椎間盤退化目前主要的治療方式為椎體融合術。雖然椎體融合術能達到穩定椎節的功能，卻也增加了鄰近椎節的受力。近年來人工椎間盤置換術提供了椎間盤退化另一種治療選擇，保留植入當節的活動度來降低鄰近椎節退化的風險。根據目前人工椎間盤的研究，椎體的破壞、植入物的破壞、植入物的沉陷等皆為人工椎間盤潛在之風險。此外正常椎間盤具有可壓縮性，具保護脊椎結構之作用，然大部分市售產品欠缺此一功能。本研究目的為設計一款新型可壓縮性質之頸椎人工椎間盤，以期能達到降低植入物破壞之風險，並使其生物力學表現得以更接近正常頸椎。研究利用三種不同有限元素模型（正常椎節、可壓縮式頸椎人工椎間盤、不可壓縮式頸椎人工椎間盤），給予一般生理活動所需之負載進行模擬，針對椎體活動度、小面關節接觸正向力、韌帶伸長量進行評估，並就人工椎間盤擺放位置及植入物本身受力等項目進行比較。研究結果顯示，所有植入物在相同負載下之應力數值均於安全範圍內。在單純施加軸向力量的情況下，可壓縮式頸椎人工椎間盤提供了與正常椎節相似的壓縮性；不可壓縮式頸椎人工椎間盤在活動度、小面關節接觸正向力及韌帶伸長量均高於可壓縮式頸椎人工椎間盤以及正常椎節。在植入位置影響方面，可壓縮式頸椎人工椎間盤置放於中央時在屈曲、伸展動作下擁有較接近正常頸椎，而置於後方時在軸向旋轉、側彎動作下較為接近。根據本研究評估，在頸椎人工椎間盤設計加上軸向可壓縮機構可使椎節在承受生理負載下得以更接近正常頸椎的生物力學表現，改善過去欠缺壓縮功能之頸椎人工椎間盤的部分問題。此概念未來應可應用於後續人工椎間盤設計之考量。

Spinal interbody fusion is the main surgical treatment for disc degeneration. Although spinal interbody fusion achieves the goal of spinal stability, it also increases the stress on adjacent level. Disc replacement become an alternative treatment for disc degeneration recently, it decrease the risk of adjacent level degeneration by preserving range of motion of inserted level. Base on previous studies, endplate fracture, implant failure, and implant subsidence are potential risks of artificial disc replacement. Besides, compressibility of intact intervertebral disc is contributive to protect spinal structure. However, certain mechanism was not applied to most of the commercially available products. Purpose of this study was to develop a novel compressible cervical artificial disc to reduce the risk of implant failure, and further to achieve normal biomechanical behavior of cervical spine. Three different finite element models including normal spine segments, artificial disc with or without axial compressible mechanism were reconstructed. With given physical loading on each model, vertebral mobility, facet joint contact force, and ligament lengthening were evaluated. Effect of inserting position and stress on compressible artificial disc were also compared. The results showed that all stresses on implants in simulated models were allowable. Artificial disc with compressible mechanism had similar compressibility as intact cervical spine under axial load. Artificial disc without compressible mechanism would result in higher mobility, facet joint contact force, and ligament lengthening than compressible design and intact cervical spine. For the effect of inserting position, central positioned compressible artificial disc had closer mobility in flexion and extension to intact cervical spine while posterior positioned one in axial rotation and lateral bending. According to the evaluation in current study, biomechanical performances of cervical artificial disc with compressible mechanism can be achieved to be more similar to that of intact cervical spine under physical loadings. Some problems related to previous cervical artificial disc designs without compressible mechanism can be solved. Certain concept can be applied to further design of cervical artificial disc as consideration in the future.

目錄
目錄.......................................................i
表目錄...................................................iii
圖目錄....................................................iv
摘要....................................................viii
Abstract..................................................ix
第一章 前言................................................1
1-1 研究背景...............................................1
1-2脊椎解剖生理與生物力學特性..............................3
1-3 人工椎間盤簡介........................................10
1-4 人工椎間盤之文獻回顧..................................12
1-5 可壓縮型人工椎間盤專利回顧............................18
1-6 有限元素法於頸椎之文獻回顧............................21
1-7 研究動機與目的........................................23
第二章 材料與方法.........................................24
2-1 頸椎有限元素模型之建立................................24
2-2 頸椎人工椎間盤模型之建立..............................28
2-3 頸椎模型的收斂測試....................................30
2-4 頸椎模型的驗證........................................34
2-5 接觸條件、邊界條件與負荷條件..........................37
第三章 結果...............................................39
3-1 軸向負載下之軸向位移..................................39
3-2 三種模型之活動度......................................42
3-3 三種模型的小面關節最大接觸正向力......................48
3-4 三種模型下韌帶之變形量................................53
3-5 植入物不同擺放位置之分析..............................55
3-6 雙螺旋壓縮機構及植入物本身之安全性評估................60
第四章 討論...............................................63
4-1 軸向位移之比較........................................63
4-2 活動度之比較..........................................64
4-3 小面關節接觸正向力之比較..............................69
4-4 韌帶變形量之比較......................................71
4-5 擺放位置對於植入物表現之影響..........................73
4-6 有限元素模型之限制....................................73
4-7 人工椎間盤設計之考量..................................75
第五章 結論...............................................76
參考文獻..................................................77

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