跳到主要內容

臺灣博碩士論文加值系統

(44.200.86.95) 您好!臺灣時間:2024/05/28 08:46
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:姜智騫
研究生(外文):Jhih-JianJiang
論文名稱:以有限元素法分析腰椎退化性疾病經後方融合手術後已退化鄰近節之生物力學研究
論文名稱(外文):Finite Element Analysis of Biomechanics for the Adjacent Segments with Pre-existing Degeneration after Posterior Spinal Fusion in degenerative Lumbar disease
指導教授:胡宣德
指導教授(外文):Hsuan-Teh Hu
學位類別:碩士
校院名稱:國立成功大學
系所名稱:土木工程學系
學門:工程學門
學類:土木工程學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:180
中文關鍵詞:DIAMPEEK Cage退化性椎間盤疾病後方融合固定手術腰椎非融合固定手術有限元素法
外文關鍵詞:DIAMPEEK CageDegenerative Disc DiseasePosterior lumbar interbody fusionnon-fusion surgeryfinite element method
相關次數:
  • 被引用被引用:3
  • 點閱點閱:339
  • 評分評分:
  • 下載下載:56
  • 收藏至我的研究室書目清單書目收藏:0
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
參考文獻
[1]周姝妤: '椎弓根骨螺絲固定系統於治療腰椎椎間盤退化之生物力學研究'
,機械工程研究所,國立台灣科技大學,2012
[2]G. Henry: 'Grey's Anatomy', 1917.
[3]M. Nordin and V. H. Frankel: 'Basic Biomechanics of the Musculoskeletal System. Lippincott Williams and Wilkins', 2001.
[4]Frankel, Victor H.: 'Basic biomechanics of the skeletal system', 1980
[5]M.J. Silva, C. Wang, T.M. Keaveny1, W.C. Hayes: 'Direct and computed tomography thickness measurements of the human lumbar vertebral shell and endplate', Bone, 1994, 15(4), 409–414
[6]W. III, A. A., and M. M. Panjabi: 'Clinical biomechanics of the spine', 1990.
[7]A. Strayer: 'Lumbar Spine Surgery-A Guide to Preoperative and Postoperative Patient Care', AANN Reference Series for Clinical Practice.
[8]C. Lee, Y. E. Kim, C. S. Lee, Y. M. Hong, J. Jung, and V. K. Goel: 'Impact response of the intevertebral disc in a finite element model', Spine, 25, 2431-2439, 2000,
[9]J. T. M. Cheung, M. Zhang, and D. H. K. Chow: 'Biomechanical reponses of the intervertebral jionts to static and vibrational loading: a finite element study', Clinical Biomechanics, 2003, 18, 790-799.
[10]G. Baroud, J. Nemes, P. Heini, and T. Steffen: 'Load shift of the intervertebral disc after a vertebroplasty: a finite-element study', European Spine Journal, 2003, 12(4), 421-426.
[11]A. Polikeit, F. S. J., N. L. P., and O. T. E.: 'Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: finite element analysis', European Spine Journal, 2003, 12(4), 413-420.
[12]G. Denozière: 'Numerical modeling of a ligamentous lumbar motion segment', PhD thesis, Georgia Institute of Technology, 2004.
[13]A. Rohlmann, N. K. Burra, T. Zander, and G. Bergmann: 'Comparison of the effects of bilateral posterior dynamic and rigid fixation devices on the loads in the lumbar spine', European Spine Journal, 2007.
[14]K. Sairyo, V. K. Goel, A. Masuda, S. Vishnubhotla, A. Faizan, A. Biyani, N. Ebraheim, D. Yonekura, R. I. Murakami, and T. Terai.: 'Three-dimensional finite element analysis of the pediatric lumbar spine', European Spine Journal, 2006, 15, 923-929.
[15]J. L. Wang, M. Parnianpour, A. Shirazi-Adl, and A. E. Engin: 'Viscoelastic Finite Element Analysis of a Lumbar Motion Segment in Combined Compression and Sagittal Flexion: Effect of Loading Rate', Spine, 2000, 25(3), 310-318.
[16]T. Pitzen, F. H. Geisler, D. Matthis, H. Müller-Storz, K. Pedersen, and W. I. Steudel: 'The influence of cancellous bone density on load sharing in human lumbar spine: a comparison between an intact and a surgically altered motion segment', European Spine Journal, 2001, 10(1), 23-29.
[17]K. Goto, N. Tajima, E. Chosa, K. Totoribe, H. Kuroki, and Y. Arizumi: 'Mechanical analysis of the lumbar vertebrae in a three-dimensional finite element method model in which intradiscal pressure in the nucleus pulposus was used to establish the model', Journal of Orthopaedic Science, 2002, 7(2), 243-246.
[18]R. N. Natarajan and G. B. J. Andersson: 'Modeling the annular incision in a herniated lumbar intervertebral disc to study its effect on disc stability', Computers Structures, 1997, 64(5-6), 1291-1297.
[19]V. Mow and W. C. Hayes: 'Basic orthopaedic biomechanics', 1991.
[20]S. Gwanseob: 'Viscoelastic responses of the lumbar spine during prolonged stooping', Ph. D. dissertation, 2005.
[21]A. Glema, T. Lodygowski, W. Kakol, M. Wierszycki, and M. B. Ogurkowska: 'Modeling of intervertebral discs in the numerical analysis of spinal segment', ECCOMAS, 2004, 24-28
[22]M. A. Adams and W. C. Hutton: 'The effect of posture on the role of the apophysial joints in resisting intervertebral compressive forces', The Journal of Bone and Joint Surgery, 1980, 62-B(3), 368-362.
[23]M. Sharma, N. A. Langrana, and J. Rodriguez: 'Role of ligaments and facets in lumbar spinal stability', Spine, 1995, 20(8), 887-900.
