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基于回顾性临床病例的颈椎后凸畸形矫正的个体化数值研究

Patient-specific numerical investigation of the correction of cervical kyphotic deformity based on a retrospective clinical case.

作者信息

Wu Tianchi, Chen Hongyu, Sun Yu, Xia Tian, Zhou Feifei, Lu William W

机构信息

Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.

Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China.

出版信息

Front Bioeng Biotechnol. 2022 Sep 9;10:950839. doi: 10.3389/fbioe.2022.950839. eCollection 2022.

DOI:10.3389/fbioe.2022.950839
PMID:36159686
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9500315/
Abstract

Little research has been reported on evaluating the safety of the fixation construct in cervical kyphosis correction. In this study, we proposed a principal-strain criterion to evaluate the safety of the fixation construct and validated the modeling method against a retrospective case of anterior cervical discectomy fusion (ACDF). From C2 to T2 vertebra bodies, fixation instruments were reconstructed and positioned as per postoperative computed tomography (CT) scans. Head weight (HW) and various moments estimated from isometric strength data were imposed onto the C2. The postoperative stability of non-surgical segments, deformations surrounding the screw trajectories, and contact slipping on zygapophysial joints were analyzed. The model was validated against the reality that the patient had a good fusion and deformity correction. The ACDF restricted the range of motions (ROMs) of cervical segments and lent stability to vertebra fusion, no failure was found in the finite element (FE) model of cervical vertebrae. The deformation surrounding the screw trajectories were concentrated to the lateral sides of trajectories, recommending that the shape of the anterior cervical plate conforming to the curvature of the vertebra and screws fully inserted into vertebrae reduced the deformation concentration around the screw trajectories.

摘要

关于评估颈椎后凸畸形矫正中固定结构安全性的研究报道较少。在本研究中，我们提出了一种主应变标准来评估固定结构的安全性，并针对一例颈椎前路椎间盘切除融合术（ACDF）的回顾性病例验证了建模方法。从C2至T2椎体，根据术后计算机断层扫描（CT）图像重建并定位固定器械。将头部重量（HW）和根据等长肌力数据估算的各种力矩施加于C2。分析了非手术节段的术后稳定性、螺钉轨迹周围的变形以及关节突关节上的接触滑动情况。该模型依据患者融合良好且畸形矫正的实际情况进行了验证。ACDF限制了颈椎节段的活动范围（ROM）并为椎体融合提供了稳定性，在颈椎有限元（FE）模型中未发现失败情况。螺钉轨迹周围的变形集中在轨迹的外侧，这表明符合椎体曲率的颈椎前路钢板形状以及将螺钉完全插入椎体可减少螺钉轨迹周围的变形集中。

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