本研究旨在探討青少年脊椎側彎患者接受長節段脊椎側彎矯正手術後之脊椎力學行為，並評估椎板下帶作為預防近端交界性後凸（proximal junctional kyphosis, PJK）策略之潛在效益。由於剛性矯正手術後，固定節段與鄰近活動節段之間可能因活動度差異而產生代償性運動，進而增加近端交界區負荷，因此本研究針對術後個案建立個體化有限元素模型進行分析。
本研究模型範圍包含胸腰椎至骨盆（T9–S1），來源為臺北榮民總醫院提供之電腦斷層掃描影像，經電腦輔助設計( Computer-Aided Design, CAD )軟體進行前處理並建立三維模型後，利用 Abaqus 進行有限元素分析。模型配置包含無植入物之基準模型 (Baseline model) 與僅椎弓根釘固定模型；另三個模型則除了椎弓根釘固定之外，分別於最上方固定椎體之上一節椎體（One Level Above the Upper Instrumented Vertebra , UIV-1）配置單節段椎板下帶、於最上方固定椎體之上兩節椎體（Two Levels Above the Upper Instrumented Vertebra , UIV-2）配置跨節段單節段椎板下帶，以及於 UIV-1 與 UIV-2 配置雙節段椎板下帶。藉由本研究所建立之模型，探討屈曲、伸展、側彎與軸向旋轉等運動下，脊椎活動度、鄰近節段椎間盤應力、植入物應力與螺釘軸向力之結果與比較。
結果顯示，僅有椎弓根釘固定下，會增加固定區與鄰近活動節段間的活動度落差，使近端交界區承受較大的代償性活動與應力。單節段UIV-1模型於低預張力（50 N）下，可使固定區與剩餘活動節段間呈現較平緩的活動度過渡，且植入物應力接近僅椎弓根釘固定模型，但 UIV-2 節段的活動度與椎間盤應力在部分生理運動下略高於基準模型。當預張力進一步增加時，近端節段活動度雖下降，但椎間盤與植入物應力亦呈上升趨勢，高預張力條件（300 N）下已顯示潛在植入物失效風險。單節段UIV-2模型與雙節段椎板下帶配置可進一步降低近端交界區活動度，並於部分條件下降低鄰近椎間盤應力，但也明顯減少剩餘活動角度，且可能增加植入物受力。
綜合而言，不同椎板下帶配置方式與預張力條件於近端交界區活動度控制、鄰近節段負荷分布及植入物受力表現上各有差異，臨床上仍需依患者剩餘活動節段、生理條件與實際力學需求進行綜合評估。本研究結果可作為臨床術前評估近端交界區力學風險與規劃預防手術策略之參考依據。

This study aims at patient-specific finite element analysis for postoperative biomechanics in adolescent scoliosis following long-segment correction and evaluates sublaminar bands for preventing proximal junctional kyphosis (PJK). Customized geometry-based finite element models (T9–S1) were developed from computed tomography images of a patient with adolescent scoliosis. Five configurations were analyzed using Abaqus: a baseline model, a pedicle-screw-only model, and three sublaminar band setups (single-level UIV-1, spanning UIV-2, and double-level UIV-1/UIV-2). These models were utilized to investigate and compare spinal ROM, adjacent intervertebral disc stress, implant stress, and screw axial force under flexion, extension, lateral bending, and axial rotation.
The FEM results indicate that an abrupt deformation change in spine deformation between fixation vertebra and proximal vertebra is observed in pedicle-screw-only model, resulting in greater compensated motions and stresses. At a low pre-tension of 50 N, the UIV-1 band facilitates a smoother ROM transition with implant stresses comparable to pedicle-screw-only fixation; however, stresses in UIV-2 slightly increase. Increasing pre-tension to 300 N restricts proximal ROM but critically elevates disc and implant stresses, risking implant failure. Alternatively, the UIV-2 and double-band configurations further constrain proximal ROM and reduce adjacent disc stress, yet they significantly limit remaining functional mobility and increase implant loads.
In conclusion, sublaminar band configurations and pre-tension levels distinctly impact proximal ROM control, load distribution, and implant performance. Personalized clinical assessments that balance these biomechanical trade-offs are essential for optimizing PJK prevention strategies.

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