脊椎退化問題隨著人口老化而愈趨嚴重，過去治療椎間盤退化問題皆使用融合手術，但施行融合手術後會限制腰椎手術椎節之活動度，使腰椎鄰近椎節產生過多活動度而加速退化。人工椎間盤為一種改善此問題之手術方式，分為拘束式與非拘束式兩種，拘束式人工椎間盤可能會受植入位置與尺寸之不同，而影響其生物力學效應。此外，過去研究指出人工椎間盤會引起手術椎節小面關節退化、鄰近椎節椎間盤退化與磨耗等問題，因此本研究目的即透過有限元素法探討不同尺寸人工椎間盤植入不同位置對腰椎之生物力學影響。
利用已驗證之腰椎與Prodisc人工椎間盤之有限元素模型，將Prodisc人工椎間盤修改為小、中、大三種尺寸，三種尺寸各別植入於L3-L4椎節間之前面、正常與後面共三個位置上，因此加上正常組共有十組模型。邊界條件設定第五節腰椎底部所有自由度為零，負荷條件以混合控制方式進行，預力為150N，而施加於正常組之力矩為10Nm，分為前彎、後彎、扭轉與側彎四種動作。探討項目為椎節活動度、手術椎節小面關節受力、鄰近椎節椎間盤L2-L3應力、聚乙烯核心之接觸壓力。
研究結果指出前彎時，大尺寸人工椎間盤放置於前面，椎節活動度較接近正常組，比正常組多10.6%，相對其他尺寸與位置而言，最接近正常組。手術椎節小面關節受力與鄰近椎節椎間盤L2-L3應力與分佈皆不受尺寸與位置影響。聚乙烯球頭接觸壓力在扭轉時，呈現尺寸愈大接觸壓力愈小的趨勢，其中置放正常位置時大尺寸甚至比小尺寸接觸壓力少十倍。因此本研究結論為人工椎間盤放置在椎節前方且使用大尺寸球頭可減少聚乙烯球頭之接觸壓力及維持人體在前彎下的正常運動範圍。

In the recent years, artificial disc (AD) replacement is a method to treat the degenerative disc disease. This implant can restore disc height, physiological motions, and prevent adjacent tissue disease. After implanting the AD, there were some problems such as facet arthritis, adjacent disc degeneration, and polyethylene (PE) wear were reported. Although constrained AD could treat the degenerative disc disease, the size and implanting position might result in the iatrogenic effect. Therefore, this study was aimed to analyze the biomechanical effects of the lumbar spine with AD on different sizes and positions.
A validated intact lumbar finite element (FE) model was used to implant a constrained AD at level L3-L4. The sizes of AD were respectively small, median and large, and the positions of implanting AD were respectively located at anterior, normal, and posterior region on vertebral body. The intact spine model was set 150N preload and 10Nm moment, and the other models were loaded according to hybrid control method. All degree of freedom were fixed at the bottom of L5. The range of motion (ROM), facet joint contact force, adjacent disc stress, and PE contact pressure, were investigated by using FE software ANSYS 11.
The results showed that ROM of implanting AD with large size located at anterior region was not only 10.6% greater than that of intact spine but also comparable to intact spine when compared to other FE models during flexion. Besides, the size and position only had slight influence on the facet joint contact force and adjacent disc stress. During axial rotation, the PE contact pressure was lower following with increasing PE core size. In normal location, the PE contact pressure of AD with large size was ten times less than that of AD with small size. Therefore, this study concluded that implanting AD with large size located at anterior position could reduce PE contact pressure as well as maintain a normal ROM during flexion.

?| 論文電子檔著作權授權書......................I
?| 論文審定同意書..............................II
? 誌謝........................................III
? 中文摘要....................................IV
? ABSTRACT....................................V
? 目錄........................................VI
?| 圖目錄......................................VIII
?| 表目錄......................................X
第一章 前言...........................................1
1-1 背景..............................................1
1-2 脊椎解剖構造......................................1
1-3 脊椎病變與治療方式................................5
1-4 人工椎間盤........................................8
1-4-1 人工椎間盤之簡介..............................8
1-4-2 人工椎間盤之臨床文獻探討......................10
1-4-3 人工椎間盤之生物力學文獻探討..................16
1-5 研究動機與目的....................................24
第二章 材料與方法.....................................25
2-1 正常腰椎有限元素模型..............................27
2-2 不同位置植入不同尺寸人工椎間盤之腰椎模型..........33
2-3 邊界條件與負載....................................36
2-4 研究參數與分析....................................37
第三章 結果...........................................42
3-1 前彎動作之生物力學分析............................42
3-1-1 椎節活動度....................................42
3-1-2 手術椎節L3-L4小面關節受力.....................43
3-1-3 鄰近椎節L2-L3椎間盤應力.......................43
3-1-4 聚乙烯核心接觸壓力............................43
3-2 後彎動作之生物力學分析............................49
3-2-1 椎節活動度....................................49
3-2-2 手術椎節L3-L4小面關節受力.....................49
3-2-3 鄰近椎節L2-L3椎間盤應力.......................49
3-2-4 聚乙烯核心接觸壓力............................49
3-3 扭轉動作之生物力學分析............................54
3-3-1 椎節活動度....................................54
3-3-2 手術椎節L3-L4小面關節受力.....................54
3-3-3 鄰近椎節L2-L3椎間盤應力.......................54
3-3-4 聚乙烯核心接觸壓力............................54
3-4 側彎動作之生物力學結果............................62
3-4-1 椎節活動度....................................62
3-4-2 手術椎節L3-L4小面關節受力.....................62
3-4-3 鄰近椎節L2-L3椎間盤應力.......................62
3-4-4 聚乙烯核心接觸壓力............................62
第四章 討論...........................................70
4-1 研究結果之探討....................................70
4-1-1 椎節活動度....................................70
4-1-2 手術椎節L3-L4小面關節接觸力...................71
4-1-3 鄰近椎節L2-L3椎間盤應力.......................73
4-1-4 聚乙烯核心接觸壓力............................74
4-2 研究假設與限制....................................82
4-3 未來研究方向......................................85
第五章 結論...........................................86
參考文獻..............................................87
附錄一：有限元素種類特性..............................91
附錄二：所有模型結果..................................94

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