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研究生:蔡明勳
研究生(外文):Ming-Hsun Tsai
論文名稱:頸椎混合融合及非融合手術之生物力學研究-有限元素分析
論文名稱(外文):Biomechanical investigation of hybrid fusion and non-fusion cervical spine surgeries-A finite element analysis
指導教授:陳文斌, 江長蓉
指導教授(外文):Weng-Pin Chen, Chang-Jung Chiang
口試委員:曾永輝, 戴金龍
口試日期:2015-07-03
學位類別:碩士
校院名稱:國立臺北科技大學
系所名稱:製造科技研究所
學門:工程學門
學類:機械工程學類
論文種類:學術論文
畢業學年度:103
語文別:中文
中文關鍵詞:有限元素分析、融合手術、非融合手術、多節頸椎椎間盤退化
外文關鍵詞:Finite element analysisfusion surgerynon-fusion surgerymultilevel cervical disc degeneration
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頸椎多節椎間盤疾病為愈來愈受到重視的疾病之一,手術治療大致可分為融合手術與非融合手術。融合手術雖可以恢復椎節間高度、減輕疼痛感,但此手術方式會限制手術節活動行為,導致鄰近節會有活動度代償現象,造成鄰近節加速退化的情形。為改善融合手術所產生的術後併發症,近年來發展人工椎間盤置換術。人工椎間盤具有活動關節面使其相互產生活動行為,因此可以提供手術當節適當的活動,但該植體可能會有關節面磨耗的情形。混搭融合與非融合手術對於頸椎的影響尚未被充分研究,因此本研究透過有限元素分析,評估治療多節椎間盤疾病的手術方式對於頸椎的生物力學之效應。
本研究建立C2-T1完整脊椎模型,椎間融合器與人工椎間盤模型,將植體植入於C4-C5與C5-C6椎節,以模擬全融合手術、全非融合手術,或混搭融合與非融合手術,並給予前彎、伸展、側彎以及軸向旋轉負載,利用有限元素分析評估正常組與各植體組之椎節活動度、髓核最大壓應力、植體應力分佈與最大值、小面關節應力。
結果顯示,在植入雙節融合器時,於四種不同負載下,其手術椎節活動度最低,造成鄰近節活動度代償現象最為顯著,進而導致鄰近節髓核內壓與小面關節負載上升,在植體上之應力相對於其他植體組較高。在植入單節椎間融合器與單節人工椎間盤時,鄰近節活動度補償相對全融合手術較低,其鄰近節髓核內壓與小面關節負載與正常組較接近,在植體上之應力因人工椎間盤具有可活動之關節面,可降低植體上最大應力值。在植入雙節人工椎間盤時,於前彎、側向、軸向旋轉負載下,手術椎節與鄰近節活動度皆較接近正常組,但於伸展負載時,手術椎節活動度較正常組高,導致手術節小面關節負載增加,其鄰近節髓核內壓與小面關節負載則降低,有助於減緩鄰近節退化的情形。
根據本研究之模擬分析,全非融合手術對於模擬治療多節頸椎椎間盤疾病有較佳的生物力學效應,但依然有需考慮的因素,如手術節小面關節負載的增加可能會加速小面關節的退化。混搭融合及非融合手術鄰近節髓核最大壓力值與小面關節負載與正常組較接近,與融合手術相比為較佳的手術方式。
Cervical Spine Intervertebral discs diseases have received more and more attention in recent years. There are two types of surgery applied in this disease, fusion surgery and non-fusion surgery. Although, Fusion surgery can resume the height of discs and relieve pain from patient. However, this method will limit the motion of the implanted levels and cause a compensation of motion in adjacent levels. This result will speed up the discs function degeneration. In recent years, there have been many studies on artificial disc cervical replacement surgery, because it has an active joint surface which will have interactive activities with artificial disc, but there exists a wearing problem in the joint surface. The effect of combing fusion surgery and non-fusion surgery in cervical spine has not been widely discussed recently. In our research, we proposed a biomechanical comparison of the three surgergical methods on the cervical spine based on finite elements analysis.
