胸腰椎骨折合并后凸畸形矫正的生物力学机理研究

Patients with thoracolumbar traumatic kyphosis (TL-TK) often accompany with alteration of sagittal alignment, leading to the changes of biomechanical characteristics of the spine column. Thus how to choose proper surgical strategy for patients with TL-TK has always been a hotpot and a difficulty. Theoretically, essential factors as degree of local kyphosis, types of spinal sagittal alignment, types of osteotomy and fusion segments will affect the postoperative outcomes. However, the types of osteotomy and fusion segments have mainly relied on clinical experience with the lack of biomechanical theoretical research support. In this study, we try to combine ultrathin sheet plastination slice and finite element analysis, and establish accurate finite element models mimicking different types of osteotomy and fusion segments for patients with TL-TK. Mutual authentication will be made by biomechanical results from finite element analysis and specimen measurement after mechanical analysis. Under different types of sagittal alignment, this study aims to clarify the effect of different types of osteotomy and fusion segments on the spinal rigidity and range of motion, stress distribution of the internal fixation system and biomechanical characteristics of adjacent segments. What’s more, this study will also provide biomechanical basis for the correction strategies in patients with TL-TK.

胸腰椎骨折合并后凸畸形（TL-TK）的患者多存在脊柱矢状面序列改变，造成脊柱相关节段生物力学特性变化，因此其手术策略的选择一直是临床中的热点和难点。理论上，局部后凸的程度、脊柱矢状面序列分型、截骨方式和融合节段是影响术后疗效的重要因素，但目前截骨方式和融合节段的选择主要依靠临床经验，缺乏生物力学理论研究支持。本项目拟采用薄层塑化建模及有限元分析的方法，模拟胸腰椎骨折合并后凸畸形的不同截骨方式和融合节段，精确建立三维有限元模型，与标本生物力学测试结果相互验证，明确在不同矢状面分型下，不同截骨方式和融合节段对胸腰椎骨折合并后凸畸形患者的脊柱整体刚度和活动度、内固定系统应力分布以及相邻节段生物力学的影响，为选择TL-TK的矫形策略提供生物力学机理研究基础。

胸腰椎骨折合并后凸畸形（TL-TK）的患者多存在脊柱矢状面序列改变，造成脊柱相关节段生物力学特性变化，因此其手术策略的选择一直是临床中的热点和难点。理论上，局部后凸的程度、脊柱矢状面序列分型、截骨方式和融合节段是影响术后疗效的重要因素，但目前截骨方式和融合节段的选择主要依靠临床经验，缺乏生物力学理论研究支持。本项目采用生物力学标本测试以及有限元分析的方法，模拟胸腰椎骨折合并后凸畸形的不同截骨方式和融合节段，精确建立三维有限元模型，与标本生物力学测试结果相互验证，明确在不同矢状面分型下，不同截骨方式和融合节段对胸腰椎骨折合并后凸畸形患者的脊柱整体刚度和活动度、内固定系统应力分布以及相邻节段生物力学的影响，为选择TL-TK的矫形策略提供生物力学机理研究基础。

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