mechanical properties of lumbar tissues and fixator components are cited from the literature. The kinematic and mechanical compensation from the fixed to transition levels are predicted in this study. The results show that both hinge type and joint type fixator have adjacent segment disease (ASD). And the higher rigidity of fixator is used, the severer stress and motion is compensated. This is correlated with the literature findings. Compared with the rigid fixation, the use of dynamic fixator can reduce the stress (motion) compensation at the transition levels. The stiffness-related problem is more significantly reduced by the dynamic fixator. This indicates the flexible design of cord and spacer can effectively suppress the junction problem. For the semi-rigid or dynamic fixator, the fixator-assisted constraints at the L3/L4 level can reduce the stress (motion) compensation at the bridged level. However, the stress and motion at the cephalic (L2/L3) level is highly affected than the caudal (L5/S1) level by the hybrid fixator.

    摘要 I ABSTRACT II 致謝 III 目錄 IV 第一章 緒論 1 1.1 研究背景及目的 1 1.2 腰椎的解剖、病理及生物力學 2 2.3.1.肌肉與韌帶 4 1.2.2.前方椎體 6 1.2.3.後方元件 8 1.2.4.椎間盤 11 1.2.5.椎間盤退化 13 1.3 腰椎動靜態椎弓足固定器介紹 15 1.3.1.高強度連接桿固定器 20 1.3.2.具饒性連接桿固定器 20 1.3.3.具關節連接桿固定器 21 1.3.4.具關節螺絲頭固定器 23 1.3.5.動靜態混和式固定器 24 第二章 文獻回顧 28 2.1 腰椎椎間盤退化研究 28 2.2 固定區域鄰近節問題 33 2.3 動態固定器臨床報告 36 2.4 動態固定器體外測試 42 2.5 腰椎有限元素法分析 48 第三章 材料方法 55 3.1 健康腰椎有限元素模型建立 55 3.1.1幾何模型建立 56 3.1.2材料參數設定 60 3.1.3腰椎組織介面接觸行為 60 3.1.4網格參數設定 62 3.1.5肌肉與韌帶系統 63 3.1.6運動形式設定 65 3.1.7運動分析結果與驗證 66 3.2 退化腰椎有限元素模型建立 67 3.2.1椎間盤退化等級建立 67 3.2.2腰椎退化位置建構 68 3.3 後方椎弓足植入物模型建立 70 3.3.1靜態固定器 70 3.3.2具饒性連接桿形式 72 3.3.3具關節連接桿形式 75 3.3.4具關節螺絲頭形式 77 3.4 鄰近區域之力學與運動學轉移 79 3.4.1椎間盤運動角度運算方式 79 3.4.2手術固定區域之鄰近節問題 80 3.4.3動態固定器的平衡剛性概念 81 第四章 結果 84 4.1. 健康有限元素腰椎模型驗證 84 4.2. 腰椎不同退化等級模擬結果 85 4.3. 單節靜態固定器之腰椎生物力學分析 93 4.4. 動靜態混合固定器之腰椎生物力學分析 100 4.4.1不同型態固定植入相同退化程度椎 101 4.4.2不同退化等級搭配饒姓連接桿固定器 109 4.4.3不同退化等級搭配關節連接桿固定器 116 4.4.4不同退化等級搭配關節螺絲頭固定器 123 4.5. 動態固定器之剛性平衡區間分析與建立 131 4.5.1具饒性連接桿固定器平衡區間探討 131 4.5.2具關節連接桿固定器平衡區間探討 144 第五章 討論 156 5.1 有限元素模型之基本假設與誤差來源 157 5.1.1幾何與材質之假設與限制 157 5.1.2腰椎肌肉群之假設與限制 157 5.1.3負載條件的探討 158 5.1.4退化椎間盤之假設與限制 158 5.1.5椎弓足固定器之假設與限制 159 5.1.6驗證之討論 159 5.2 手術鄰進節退化問題結果與討論 160 5.2.1退化模型討論 161 5.2.2單節靜態固定器生物力學討論 162 5.2.3動靜態混用固定器之模擬結果討論 163 5.2.4植入物剛性區間概念討論 169 5.3 研究結果之臨床意義 171 第六章 結論 173

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