【作者】 张彬；

【导师】 孙东明；

【作者基本信息】 昆明理工大学 ， 机械制造及其自动化， 2016， 硕士

【摘要】 青少年特发性(发病原因不明)脊柱侧弯(Adolescent Idiopathic Scoliosis)是脊柱侧弯类疾病中发病率最高、危害程度最大的病例之一,它的力学方面的研究已经逐渐成为一个多学科研究者参与的热点。本课题是本研究所与昆明医科大学第二附属医院骨科合作交流中产生,由云南省自然基金支持。目的在于建立患者的三维脊柱有限元模型,探究该模型的生物力学特性,从而为昆明医科大学第二附属医院骨科使用的经后路全脊椎切除手术(PVCR)的具体临床手术方案的验证与优化提供力学依据。本文根据医院提供的真实患者的CT扫描图片数据,使用Mimics10.01软件、Geomagic12、UG8.0三维建模软件以及Workbench有限元分析软件的辅助,经过调整,模型的CVSL和生物力学性状验证有效,建立了青少年特发性脊柱侧弯三维有限元模型。结合患者真实体重资料和医生提出的具体一个PVCR矫形手术实际操作方案,进行两个方面的工作：(1)预测患者脊柱在无矫正辅助情况下一年以后的发展变化；(2)对患者脊柱模型进行具体方案的PVCR手术矫正,观测矫正合格后的脊柱的整体变化以及“钉-棒”系统、重要节段的椎体、椎间盘在矫正中的应力应变情况,从而为优化手术提供参考。本文所得结论如下：(1)如果在没有任何矫正辅助的情况下,患者脊柱凹侧承担的平均应力要大于凸侧,一年之后,患者的脊柱的畸形程度会增加,主弯的Cobb角会增加3.1°,次弯的Cobb角会增加1.13°。(2)经过具体的PVCR矫形手术的矫正,患者的脊柱可以恢复到较为理想的状态,效果明显,患者整体身高预计增高32.22mm。(3)在本矫形方案中,椎体上最大的应力易出现在处于次弯矫正位置和主弯矫正位置中间的胸椎T8、T9、T10节椎体上,具体手术施行时需要重点注意。(4)在本矫形方案中,医生设计的手术方案中处于置钉端椎位置胸椎T3、腰椎L4以及矫正载荷具体施加位置附近的胸椎T5、T6、T7、T11、腰椎L1上应力仍旧较大,椎间盘上的应力多集中于纤维环,髓核部分应力较小。相对真实手术过程,本文虽然对脊柱具体组织做了一些忽略和简化处理,但是所建立的模型整体较好,手术的模拟接近真实手术操作过程,得到了一些具有参考价值的结论,可以为患者脊柱PVCR矫形手术的实施和优化提供一些力学方面的指导。更多还原

【Abstract】 Adolescent idiopathic scoliosis (etiology remains unknown) is one of the scoliosis diseases which keeps the highest incidence rate and biggest damage. The researches of which mechanics have been a hotspot multidisciplinary researchers involved in. This topic was supported by the nature fund of Yunnan province, and created among the communication and cooperation between our institute and the orthopedic departments of the second affiliated hospital of Kunming medical college. Aim at establishing the 3D finite element spinal models of patients and exploring the biomechanical properties, finally provide mechanical basis for the validation and optimization of specific clinic surgery of posterior vertebral column resection (PVCR) adopted by the orthopedic departments of the second affiliated hospital of Kunming medical college.Based on the CT scan images of real patient offered by hospital, Mimics10.01, Geomgic12, UG 8.03D modeling software and Workbench software of finite element analysis were applied, the adjusted adolescent idiopathic scoliosis 3D finite element model was created successfully, and the CVSL and biomechanical properties were proved effective. Two aspects of the work in this article were performed combined with the real weight data of patient and a specific PVCR orthopedic operation scheme offered by doctor:1. Predict the spinal development and changes of the patient without any orthodontic treatment after one year.2. Correct the spinal model of patient with specific PVCR orthopedic scheme, and observe the overall change of the spine and the stress and strain status of "screw-rod" system and the vertebral bodies and intervertebral discs of important segments after corrected qualified, so as to provide reference for operation optimization. The conclusions are as follows:(1) The average stress the spinal concave sides of patient could bear are bigger than the convex sides without any orthodontic treatment, the spinal deformity of patient will increase after one year, and the Cobb angle of main bend will increase 3.1°,the Cobb angle of secondary bend will increase 1.13°.(2) The spine of patient could recover back to ideal situation after specific PVCR orthopedic surgery, and the height of patient will increase 32.22mm.(3) In this orthopedic operation scheme, thoracic vertebra T8, T9, T10 which in the middle of main bend and secondary bend will afford the biggest stress, special attention are needed on the operation.(4)In this orthopedic operation scheme, the stress of thoracic vertebra T3 and lumbar vertebra L4 which regarded as end vertebra to screw are still bigger, so do the thoracic vertebra T5, T6, T11 and lumbar vertebra L1 which are close to where to load the orthodontic force. In general, the stress of intervertebral discs are bigger in the annular fibrosus, nucleus pulposus are smaller.Although some spinal tissues had been ignored or simplified compared with real human body in this article, but the whole structure of the model is better, and the surgery simulation were close to the real operation process. Some conclusions were drawn, reference of the mechanical aspects could be provided to the PVCR orthopedic validation and optimization of patients.更多还原