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强直性脊柱炎后凸畸形患者数字化术前设计、临床应用及有限元分析的病例报告

A case report on digital preoperative design, clinical application and finite element analysis for a patient with ankylosing spondylitis kyphosis.

作者信息

Zhu Lei, Zhang Chi, Peng Li, Cheng Zifei, Liang Xiuwen

机构信息

Department of Orthopedics, Hulunbeir People's Hospital, Hulunbuir, China.

Department of Endocrinology, Hulunbeir People's Hospital, Hulunbuir, China.

出版信息

Front Bioeng Biotechnol. 2023 Sep 12;11:1220102. doi: 10.3389/fbioe.2023.1220102. eCollection 2023.


DOI:10.3389/fbioe.2023.1220102
PMID:37771572
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10523558/
Abstract

By assessing a case of ankylosing spondylitis (AS) after thoracic lumbar protrusion deformity in a digital model and verifying its effectiveness after surgery for orthopaedic surgery process simulation, a finite element model was established for biomechanical experiments. A 56-year-old patient with AS underwent preoperative thoracic lumbar spine computed tomography. The data were reconstructed using MIMICS16.0 software and modelled to design and measure the nailing parameters. A three-dimensional model was established using ANSYS14.0 software, and the actual surgical procedure was simulated using biomechanical experiments. The model was verified by comparing the X-ray films obtained from patients during preoperative forward bending, stretching and lateral flexion, with the model further tested using the Hueter-Volkmann principle. On comparing the measurements across three different load cases (forward bending, after stretching and lateral flexion) in patients with AS after thoracic lumbar protrusion deformity and the original X-ray images, no difference was found between the model of deformation and real patient movement displacement across the vertebral body. On simulating the stress distribution, the measured T10-L4 vertebral body stress values at every point in the injured vertebrae were, on the whole, directed at both the upper and lower ends and exhibited a decreasing trend, and the stress distribution gradually decreased from the injured vertebrae (T12 and L1) to the upper and lower ends. The accuracy of the research model is high, the geometric similarity is good and relevant applied anatomy can be undertaken using the model parameter measurement. This study provides a successful example of the application of digital technology in the field of spinal deformity and a novel idea for the treatment of AS-related kyphosis.

摘要

通过在数字模型中评估一例胸腰椎后凸畸形后的强直性脊柱炎(AS)病例,并在骨科手术过程模拟中验证其手术后的有效性,建立了用于生物力学实验的有限元模型。一名56岁的AS患者接受了术前胸腰椎计算机断层扫描。使用MIMICS16.0软件重建数据并进行建模以设计和测量钉扎参数。使用ANSYS14.0软件建立三维模型,并通过生物力学实验模拟实际手术过程。通过比较患者术前前屈、伸展和侧屈时获得的X线片对模型进行验证,并使用休特-福尔克曼原理对模型进行进一步测试。比较胸腰椎后凸畸形的AS患者在三种不同负荷情况下(前屈、伸展后和侧屈)的测量结果与原始X线图像,发现椎体变形模型与真实患者运动位移之间没有差异。在模拟应力分布时,受伤椎骨各点处测得的T10-L4椎体应力值总体上指向上下两端并呈下降趋势,应力分布从受伤椎骨(T12和L1)向上下两端逐渐降低。研究模型准确性高,几何相似性好,可利用模型参数测量进行相关应用解剖学研究。本研究为数字技术在脊柱畸形领域的应用提供了成功范例,为AS相关驼背的治疗提供了新思路。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/aa9cae4dad6c/fbioe-11-1220102-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/d7f3ec9643ec/fbioe-11-1220102-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/8f8d223b2510/fbioe-11-1220102-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/8cf0f8581fd7/fbioe-11-1220102-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/88ddbc35a2b2/fbioe-11-1220102-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/dfa717f7ea56/fbioe-11-1220102-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/8624b1404e98/fbioe-11-1220102-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/1b8f49c21f8e/fbioe-11-1220102-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/2ddaea7655e2/fbioe-11-1220102-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/aa9cae4dad6c/fbioe-11-1220102-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/d7f3ec9643ec/fbioe-11-1220102-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/8f8d223b2510/fbioe-11-1220102-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/8cf0f8581fd7/fbioe-11-1220102-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/88ddbc35a2b2/fbioe-11-1220102-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/dfa717f7ea56/fbioe-11-1220102-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/8624b1404e98/fbioe-11-1220102-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/1b8f49c21f8e/fbioe-11-1220102-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/2ddaea7655e2/fbioe-11-1220102-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ceb9/10523558/aa9cae4dad6c/fbioe-11-1220102-g009.jpg

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引用本文的文献

[1]
[Advances in application of digital technologies in surgery for ankylosing spondylitis].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025-7-15

本文引用的文献

[1]
Comparison of corrective and clinical effects between SRS-Schwab grade IV osteotomy combined with the interbody fusion cage and pure grade IV osteotomy in the treatment of old thoracolumbar vertebral osteoporotic fractures with kyphosis.

Ann Palliat Med. 2022-1

[2]
Multiple-Rod Constructs Do Not Reduce Pseudarthrosis and Rod Fracture After Pedicle Subtraction Osteotomy for Adult Spinal Deformity Correction but Improve Quality of Life.

Neurospine. 2021-12

[3]
Effectiveness and safety of Chinese herbal formula combined with western medicine for ankylosing spondylitis: A protocol for systematic review and meta-analysis.

Medicine (Baltimore). 2021-6-25

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Does the Level of Pedicle Subtraction Osteotomy Affect the Surgical Outcomes in Ankylosing Spondylitis-Related Thoracolumbar Kyphosis With the Same Curve Pattern?

Global Spine J. 2022-9

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Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020-12-15

[6]
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BMC Musculoskelet Disord. 2020-9-28

[7]
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Clin Rheumatol. 2021-4

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