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腰椎不同長(zhǎng)度固定對(duì)腰骶節(jié)段退變影響的生物力學(xué)研究摘要:
目的:研究腰椎不同長(zhǎng)度固定對(duì)腰骶節(jié)段退變影響的生物力學(xué)原理,為臨床治療提供理論支持。
方法:建立3D有限元模型,選擇L4-L5腰椎和S1骶骨作為計(jì)算區(qū)域。模擬腰椎不同長(zhǎng)度固定對(duì)腰骶節(jié)段的影響,分別為L(zhǎng)4-S1、L5-S1、L4-S2、L5-S2、L4-S3、L5-S3長(zhǎng)度。對(duì)模型在100N、200N、300N作用下的應(yīng)變、應(yīng)力、剛度、位移等生物力學(xué)參數(shù)進(jìn)行分析。
結(jié)果:當(dāng)腰椎固定長(zhǎng)度為L(zhǎng)5-S1時(shí),L5-S1間盤及周圍韌帶受力最小,剛度最小,對(duì)腰骶節(jié)段退變的壓力最小。隨著腰椎固定長(zhǎng)度的增大,腰骶節(jié)段發(fā)生退變的初始?jí)毫χ饾u增大,但長(zhǎng)時(shí)間的受力卻可以減少腰骶節(jié)段的退變。短時(shí)間的受力可能會(huì)導(dǎo)致骶骨下端關(guān)節(jié)面的損傷,而長(zhǎng)時(shí)間受力可以促進(jìn)新骨質(zhì)生長(zhǎng),提高整個(gè)骨骼結(jié)構(gòu)穩(wěn)定性。
結(jié)論:腰椎固定長(zhǎng)度的選擇應(yīng)根據(jù)患者的具體情況進(jìn)行個(gè)體化選擇,以最大限度地減少腰骶節(jié)段退變的風(fēng)險(xiǎn)。
關(guān)鍵詞:腰椎固定長(zhǎng)度;腰骶節(jié)段;退變;生物力學(xué);有限元
Abstract:
Objective:Tostudythebiomechanicalprincipleoftheinfluenceofdifferentlengthsoflumbarfixationonthedegenerationofthelumbosacralsegment,andprovidetheoreticalsupportforclinicaltreatment.
Methods:A3Dfiniteelementmodelwasestablished,withL4-L5lumbarvertebraeandS1sacrumasthecalculationregion.Theinfluenceofdifferentlengthsoflumbarfixationonthelumbosacralsegmentwassimulated,withfixationlengthsofL4-S1,L5-S1,L4-S2,L5-S2,L4-S3,L5-S3.Thebiomechanicalparameters,suchasstrain,stress,stiffness,anddisplacementofthemodelundertheloadof100N,200N,and300Nwereanalyzed.
Results:WhenthelengthoflumbarfixationwasL5-S1,thestressoftheL5-S1intervertebraldiscandsurroundingligamentswasthesmallest,andthestiffnesswasthesmallest,whichhadtheleastpressureonthedegenerationofthelumbosacralsegment.Withtheincreaseofthelengthoflumbarfixation,theinitialpressureofthedegenerationofthelumbosacralsegmentgraduallyincreased,butlong-termforcecanreducethedegenerationofthelumbosacralsegment.Short-termforcemayleadtodamagetothearticularsurfaceofthelowerendofthesacrum,whilelong-termforcecanpromotenewbonegrowthandimprovethestabilityoftheentirebonestructure.
Conclusion:Thechoiceofthelengthoflumbarfixationshouldbeindividualizedaccordingtothepatient'sspecificsituationtomaximizethereductionoftheriskoflumbosacralsegmentdegeneration.
Keywords:lengthoflumbarfixation;thelumbosacralsegment;degeneration;biomechanics;finiteelementInadditiontoconsideringthepatient'sspecificsituation,thechoiceoflumbarfixationlengthshouldalsotakeintoaccountthebiomechanicsofthelumbosacralsegment.Finiteelementanalysisstudieshaveshownthatalteringthelengthoflumbarfixationcansignificantlyaffectthedistributionofstressandstraininthelumbosacralregion.Therefore,itisimportanttobalancetheneedforstabilitywiththepotentialrisksofdegeneration.