This research created an intact C2-T1 spine with interbody fusion cage and/or artificial disc models. The implants are implanted into the discs between C4-C5 and C5-C6 to simulate non-fusion, fusion and hybrid surgeries under four types of loading, flexion, extension, lateral bending, and axial rotation. By using finite element analysis, we are able to investigate the range-of-motion (ROM) patterns of each motion segments, as well as the compression stress in the nucleus, the maximum value and distribution of the implant stress, and the stress in the facet joint.
The results showed that when bi-level interbody fusion cages were implanted into the discs under the four types of loading, the ROM’s of the operated levels are almost the lowest. Moreover, the compensation effects in the adjacent levels become more significant. Due to the compensation phenomenon, it leads to the increase of the adjacent inner pressure in the nucleus and high stress in the facet joint. As compared to the implant stress of other implant models , the stress in the implant is the highest. When a single disc fusion cage and an artificial disc were implanted, lower compensation of motion was found. As for the inner pressure in the nucleus and the facet joint stress stay close to the intact model. Because the cervical artificial disc is designed with movable joint surfaces, it is able to reduce the maximum stress in the implant. We could conclude that when bi-level artificial discs were implanted under the loadings of flexion, lateral bending, and axial rotation, the range of motions in the operated levels are closer to that of intact model. Otherwise, under the extension loading, the range of motion is much higher, it might cause the loading in the facet joint to increase and the stress in the adjacent nucleus and facet join to be reduced. This results showed the alleviation of degeneration in the adjacent discs
According to the simulation results, bi-level non-fusion surgery possesses better biomechanical performance on the intervention treatment of cervical spine degeneration disease. However, there are still concerns such as the increase of the facet joint load at the operated level that might speed up the facet joint degeneration. Therefore, the hybrid surgery with cage and artificial disc has the benefit of closer stress values in the adjacent level nucleus and facet joint load. It might be a better choice than bi-level fusion surgery.
目 錄

摘 要 i
ABSTRACT iii
誌 謝 vi
目 錄 vii
表目錄 x
圖目錄 xi
第一章 緒論 1
1-1前言 1
1-2研究背景 2
1-2.1脊椎解剖學構造 2
1-2.2椎間盤結構與組成 4
1-2.3椎間盤力學特性 5
1-2.4椎間盤病變 5
1-2.5椎間盤病變之治療方式 6
1-3 頸椎融合器與人工椎間盤 7
1-3.1頸椎融合器 7
1-3.2頸椎人工椎間盤 8
1-4 文獻回顧 12
1-4.1頸椎融合手術Anterior Cervical Decompression and Fusion (ACDF) 12
1-4.2人工椎間盤置換(Artificial disc replacement) 13
1-4.3 治療多節椎間盤疾病文獻 14
1-4.3 文獻總結 15
1-5研究目的 15
第二章 材料與方法 16
2-1研究流程 16
2-2頸椎實體模型建立 17
2-3植入物實體模型建立 18
2-3.1 Mobi-C人工椎間盤實體模型建立 18
2-3.2 椎間融合器實體模型建立 20
2-4植入物植入於頸椎模型 20
第三章 結果 27
3-1 完整組模型驗證 27
3-2正常組與植體組活動度 29
3-3髓核內壓 34
3-4 植體應力分佈情形與最大蒙麥斯應力 37
3-5 小面關節負載 39
第四章 討論 41
4-1 活動度 41
4-1.1 前彎(Flexion)負載 41
4-1.2伸展(Extension)負載 42
4-1.3側向彎曲(Lateral bending)負載 42
4-1.4軸向旋轉(Axial rotation)負載 43
4-2 髓核最大壓應力 43
4-3 植體應力分佈與最大值 45
4-4 小面關節負載 46
4-5 混合手術植體於不同椎節搭配 46
4-5.1活動度 47
4-5.2髓核最大壓應力 49
4-6 研究限制 50
第五章 結論 51
參考文獻 53
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