葛挺 胡佰文 肖进 张峭霖 吴小川 夏冬冬

摘要：目的 探讨斜外侧腰椎椎间融合术（OLIF）结合4钉固定法治疗两节段腰椎退变性疾病的可行性。方法 构建并验证L3～S1节段腰椎有限元模型（M0），于M0模型上模拟L3/4及L4/5两节段OLIF手术构建M1模型。在M1模型上附加后路4钉或6钉固定，建立3个4钉固定模型（M2～M4）和1个6钉固定模型（M5）。分析不同内固定条件下融合节段和整体活动度以及上终板、融合器、后路钉棒所受应力峰值的变化。结果 在前屈、后伸、左右侧屈及左右旋转6种运动下，与M1模型比较，M2模型L3/4和M3模型L4/5节段活动度增加，M4和M5模型L3/4、L4/5节段活动度明显下降。在不同运动下，M2模型L4上终板von Mises应力峰值最大，M3模型L5上终板von Mises应力峰值最大，M4和M5模型L4及L5上终板von Mises应力峰值较为接近；M2模型L3/4融合器von Mises应力峰值最大，M3模型L4/5融合器von Mises应力峰值最大，M4和M5模型各融合器von Mises应力峰值较为接近；M2～M5模型内固定最大应力峰值较为接近。结论 在两节段OLIF手术中，4钉固定可以有效替代6钉固定用于腰椎退变性疾病的治疗。

关键词：斜外侧腰椎椎间融合术；有限元模型；椎弓根螺钉；4钉固定；6钉固定

中图分类号： R687.3  文献标识码： A  文章编号：1000-503X（2024）03-0341-07

DOI：10.3881/j.issn.1000-503X.15878

Oblique Lumbar Interbody Fusion Combined With 4-Screw Fixation for Treating Two-Level Degenerative Lumbar Diseases：A Finite Element Study

GE Ting HU Baiwen XIAO Jin ZHANG Qiaolin2，WU Xiaochuan XIA Dongdong1

1Department of Orthopedics，The First Affiliated Hospital of Ningbo University，Ningbo，Zhejiang 315010，China

2Faculty of Sports Science，Ningbo University，Ningbo，Zhejiang 31521 China

Corresponding author：GE Ting Tel：18868627987，E-mail：gt511512@163.com

ABSTRACT：Objective To demonstrate the feasibility of oblique lumbar interbody fusion （OLIF） combined with 4-screw fixation for treating two-level lumbar degenerative diseases.Methods An intact finite element model of L3-S1 （M0） was constructed and validated.Then，we constructed the M1 model by simulating OLIF surgery at L3/4 and L4/5 segments on the M0 model.By attachment of posterior 4-screw or 6-screw fixation to the M1 model，three 4-screw fixation models （M2-M4） and one 6-screw fixation model （M5） were established.The segmental and overall range of motion （ROM） and the peak von Mises stresses of superior endplate，cage，and posterior screw-rod were investigated under each implanted condition.Results Under the motion modes of forward flexion，backward extension，bilateral （left and right） flexion，and left and right rotation，the L3/4 ROM of M2 model and L4/5 ROM of M3 model increased，while the L3/4 and L4/5 ROM of M4 and M5 models significantly decreased compared with those of M1 model.Under all motion modes，the L4 superior endplate in M2 model and the L5 superior endplate in M3 model showed the maximum peak von Mises stress，and the peak von Mises stresses of L4 and L5 superior endplates in M4 and M5 models were close.The L3/4 cage in M2 model and the L4/5 cage in M3 model showcased the largest peak von Mises stress，and the peak von Mises stresses of cages in M4 and M5 models were close.The peak stresses of internal fixation in M2-M5 models were close.Conclusion Four-screw fixation can replace 6-screw fixation in the OLIF surgery for treating two-level degenerative lumbar diseases.

Key words：oblique lumbar interbody fusion；finite element model；pedicle screw；4-screw fixation；6-screw fixation

Acta Acad Med Sin，2024，46（3）：341-347

斜外侧腰椎椎间融合术（oblique lumbar interbody fusion，OLIF）已被广泛应用于腰椎退变性疾病的治疗，该技术具有微创手术的常规优点，并且还保留了关节突关节、椎旁肌肉等组织结构，最大限度地维持腰椎的稳定性，避免神经损伤的发生［1-2］。单纯OLIF技术应用于单节段腰椎退变性疾病取得了良好的手术效果。而对于两节段OLIF手术通常需要通过附加后路6钉固定来提高脊柱的稳定性和融合率，但这种固定方式会增加手术的创伤程度和操作难度。……