骨质疏松对侧方入路腰椎椎间融合术后相邻节段椎体及终板生物力学的影响  

The impact of osteoporosis on the biomechanics of adjacent vertebral bodies and endplates following lateral lumbar interbody fusion in the adjacent segments

作　　者：王彪 狄鸣远 张益铭 任亚楠 刘洋[3] 赵清乾 杨强[3] 孙逊 Wang Biao;Di Mingyuan;Zhang Yiming;Ren Yanan;Liu Yang;Zhao Qingqian;Yang Qiang;Sun Xun(Graduate School,Tianjin Medical University,Tianjin 300070,China;Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education,School of Mechanical Engineering,Tianjin University of Technology,Tianjin 300384,China;Department of Spine Surgery,Tianjin Hospital,Tianjin University,Tianjin 300211,China)

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津理工大学天津市先进机电系统设计与智能控制重点实验室,机电工程国家级实验教学示范中心,天津300384 [3]天津大学天津医院骨科,天津300211

出　　处：《中华生物医学工程杂志》2024年第3期167-172,共6页Chinese Journal of Biomedical Engineering

基　　金：科技部国家重点研发计划项目(2023YFC2416900);天津市科技计划项目(23JCZXJC00010、21JCZDJC01040);国家骨科与运动康复临床医学研究中心“以临床应用为导向的医疗创新基金”转化项目(2021-NCRC-CXJJ-ZH-22)

摘　　要：目的探究骨质疏松对侧方入路腰椎椎体间融合术(LLIF)后相邻椎体的生物力学影响。方法本研究以L_(3)~S_(1)为研究对象,模拟LLIF术前及术后的腰椎正常骨密度和骨质疏松状态,建立有限元模型(FEM)。通过赋予FEM不同的材料属性来模拟术后骨质正常有限元模型(NFEM)和骨质疏松的有限元模型(OFEM)。手术节段模拟在L_(4)~L_(5)。对模型施加一个500 N的随动载荷和7.5 N·m的力矩载荷模拟腰椎的屈伸、侧弯、轴向旋转的不同姿态。不同姿态下,计算NFEM和OFEM的邻近节段(L_(3)和S_(1))椎体松质骨和终板的Von Mises力峰值。结果与NFEM组相比,OFEM组的L_(3)松质骨的Von Mises力峰值在前后屈伸、左右侧弯、左右轴向旋转6种姿态下均有明显降低(8%、12%、21%、16%、20%、29%)。观察S_(1)松质骨Von Mises力峰值,OFEM组在后伸、左弯、右弯和右旋的姿态下的Von Mises力峰值增加(49%、17%、25%、14%),在前屈和左旋姿态Von Mises力峰值减小(31%、12%)。与L_(3)松质骨相比,S_(1)松质骨在各姿态下的应力变化方向存在差异。与NFEM组相比,在上述6种姿态下OFEM组的L_(3)下终板的Von Mises力峰值均有明显增加(42.10%、34.13%、30.05%、17.88%、26.50%、24.15%)。与NFEM组相比,OFEM组在前屈、侧弯、轴向旋转姿态的S_(1)上终板的Von Mises力峰值增加(23.25%、0.07%、29.94%、22.69%、32.43%),在后伸姿态下应力降低(5.36%)。与NFEM组比,OFEM组L_(4)~L_(5)节段相邻终板应力峰值大部分有明显增加。结论骨质疏松模型中LLIF术后手术节段临近椎体生物力学发生明显改变,相邻椎体终板应力明显增加,头侧松质骨应力明显降低,而尾侧松质骨应力呈现出增加趋势。Objective To investigate the biomechanical effects of osteoporosis on adjacent vertebral bodies after lateral lumbar interbody fusion(LLIF).Methods In this study,L_(3)-S_(1)was used to simulate the normal bone mineral density(BMD)and the state of osteoporosis of lumbar spine before and after LLIF,and to establish the finite element model(FEM).By endowing FEM with different material properties,the normal finite element model(NFEM)and the osteoporosis finite element model(OFEM)after surgery were simulated.The surgical segment is simulated at L_(4)-L_(5).A follower force of 500 N and a moment load of 7.5 N·m were applied to the model to simulate the different postures of flexion and extension,lateral bending and axial rotation of the lumbar spine.The peak Von Mises force of the vertebral cancellous bone and endplates of the adjacent segments(L_(3)and S_(1))of NFEM and OFEM were calculated under different postures.Results Compared with the NFEM group,the peak Von Mises force of L_(3)cancellous bone in the OFEM group was significantly decreased in all six postures of anterior-posterior flexion and extension,left and right lateral bending,and left and right axial rotation(8%,12%,21%,16%,20%,29%).Observing the S_(1)cancellous bone,and peak Von Mises force of the OFEM group increased in the left-bending,right-bending,left-axial rotation,and right-axial rotation postures(49%,17%,25%,14%),and decreased in the flexion and left-axial rotation postures(31%,12%).Compared with the L_(3)cancellous bone,the direction of stress change of the S_(1)cancellous bone was different in each posture.Compared with the NFEM group,the peak Von Mises force of the L_(3)lower endplate was significantly increased in all six postures in the OFEM group(42.10%,34.13%,30.05%,17.88%,26.50%,24.15%).Compared with the NFEM group,the OFEM group had an increase in the peak Von Mises force of the S_(1)upper endplate in the flexion,lateral bending,and axial rotation postures(23.25%,0.07%,29.94%,22.69%,32.43%),and decreased stress in the extension posture(5

关 键 词：骨质疏松 生物力学 有限元分析 侧方腰椎椎间融合术 

分 类 号：R580[医药卫生—内分泌] R687.3[医药卫生—内科学]