PKP不同增强方式对相邻椎体结构生物力学影响的有限元分析  

Effects of various augmentation methods during PKP on the biomechanics of adjacent vertebral structures via finite element analysis

作　　者：唐勇涛 魏思奇 吴长军 欧阳汉斌[2] 刘岗 

机构地区：[1]深圳市光明新区人民医院骨一科,广东518106 [2]南方医科大学基础医学院人体解剖学教研室,广州510515

出　　处：《中国骨科临床与基础研究杂志》2017年第3期167-174,共8页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：深圳市卫生计生系统科研项目(201402143)

摘　　要：目的探讨经皮椎体后凸成形术(PKP)术中不同椎体增强方式对相邻椎体结构生物力学特性的影响。方法应用1例正常志愿者CT断层扫描数据对T_(12)~L_2椎体进行三维重建,共建立3个椎体模型和2组椎间盘模型,基于文献数据对上述结构分别赋予相应的材料参数,设定站立位状态下脊柱承受的轴向压缩生理载荷和边界条件,分别模拟非增强、前柱增强、前中柱增强、中柱增强以及全椎体增强5种不同增强方式的L1PKP模型,对比不同组间结构的应力峰值和分布。结果 5组不同增强方式产生的相邻椎体最大应力峰值变化差异均不超过5%;骨折的L1椎体强化后应力峰值显著降低,最大应力降低幅度可达80.85%;T_(12)~L1及L1~L_2椎间盘最大应力变化差异分别为5.9%和2.1%。结论 PKP在术后早期静态垂直载荷下不会引起相邻结构应力的显著变化,而强化椎体则呈现出显著的应力下降,下降幅度与强化部位、范围密切相关。Objective To investigate the effects of various augmentation methods during percutaneous kyphoplasty （PKP） on the biomechanics of adjacent vertebral structures. Methods A group of a volunteer＇s CT scan data was obtained for 3D reconstruction of spine, ranging from T12 to L2 vertebrae. A total of five models including three vertebrae and two intervertebral discs were established. Material properties assignment of all above structures, axial compressive load during mid-stance, and boundary conditions were set according to previous studies. With regard to the L1 vertebrae, various augmentation methods during PKP, including non-augmentation, anterior column, anterior-middle column, middle column, and full vertebral augmentation, were simulated. Comparisons for the magnitude and distribution of peak yon Mises stress among five groups were conducted. Results The maximal deviations of peak stress on the adjacent vertebra among five groups were all under 5%; A significant greater decrease up to 80.85% in peak stress was exhibited in the augmented L1 vertebra comparing to those non-augmented adjacent vertebrae; The maximal deviations of peak stress for the intervertebral discs of T12-L1 among the five groups were 5.9%, and 2.1% for L1-L2 respectively. Conclusions In the early stage after PKP, no significant change of peak stress was observed in the adjacent vertebral structures under the static vertical load. However, a significant decrease of peak stress was found in the augmented vertebra, and the decrease magnitude showed a significant correlation to both location and volume of the augmentation.

关 键 词：胸椎 腰椎 椎间盘 脊柱骨折 骨质疏松 椎体成形术 骨黏合剂 生物力学 有限元分析 应力 物理 

分 类 号：R687.3[医药卫生—骨科学]