臺灣博碩士論文加值系統

隨著年齡增長，脊椎可能會引發椎間盤退化、腰椎滑脫症或椎管狹窄症等情況。椎管狹窄症通常會產生神經性跛行，導致下肢不協調，造成患者長期行走不良等等的情形。然而，在臨床醫師會依照狹窄程度去選擇使用椎板減壓術(laminectomy)或椎弓減壓術(laminotomy)兩種手術解除此症狀，儘管可以暫時性解除神經性症狀，但在術後仍有可能因結構不穩定而造成鄰近椎節滑脫，此時就會置入後固定器，以維持腰椎穩定性，選擇後固定器的搭配方式則有許多種，要依患者症狀而決定。
本研究使用電腦模擬分析，針對椎板減壓術後椎板移除之結構以及植入後固定器後的生物力學特性，與正常腰椎相比較，模擬結果可得知術後在進行動作時的位移、應力分布以及鄰近椎節的應力變化，藉此可讓臨床醫師選擇何種手術對病人較佳，並由模擬的結果希望能幫助臨床醫師了解各椎節可能會受到的影響。

Spine would be degenerated with aging and may suffer from herniation of intervertebral disc, spondylolisthesis, spondylosis or stenosis. Stenosis of spinal canal usually accompanied with neurological problem. Laminectomy or laminotomy would be operated by orthopedic surgeons according to the severity of the stenosis. After that, the posterior fixation would be implanted to maintain the stability of the lumbar spine. This study is to investigate the biomechanical effect of the laminectomy by numerical simulation. The range of motion, stress distribution of the vertebral body and intervertebral disc were observed. The results might help surgeons to select suitable treatments to the patients and understand the possible effect on adjacent vertebral segments.

第一章 緒論...1
1-1研究背景...1
1-1-1脊椎解剖構造...1
1-2脊椎力學特性...4
1-2-1椎間盤生物力學特性...5
1-2-2脊椎韌帶...7
1-3脊椎疾病症狀...9
1-4文獻回顧...14
1-5研究目的...17
第二章 材料及方法...18
2-1研究流程...18
2-2研究材料...19
2-3模型建立...20
2-3-1腰椎模型建立...20
2-3-2腰椎模型建構...21
2-3-3固定器建構...22
2-3-4手術切除位置...23
2-3-5椎跟釘位置...24
2-4建立有限元素模型...25
2-4-1各組有限元素模型建立...25
2-4-2材料參數與邊界設定...27
第三章 結果...29
3-1脊椎活動度...29
3-1-1 L2~L4軸向下壓椎體下沈量...29
3-1-2前彎椎體角度變化...32
3-1-3後彎椎體角度變化...33
3-1-4軸向旋轉椎體角度變化...34
3-1-5側彎椎體角度變化...35
3-2應力分布...38
3-2-1軸向下壓之椎體應力分布 .38
3-2-2前彎之椎體應力分布...40
3-2-3後彎之椎體應力分布 ...42
3-2-4軸向旋轉之椎體應力分布...44
3-2-5側彎之椎體應力分布 ...46
3-3鄰近節的應力結果...48
3-3-1 L1軸向施力應力分布...48
3-3-2 L1前彎應力分布...49
3-3-3 L1後彎應力分布...50
3-3-4 L1軸向旋轉應力分布...51
3-3-5 L1側彎應力分布...52
3-3-6 L5軸向施力應力分布...53
3-3-7 L5前彎應力分布...54
3-3-8 L5後彎應力分布...55
3-3-9 L5軸向旋轉應力分布...56
3-3-10 L5側彎應力分布...57
3-4椎間盤的應力結果...58
3-4-1第一節椎間盤軸向施力應力分布...58
3-4-2 第一節椎間盤前彎應力分布..59
3-4-3 第一節椎間盤後彎應力分布...60
3-4-4 第一節椎間盤軸向旋轉應力分布...61
3-4-5 第一節椎間盤側彎應力分布...62
3-4-6第四節椎間盤軸向施力應力分布...63
3-4-7 第四節椎間盤前彎應力分布...64
3-4-8 第四節椎間盤後彎應力分布...65
3-4-9 第四節椎間盤軸向旋轉應力分布...66
3-4-10第四節椎間盤側彎應力分布...67
第四章 討論...... 68
4-1 腰椎受力後之活動量變化...69
4-2 椎體之應力分布...72
4-3 條件設定與限制...74
第五章 結論...76

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