[24]M. Sharma, N. A. Langrana, and J. Rodriguez: 'Modeling of facet articulation as a nonlinear moving contact problem: sensitivity study on lumbar facet response', Journal of Biomechanical Engineering, 1998, 120, 118-125.
[25]Yang-Hwei Tsuang, Yueh-Feng Chianga,Chih-Yi Hung,Hung-Wen Wei, Chang-Hunag, Cheng-Kung Cheng: 'Comparison of cage application odality in posterior lumbar interbody fusion with posterior instrumentation—A finite element study', Medical Engineering & Physics, 2009, 31, 565-570.
[26]J. Chazal, A. Tanguy, M. Bourges, G. Gaurel, G. Escande, M. Guillot, and G. Vanneuville: 'Biomechanical properties of spinal ligaments and a histological study of the supraspinal ligament in traction', Journal of Biomechanical Engineering, 1985, 18(3), 167-176.
[27]S. A. Shirazi-Adl, A. M. Ahmed, and S. C. Shrivastava: 'A finite element study of a lumbar motion segment subjected to pure sagittal plane moments', Journal of Biomechanical Engineering, 1986, 19, 331-350.
[28]H. W. Ng and E. C. Teo: 'Nonlinear Finite Element Analysis of the Lower Cervical Spine(C4-C6) Under Axial Loading', Journal of Spinal Disorders, 2001, 14(3), 201-210.
[29]V. K. Goel, H. Park, and W. Kong: 'Investigation of vibration characteristics of ligamentous lumbar spine using the finite element approach', Journal of Biomechanical Engineering, 1994, 116, 377-383.
[30]N. H. C. K.: 'Computational analysis of the time-dependent biomechanical behavior of the lumbar spine', PhD thesis, Ohio State University, 2004.
[31]Manuel, J. G. R., Leidy Y. S. G., 'Comparison of hyperelastic material models in the analysis of fabrics', International Journal of Clothing Science and Technology, Vol. 18 No. 5, pp. 314-325, 2006.
[32]ABAQUS CAE, Material Property Evaluation.
[33]Stryker: 'AVS PL PEEK Spacer Implant',
http://www.stryker.com/en-us/products/Spine/InterbodyVertebralBodyReplacement/AVSPLPEEKSpacerImplant/index.htm#., June 13, 2014
[34]C. F. Jean Taylor: 'INTERSPINOUS IMPLANT', U.S Patent, No. US 8,118,839 B2, 2012
[35]C. M. Bellini, F. Galbusera, M. T. Raimondi, G. V. Mineo, and M. Brayda-Bruno: 'Biomechanics of the Lumbar Spine After Dynamic Stabilization', Journal of Spinal Disorders & Techniques, vol. 20, pp. 423-429, 2007.
[36]黃友恆: '以有限元素法分析骨質疏鬆症病患因胸腰椎骨折接受減壓及固定手術治療之生物力學影響', 土木工程研究所, 國立成功大學, 2013,
[37]Tae-Ahn Jahng: 'Comparison of the biomechanical effect of pedicle-base dynamic stabilization: a study using finite element analysis', THE SPINE JOURNAL,vol. 13,pp.85-94
[38]劉俊顯: '動態式腰椎固定系統穩定度之生物力學探討', 醫學工程研究所,國立臺灣大學,2011,碩士論文
[39]臺北市立聯合醫院中興院區: '衛教資訊-腰椎椎間盤退化性疾病'
http://www.tpech.gov.tw/ct.asp?xItem=186303&ctNode=16441&mp=109141, June 13, 2014
[40]CAROLINA SPINE &HAND,PA: 'PLIF:Posterior Lumbar Interbody Fusion'
http://carolinaspineandhand.com/educational-animations/plif-posterior-lumbar-interbody-fusion/, June 13, 2014
[41]Kyphon: 'Hi-Res Photo',
http://multivu.prnewswire.com/mnr/kyphon/27585/, June 18, 2013.
[42]Spinal normaliztion: ' the Wallis Implant',
http://www.pauldurso.com/spinal_normalisation.htm, June 18, 2013.
[43]Coflex: 'The coflex(TM) device',
http://globalpatientnetwork.com/devices/Coflex.html, June 18, 2013.
[44]Medtronic: 'DIAM™ Spinal Stabilization System',
http://spineinfo.ru/~files/DIAMST.pdf, June 18, 2013.
[45]SYNTHES: 'NFlex'
http://www.synthes.com/MediaBin/International%20DATA/036.000.992.pdf, June 13, 2014
[46]ZIMMER: 'Dynesys®Dynamic Stabilization Product Family'
http://www.zimmer.com/en-US/hcp/spine/product/dynesys-dynamic-stabilization-system.jspx, June 13, 2014
[47]PARADIGM SPINE: 'HPSTMHbrid Performance System'
http://int.paradigmspine.com/content/hps, June 13, 2014
[48]林冠瑋: '電腦輔助脊椎之有限元素分析', 土木工程研究所, 國立成功大學, 2007, 碩士論文
[49]高力行: '以有限元素法分析退化性椎間盤疾病經腰椎手術後置入腰椎脊突間支架或椎籠之生物力學影響', 土木工程研究所, 國立成功大學, 2013, 碩士論文.
[50]I. YAMAMOTO, M. M. PANJABI, T. CRISCO, and T. OXLAND: 'Three-Dimensional Movements of the Whole Lumbar Spine and Lumbosacral Joint', Spine, vol. 14, pp. 1256-1260, 1989.
[51]劉哲榮: '後方腰椎間融合手術後應力重新分配之有限元素分析', 土木工程研究所, 國立成功大學, 2009, 碩士論文
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關期刊