臺灣博碩士論文加值系統

椎板切除術配合後方腰椎固定器合併融合手術，主要用於治療腰椎不穩定的問題，但臨床文獻指出融合手術前，鄰近節椎間盤已經發生提早退化情形。若後方融合手術未改善鄰近節退化，則需考慮進一步治療鄰近節手術。
本研究考慮腰椎第四節(L4)與第五節(L5)之間發生退化性椎間盤的問題，並建立L4、L5與鄰近節L3、L4間退化性椎間盤及後方融合固定手術的有限元素模型，分析兩種不同狀況的實驗治療情形：
實驗一:(1)正常；(2)L4-5間椎間盤退化；(3) L4-5間經後方融合固定手術。
實驗二:(1)正常；(2) L4-5間經後方融合固定手術；(3) L4-5間後方融合固定手術以及L3-4間經三種腰椎非融合固定手術，分別為DIAM、Dynamic Rod及Peek Cage。
本研究以電腦斷層掃描(CT)與有限元素軟體建立完整的脊椎模型，取其腰椎第二節至薦椎，並以Hypermesh建立DIAM及Cage的模型。設定腰椎第四節及第五節間椎間盤纖維環的楊氏係數弱化至80%，以模擬退化性椎間盤的強度；弱化L3至L4椎節間的椎間盤纖維環的楊氏係數至60%，模擬融合手術前鄰近節椎間盤退化的情況，進而將椎弓螺釘與各植入物置入脊椎模型。最後施予150N的力在脊椎模型上模擬脊椎承受身體重量；各個椎節0.5N-m的彎矩模擬前彎、後仰、側彎、扭轉四個動作，以ABAQUS求解並分析端板間的相對轉角、最大von-Mises應力及應變能密度。

Laminectomy with Posterior lumbar interbody fusion (PLIF) is primary for the treatment of lumbar instability problems, but the clinical literature indicates that before fusion surgery, the adjacent segment of intervertebral disc have already earlier degenerated. If posterior lumbar interbody fusion do not improve the degeneration of adjacent segment, it needs to consider further surgical treatment for adjacent segment. This study consider degenerative disc problems occur between the lumbar of fourth segment (L4) and fifth segment (L5), and establish finite element model for degenerative lumbar spine from L3 to L5 and posterior lumbar interbody fusion to analyze two different situation of experiment:
Experiment 1 (1) Normal lumbar spine (2) degenerative lumbar spine from L4 to L5 (3) posterior lumbar interbody fusion from L4 to L5
Experiment 2 (1) Normal lumbar spine (2) posterior lumbar interbody fusion from L4 to L5 (3) posterior lumbar interbody fusion from L4 to L5 and three non-fusion surgery methods from L3 to L4，DIAM、Dynamic Rod and
Peek Cage
All in all, after PLIF can reduce the stress and activity of L4-5 disc, but it can increase the burdened
of adjacent segment(L3-4). Even in adjacent segment have already degenerated ,the situation can
increase more and more. Therefore it must be surgery in adjacent segment(L3-4).In Experiment 2,
the influence of three non-fusion surgery for adjacent segment(L3-4) can be promoted below table
Activity von Mises stress of disc Strain Energy of disc von Mises stress of pedicle screw ＆Rod
Dynamic Rod less mid mid less
DIAM more more more more
Peek Cage mid less less mid

目錄
第一章 緒論 1
1.1 前言 1
1.2 有限元素法在醫學工程上之應用 2
1.3 研究動機與目的 2
1.4 研究方法 3
第二章 脊椎 4
2.1 脊椎的結構 4
2.2 脊椎組成 4
2.3 植入物裝置 21
2.4 元件之交互作用 24
第三章 腰椎疾病與術後影響及治療 25
3.1 腰椎退化性疾病 25
3.2 融合固定手術與影響 26
3.3 診斷及治療方式 26
第四章 電腦輔助建立腰椎有限元素模型 32
4.1 有限元素法與建立脊椎模型介紹 32
4.2 醫學影像軟體 33
4.3 建立有限元素模型 34
4.3-1. 建模 34
4.3-2. 網格篩選及優化 36
4.3-3. 建立各種元素 37
4.4 材料性質 49
4.5 組成元素 51
4.6 邊界條件與負載方式 53
4.7 收斂性分析與驗證 59
第五章 分析結果 63
5.1 分析方向 63
5.2 分析影響椎間盤功能的各種方法 72
5.2-1 相對轉角 72
5.2-2 最大von Mises應力 75
5.2-3 應變能密度 76
5.3 實驗一 76
5.3-1相對轉角 76
5.3-2 最大von Mises 應力 85
5.3-3 應變能密度 94
5.4 實驗二 103
5.4-1相對轉角 103
5.4-2 最大von Mises應力 114
5.4-3 應變能密度 122
5.5 椎弓螺釘系統最大von Mises 應力 131
5.6 鄰近節的不同退化程度 136
5.6-1相對轉角 136
5.6-2最大von Mises應力 138
5.6-3應變能密度 140
5.7 鄰近節之小面關節的接觸合力 141
第六章 結論與建議 144
6.1 結論 144
6.2 未來展望 148
參考文獻 149
附錄A Abaqus input檔 153

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