[1]王志强彭鑫王渊博王崇宇杨光王红强**高延征**.不同骨质条件下斜外侧椎间融合术联合侧方钢板固定的生物力学稳定性的有限元研究[J].中国微创外科杂志,2025,01(9):557-565.
　Wang Zhiqiang,Peng Xin,Wang Yuanbo,et al.Biomechanical Stability of Oblique Lumbar Interbody Fusion Combined With Lateral Plate Fixation Under Different Bone Conditions: a Finite Element Study[J].Chinese Journal of Minimally Invasive Surgery,2025,01(9):557-565.
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不同骨质条件下斜外侧椎间融合术联合侧方钢板固定的生物力学稳定性的有限元研究()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年9期
页码:
557-565
栏目:
实验研究
出版日期:
2025-09-25

文章信息/Info

Title:
Biomechanical Stability of Oblique Lumbar Interbody Fusion Combined With Lateral Plate Fixation Under Different Bone Conditions: a Finite Element Study
作者:
王志强彭鑫王渊博王崇宇杨光王红强**高延征**
(河南省人民医院郑州大学人民医院脊柱脊髓外科，郑州450003)
Author(s):
Wang Zhiqiang;  Peng Xin;  Wang Yuanbo;  et al.
Department of Spinal Cord Surgery, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450003, China
关键词:
腰椎; 斜外侧椎间融合术; 内固定; 有限元
Keywords:
Lumbar fusion; Oblique lumbar interbody fusion; Internal fixation; Finite element
文献标志码:
A
摘要:
目的借助有限元(finite element，FE)分析不同骨质条件下斜外侧椎间融合术(oblique lumbar interbody fusion，OLIF)联合侧方钢板(lateral plate，LP)固定方式的生物力学特性，为临床提供力学依据。方法构建脊柱三维非线性L3~5的FE模型。模型每个部位分配不同的材料特性从而建立腰椎正常骨质(normal bone，NB)、骨量减少(osteopenia，OS)和骨质疏松(osteoporosis，OP)模型。构建OLIF联合3种内固定模型，分别为NB下：单纯OLIF(M0)、单纯OLIF＋侧方钢板（lateral plate,LP）固定(M1)、单纯OLIF＋双侧椎弓根螺钉(bilateral pedicle screw，BPS)固定(M2)；OS下：单纯OLIF(N0)、单纯OLIF＋LP固定(N1)、单纯OLIF＋BPS固定(N2)；OP下：单纯OLIF(P0)、单纯OLIF＋LP固定(P1)、单纯OLIF＋BPS固定(P2)。在L3上表面施加500 N的载荷代表上半身的重量，采用7.5 N·m的力矩来模拟前屈(flexion，FL)、后伸(extension，EX)、左侧弯(left bending，LB)、右侧弯(right bending，RB)、左旋转(left rotation，LR)、右旋转(right rotation，RR)6种不同工况的椎体运动，计算NB、OS和OP模型的固定节段活动度(range of motion，ROM)，记录椎体整体应力、融合器(Cage)应力以及内固定器械的最大应力。结果与完整模型相比，各手术模型的稳定性均有所增加，相比M0，M1腰椎ROM均降低，在左右侧弯方向下降最为明显，与BPS固定稳定性大致相当，但在控制屈伸方向稳定性弱于BPS固定。OS、OP模型的情况与NB模型类似。在同种内固定下，L4/5 ROM随骨质恶化逐渐增加，整体椎间ROM N1相比M1在FL时升高16.1%，P1相比M1在FL时升高321%，P1相比N1在FL时升高190%。随着后路内固定的增加，椎体整体应力、Cage和内固定应力总体上均呈下降趋势。在相同内固定下，随着骨量丢失，模型的整体应力逐渐增加。与M0相比，P0在LR增大最多，达到56.5%。在NB和OS模型中前屈下LP固定应力分别超过材料最低屈服强度22.7%和338%，其余运动下内固定应力均小于材料最低疲劳强度和屈服强度；在OP模型中，前屈和后伸时内固定峰值应力超过材料最低疲劳强度，前屈时达到53.3%(>50%)。结论在NB和OS下，OLIF联合LP固定可以明显提高手术节段稳定性，特别是在侧弯方向，但整体稳定性弱于BPS固定。在OP下，屈伸运动时可能会增加内固定失败的风险，应考虑联合BPS固定，提高固定安全性。
Abstract:
ObjectiveTo clarify the biomechanical properties of oblique lumbar interbody fusion (OLIF) combined with lateral plate (LP) fixation under different bone conditions by means of finite element (FE) analysis, so as to provide mechanical basis for clinical practice.MethodsThe threedimensional nonlinear L3-5 FE model of the spine was constructed. Different material properties were assigned to each part of the model to establish a model of normal bone (NB), osteopenia (OS) and osteoporosis (OP) of the lumbar spine. OLIF combined with the following three internal fixation models were established. For NB, there were OLIF alone (M0), OLIF+LP fixation (M1), and OLIF+bilateral pedicle screw (BPS) fixation (M2); for OS, there were OLIF alone (N0), OLIF+LP fixation (N1), and OLIF+BPS fixation (N2); for OP, there were OLIF alone (P0), OLIF+LP fixation (P1), and OLIF+BPS fixation (P2). A 500 N load was applied on the upper surface of L3 to represent the weight of the upper body, and a 75 N·m moment was used to simulate the vertebral motion under six different conditions: flexion (FL), extension (EX), left bending (LB), right bending (RB), left rotation (LR) and right rotation (RR). The range of motion (ROM) of the fixed segment of NB, OS and OP models was calculated, and the overall stress of the vertebral body, the stress of the cage and the internal fixation device were recorded.ResultsCompared with the complete model, the stability of each surgical model increased. Compared with M0, ROM of M1 decreased, especially in the LB and RB, which was roughly equivalent to the stability of BPS but weaker than BPS in the control FL and EX direction. The situation in OS and OP model was similar to that in NB. Under the same internal fixation, L4-5 ROM gradually increased with bone deterioration. The overall intervertebral ROM of N1 in the FL direction increased by 16.1% compared with M1, P1 in the FL direction increased by 32.1% compared with M1, and P1 in the FL direction increased by 19.0% compared with N1. With the increase of posterior internal fixation, the overall stress of vertebral body, Cage and internal fixation stress showed a downward trend. Under the same internal fixation, with the loss of bone mass, the overall stress of the model gradually increased. Compared with M0, P0 increased the most in LR, reaching 56.5%. In the NB and OS models, the peak stress of the LP fixation under FL exceeded the minimum yield strength of the material by 22.7% and 33.8%, respectively, and was less than the minimum fatigue strength and yield strength of the material under the rest of the motion. In the OP, the peak stress of the internal fixation exceeded the minimum fatigue strength of the material at FL and EX, and reached 53.3%(>50%) at FL.ConclusionsUnder NB and OS, OLIF combined with LP fixation can significantly improve the stability of the surgical segment, especially in LB and RB directions, and the overall stability is weaker than that of BPS fixation. Under OP, FL and EX may increase the risk of internal fixation failure. Combination with BPS fixation should be considered to improve the safety of fixation.

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备注/Memo

备注/Memo:
基金项目：河南省医学科技攻关计划省部共建项目（SB201901085）**通讯作者，Email：13598889672@163.com（王红强）；yanzhenggaohn@163.com（高延征）
更新日期/Last Update: 2025-10-17