Lenke5型青少年特发性脊柱侧凸手术矫形的有限元研究

摘要

目的 通过建立有限元模型探讨Lenke 5型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的最佳手术方案.方法 建立Lenke 5型AIS的有限元模型,模拟4种不同方案的90°去旋转和压缩序贯矫形,比较矫形效果及矫形后脊椎的应力水平.结果 4种方案有限元模型模拟矫形后的腰椎侧凸Cobb角分别为22°、23°、26°和26°.矢状面曲度得到维持,但前路短节段融合的脊椎应力水平较高.在远端融合止于下端椎时前路单棒与后路全节段椎弓根钉固定的顶椎旋转矫正角度分别为41.68°和37.79°.结论 模型成功模拟了4种方案的90°去旋转和压缩矫形.对柔韧性较差的Lenke 5型AIS,在远端融合止于下端椎时,全椎弓根螺钉固定可取得满意的矫正效果.%Objective To seek the best surgical protocol of Lenke 5 adolescent idiopathic scoliosis (AIS) through finite element simulation.Methods Four surgical strategy with the model of AIS were designed and simulated.All the main steps including derotation and compression of each strategy were simulated.The stress variation of the spine and corrective effect wore compared among the protocols of different surgical approach and fusion level.Results Coronary lumbar deformity was corrected to 22°,23° ,26°and 26°for the 4 surgical protocols used in the simulation, respectively.Physiological sagittal plane configuration was maintained, but higher stress in the anterior short fusion.A similar apical rotational correction was recorded between anterior single-rod corrction(41.68°) and posterior whole segment pedicle screw fixation (37.79° )when fused to the inferior extremity vertebra.Conclusion The model simulate correction procedures including 90°derotation and compression suecessfully.For Lenke 5 ALS, when fuse to the inferior extrenmity vertebra, whole segment pedicle screw fixation can achieve satisfactory corection effect.