腰椎不同長度固定對腰骶節(jié)段退變影響的生物力學(xué)研究摘要：

目的：研究腰椎不同長度固定對腰骶節(jié)段退變影響的生物力學(xué)原理，為臨床治療提供理論支持。

方法：建立3D有限元模型，選擇L4-L5腰椎和S1骶骨作為計(jì)算區(qū)域。模擬腰椎不同長度固定對腰骶節(jié)段的影響，分別為L4-S1、L5-S1、L4-S2、L5-S2、L4-S3、L5-S3長度。對模型在100N、200N、300N作用下的應(yīng)變、應(yīng)力、剛度、位移等生物力學(xué)參數(shù)進(jìn)行分析。

結(jié)果：當(dāng)腰椎固定長度為L5-S1時(shí)，L5-S1間盤及周圍韌帶受力最小，剛度最小，對腰骶節(jié)段退變的壓力最小。隨著腰椎固定長度的增大，腰骶節(jié)段發(fā)生退變的初始壓力逐漸增大，但長時(shí)間的受力卻可以減少腰骶節(jié)段的退變。短時(shí)間的受力可能會導(dǎo)致骶骨下端關(guān)節(jié)面的損傷，而長時(shí)間受力可以促進(jìn)新骨質(zhì)生長，提高整個(gè)骨骼結(jié)構(gòu)穩(wěn)定性。

結(jié)論：腰椎固定長度的選擇應(yīng)根據(jù)患者的具體情況進(jìn)行個(gè)體化選擇，以最大限度地減少腰骶節(jié)段退變的風(fēng)險(xiǎn)。

關(guān)鍵詞：腰椎固定長度；腰骶節(jié)段；退變；生物力學(xué)；有限元

Abstract：

Objective:Tostudythebiomechanicalprincipleoftheinfluenceofdifferentlengthsoflumbarfixationonthedegenerationofthelumbosacralsegment,andprovidetheoreticalsupportforclinicaltreatment.

Methods:A3Dfiniteelementmodelwasestablished,withL4-L5lumbarvertebraeandS1sacrumasthecalculationregion.Theinfluenceofdifferentlengthsoflumbarfixationonthelumbosacralsegmentwassimulated,withfixationlengthsofL4-S1,L5-S1,L4-S2,L5-S2,L4-S3,L5-S3.Thebiomechanicalparameters,suchasstrain,stress,stiffness,anddisplacementofthemodelundertheloadof100N,200N,and300Nwereanalyzed.

Results:WhenthelengthoflumbarfixationwasL5-S1,thestressoftheL5-S1intervertebraldiscandsurroundingligamentswasthesmallest,andthestiffnesswasthesmallest,whichhadtheleastpressureonthedegenerationofthelumbosacralsegment.Withtheincreaseofthelengthoflumbarfixation,theinitialpressureofthedegenerationofthelumbosacralsegmentgraduallyincreased,butlong-termforcecanreducethedegenerationofthelumbosacralsegment.Short-termforcemayleadtodamagetothearticularsurfaceofthelowerendofthesacrum,whilelong-termforcecanpromotenewbonegrowthandimprovethestabilityoftheentirebonestructure.

Conclusion:Thechoiceofthelengthoflumbarfixationshouldbeindividualizedaccordingtothepatient'sspecificsituationtomaximizethereductionoftheriskoflumbosacralsegmentdegeneration.

Keywords:lengthoflumbarfixation;thelumbosacralsegment;degeneration;biomechanics;finiteelementInadditiontoconsideringthepatient'sspecificsituation,thechoiceoflumbarfixationlengthshouldalsotakeintoaccountthebiomechanicsofthelumbosacralsegment.Finiteelementanalysisstudieshaveshownthatalteringthelengthoflumbarfixationcansignificantlyaffectthedistributionofstressandstraininthelumbosacralregion.Therefore,itisimportanttobalancetheneedforstabilitywiththepotentialrisksofdegeneration.

Itisworthnotingthatthechoiceoflumbarfixationlengthisnottheonlyfactorthatcanaffecttheriskoflumbosacralsegmentdegeneration.Otherfactorssuchaspatientage,overallhealth,andlifestyleshouldalsobetakenintoconsideration.Forexample,olderpatientsmaybeathigherriskofdegenerationduetonaturalwearandtearonthespine,whilepatientswhoengageinrigorousphysicalactivitymaybemorepronetoinjury.

