臺灣博碩士論文加值系統

摘 要
在過去對於脊椎生物力學的探討主要是依靠體外量測或是由臨床經驗的累積而來的。但隨者高速計算器的發展，以及CAD/CAE軟體的逐漸完善，使得使用數值方法對於大型、複雜的結構體進行分析及運算變為可能。
脊椎融合術是治療脊椎各類不穩定病症的常用治療方法，主要目的是藉由人體骨組織生長癒合的過程。將不穩定的脊椎骨節與其相鄰的上下方骨節或是多節骨節合併為一節以收到穩定的效果。但是將原本可動的幾節骨節合併為一節時，卻發現會對其鄰近骨節造成加速退化現象。
本研究藉由多孔媒體有限元素法，對上述現象從力學的角度予以探討，首先編寫一套自動的脊椎固定融合程式，使得前位、後位、後側位衛三種不同形態的融合方式，以及是否外加植入骨釘並行融合之模式，可於脊椎任一段區域中骨節自動生成並且完成所需融合固定的骨節數。而在分析時，對於此四大類模式分別在座椅仰角0度到20度的狀況下進行分析。以探索受損或脫位骨節融合固定後的脊椎組織內部的生物力學現象，各骨節的平均von Mises應力及受力後的變形將作為討論的依據。結果顯示不同融合方式在脊椎的不同部位融合後，所造成的影響也不盡相同，上方或是下方鄰近骨節的應力增幅也不全相同。但不論哪一種模式皆不會對脊椎各骨節所分配的應力造成重大的變化，僅對融合固定骨節的鄰近骨節有較大的影響。

Abstract
In the past , the study of the spinal biomechanics was made by the clinical case and the in vitro experience. Because of the development of the computer technology and CAD/CAE software, it is possible to use numerical methods to solver large structures ,like spine.
Spinal fusion is a common operation used to treat several unstable disorders of spine. It can be fixed the unstable segments with the adjacent stable segments to increase the stability of the spine. But many problems have been found ,for example,the method will accelerate degeneration of the adjacent unfused motin segments.
This study applied the poroelastic finite element simulation to understand the machanical property of the adjacent unfused segments after unstable segments fused. We simulated four different type of the fusion methods, like, anterior fusion, posterolateral fusion , posterior fusion and anterior fusion with posterior fixator. In the study, a algorithm can automatically genarate three types fusion and internal instrument with the intact model was established.the fused spine model included sit normally without lumbar pad and with sitting angles 0,5,10,15,20 ,and with lumbar pad on the high back position and on the low back position at sitting angle 0. The displacement and maximum von Mises stress on the addjacent unfused segments were discussed. The results reveal different fusion types and fusion position at the different part of the spine will have the differenet effect. The maximum stress increment in the superior adjacent segment is not the same with the inferior one. However, the effective occured at the adjacent segment of the fused segment is more obviously.

目 錄
誌謝……………………………………………………………….……..I
中文摘要………………………………………………………………..II
英文摘要……………………………………………………………….III
目錄…………………………………………………………………….IV
圖目錄…………………………………………………………………VII
表目錄………………………………………………………………….XII
符號說明………………………………………………………………XIII
第一章 緒論…………………………………………………………….1
1.1前言…………………………………………………………..1
1.2文獻回顧…………………………………………………….2
1.3研究目的與方法…………………………………………….4
第二章 有限元素分析原理…………………………………………….6
2.1三維有限元素的彈性力學理論……………………………..6
2.2實體元素基本理論…………………………………………..8
第三章 多孔媒體有限元素法…………………………………………16
3.1多孔媒體基本理論與組成關係式…………………………16
3.2多孔彈性體之運動方程式…………………………………19
3.3 u-w- 混元法……………………………………………….23
第四章 人體脊椎固定、融合有限元素模式…………………………26
4.1脊椎三維實體模式…………………………………………26
4.2脊椎融合模式的建立………………………………………26
4.3脊椎內固定器植入模式的建立……………………………28
4.4實例驗證……………………………………………………31
第五章 人體脊椎固定融合模式之性質與組成……………………..38
5.1人體正常脊椎各部份材料性質介紹………………………38
5.2內固定器的材料性質介紹…………………………………42
5.3補骨的材料性質介紹………………………………………43
5.4負重條件與邊界條件………………………………………43
第六章 實例討論……………………………………………………..45
6.1脊椎融合無骨釘模式………………………………………45
6.1.1受力變形後的脊椎曲線……………………………….46
6.1.2前位融合……………………………………………….47
6.1.3後側位融合…………………………………………….49
6.1.4後位融合……………………………………………….50
6.2脊椎融合並植入骨釘模式…………………………………51
6.2.1正常坐姿下融合植入骨釘模………………………….53
6.2.1.1受力變形後的脊椎曲線…………………………….53
6.2.1.2鄰近骨節的應力變化………………………………53
6.2.1.3內固定器上的最大應力……………………………55
6.2.2高背墊姿態下融合且植入骨釘模式………………….55
6.2.2.1鄰近骨節的應力變化………………………………55
6.2.2.3內固定器上的最大應力……………………………56
6.2.3低背墊姿態下融合且植入骨釘模式………………….56
6.2.3.1鄰近骨節的應力變化………………………………56
6.2.3.3內固定器上的最大應力……………………………57
6.3討論…………………………………………………………57
第七章 結論與展望…………………………………………………..95
7.1結論…………………………………………………………95
7.2展望…………………………………………………………96
參考文獻……………………………………………………………….98
附錄一…………………………………………………………………101
附錄二…………………………………………………………………106
作者簡介………………………………………………………………108

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