Itisworthnotingthatthechoiceoflumbarfixationlengthisnottheonlyfactorthatcanaffecttheriskoflumbosacralsegmentdegeneration.Otherfactorssuchaspatientage,overallhealth,andlifestyleshouldalsobetakenintoconsideration.Forexample,olderpatientsmaybeathigherriskofdegenerationduetonaturalwearandtearonthespine,whilepatientswhoengageinrigorousphysicalactivitymaybemorepronetoinjury.
Inconclusion,selectingtheappropriatelengthoflumbarfixationisessentialforreducingtheriskoflumbosacralsegmentdegeneration.Thisdecisionshouldbemadebasedontheindividualpatient'ssituationandthebiomechanicsofthelumbosacralsegment.Bycarefullybalancingtheneedforstabilitywiththepotentialrisksofdegeneration,surgeonscanhelptoensurethatpatientsreceivethebestpossibleoutcomesfromtheirspinalfusionproceduresFurthermore,postoperativemonitoringiscrucialinidentifyinganypotentialcomplicationsthatmayarisefromlumbarfixation.Patientsshouldbeeducatedonthesignsandsymptomsofinfection,instrumentationfailure,andadjacentsegmentdisease,andshouldbeadvisedtoseekmedicalattentioniftheyexperienceanyofthesesymptoms.Regularfollow-upvisitswiththesurgeonarealsoessentialtoensurethatthefusionisprogressingasexpectedandtodetectanypotentialcomplicationsearlyon.
Itisimportanttonotethatlumbarfixationisnotwithoutrisks,andpatientsshouldbefullyinformedoftheseriskspriortoundergoingtheprocedure.Someofthecommonrisksassociatedwithlumbarfixationincludeinfection,bleeding,nervedamage,andhardwarefailure.Inaddition,theuseofbonegraftorbonesubstitutesmayalsoposeariskofinfectionorimmunereactions.Itisimportanttodiscusstheseriskswiththepatientandobtaininformedconsentpriortosurgery.
Insummary,lumbarfixationisacommonsurgicaltechniqueusedinthetreatmentofvariousspinalconditions.Theappropriatelengthoffixationshouldbecarefullyselectedbasedontheindividualpatient'ssituationandthebiomechanicsofthelumbosacralsegment.Postoperativemonitoringisessentialtoidentifyanypotentialcomplicationsearlyon.ItisimportantforsurgeonstoweighthepotentialbenefitsoflumbarfixationagainsttherisksinordertoensurethatpatientsreceivethebestpossibleoutcomesfromtheirspinalfusionproceduresInadditiontocarefulselectionoffixationlength,otherfactorsmustbeconsideredinthetreatmentofspinalconditions.Forexample,patientage,degreeofspinalstenosisorcompression,andhistoryofpreviousspinalsurgeryordegenerativechangesmayallinfluencetheselectionofsurgicalapproachandmethodoffixation.Additionally,thechoicebetweenopenorminimallyinvasivesurgerymaydependonthepatient'soverallhealthstatusanddesiredoutcomes.
Thesurgicaltechniqueandchoiceofimplantscanalsoaffectoutcomesinspinalfusionsurgery.Thereareseveraltypesofinstrumentationthatcanbeusedtostabilizethespine,includingpediclescrews,rods,andinterbodycages.Theselectionofappropriateinstrumentationshouldtakeintoaccountpatientanatomy,thelevel(s)offusion,andthespecificconditionbeingtreated.
Postoperatively,carefulmonitoringforcomplicationsiscritical.Potentialcomplicationsofspinalfusionsurgeryincludeinfection,hardwarefailure,nerverootinjury,andadjacentleveldegeneration.Patientsmayalsoexperiencepainandlimitedmobilityduringtherecoveryperiod.Therefore,closefollow-upwiththesurgeonandphysicaltherapistisessentialtoensureproperhealingandrehabilitation.
Finally,itisimportantforsurgeonstoeducatepatientsabouttherisksandbenefitsofspinalfusionsurgery.Formanypatients,spinalfusioncanprovidesignificantreliefofpainandimprovefunction,butitisnotalwaysthebestoptionforeverypatient.Insomecases,conservativetreatmentssuchasphysicaltherapyormedicationmaybesufficienttomanagesymptoms.Therefore,surgeonsmustcarefullyevaluateeachpatient'ssituationandmakeindividualizedtreatmentrecommendations.
Inconclusion,spinalfusionsurgeryisanimportanttreatmentoptionforvariousspinalcondi
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