Inconclusion,selectingtheappropriatelengthoflumbarfixationisessentialforreducingtheriskoflumbosacralsegmentdegeneration.Thisdecisionshouldbemadebasedontheindividualpatient'ssituationandthebiomechanicsofthelumbosacralsegment.Bycarefullybalancingtheneedforstabilitywiththepotentialrisksofdegeneration,surgeonscanhelptoensurethatpatientsreceivethebestpossibleoutcomesfromtheirspinalfusionproceduresFurthermore,postoperativemonitoringiscrucialinidentifyinganypotentialcomplicationsthatmayarisefromlumbarfixation.Patientsshouldbeeducatedonthesignsandsymptomsofinfection,instrumentationfailure,andadjacentsegmentdisease,andshouldbeadvisedtoseekmedicalattentioniftheyexperienceanyofthesesymptoms.Regularfollow-upvisitswiththesurgeonarealsoessentialtoensurethatthefusionisprogressingasexpectedandtodetectanypotentialcomplicationsearlyon.

Itisimportanttonotethatlumbarfixationisnotwithoutrisks,andpatientsshouldbefullyinformedoftheseriskspriortoundergoingtheprocedure.Someofthecommonrisksassociatedwithlumbarfixationincludeinfection,bleeding,nervedamage,andhardwarefailure.Inaddition,theuseofbonegraftorbonesubstitutesmayalsoposeariskofinfectionorimmunereactions.Itisimportanttodiscusstheseriskswiththepatientandobtaininformedconsentpriortosurgery.

Insummary,lumbarfixationisacommonsurgicaltechniqueusedinthetreatmentofvariousspinalconditions.Theappropriatelengthoffixationshouldbecarefullyselectedbasedontheindividualpatient'ssituationandthebiomechanicsofthelumbosacralsegment.Postoperativemonitoringisessentialtoidentifyanypotentialcomplicationsearlyon.ItisimportantforsurgeonstoweighthepotentialbenefitsoflumbarfixationagainsttherisksinordertoensurethatpatientsreceivethebestpossibleoutcomesfromtheirspinalfusionproceduresInadditiontocarefulselectionoffixationlength,otherfactorsmustbeconsideredinthetreatmentofspinalconditions.Forexample,patientage,degreeofspinalstenosisorcompression,andhistoryofpreviousspinalsurgeryordegenerativechangesmayallinfluencetheselectionofsurgicalapproachandmethodoffixation.Additionally,thechoicebetweenopenorminimallyinvasivesurgerymaydependonthepatient'soverallhealthstatusanddesiredoutcomes.

Thesurgicaltechniqueandchoiceofimplantscanalsoaffectoutcomesinspinalfusionsurgery.Thereareseveraltypesofinstrumentationthatcanbeusedtostabilizethespine,includingpediclescrews,rods,andinterbodycages.Theselectionofappropriateinstrumentationshouldtakeintoaccountpatientanatomy,thelevel(s)offusion,andthespecificconditionbeingtreated.

Postoperatively,carefulmonitoringforcomplicationsiscritical.Potentialcomplicationsofspinalfusionsurgeryincludeinfection,hardwarefailure,nerverootinjury,andadjacentleveldegeneration.Patientsmayalsoexperiencepainandlimitedmobilityduringtherecoveryperiod.Therefore,closefollow-upwiththesurgeonandphysicaltherapistisessentialtoensureproperhealingandrehabilitation.

Finally,itisimportantforsurgeonstoeducatepatientsabouttherisksandbenefitsofspinalfusionsurgery.Formanypatients,spinalfusioncanprovidesignificantreliefofpainandimprovefunction,butitisnotalwaysthebestoptionforeverypatient.Insomecases,conservativetreatmentssuchasphysicaltherapyormedicationmaybesufficienttomanagesymptoms.Therefore,surgeonsmustcarefullyevaluateeachpatient'ssituationandmakeindividualizedtreatmentrecommendations.

Inconclusion,spinalfusionsurgeryisanimportanttreatmentoptionforvariousspinalcondi