腰椎椎间孔成形幅度对关节突关节应力变化的有限元分析  

Lumbar facet joint characteristics after foraminoplasty in different amplitudes :finite element analysis

作　　者：阮朝阳[1] 何永清[1] 曾强华[1] 朱群威 付强[2] RUAN Zhao-yang;HE Yong-qing;ZENG Qiang-hua;ZHU Qun-wei;FU Qiang(Second Department of Orthopaedics,Haining People’s Hospital,Haining 314400,Zhejiang,China;Department of Orthopaedics,Changhai Hospital,Second Military Medical University,Shanghai 200433,China)

机构地区：[1]浙江省海宁市人民医院骨二科,浙江314400 [2]第二军医大学附属长海医院骨科,上海200433

出　　处：《脊柱外科杂志》2017年第6期357-360,365,共5页Journal of Spinal Surgery

基　　金：浙江省医药卫生科技计划项目(2015KYB395)

摘　　要：目的建立L_(3~5)三维有限元模型,分析椎间盘摘除并不同幅度椎间孔成形前后对L_4/L_5关节突关节应力分布的影响。方法选取1名既往无腰椎疾病史的20岁男性志愿者,获取其腰椎CT数据构建有限元模型并验证其有效性。在L_4/L_5椎间盘中度退变模型(M1)的基础上,模拟经椎间孔入路经皮内窥镜技术,去除椎间盘左后侧约1/4纤维环中部及1/4髓核,模拟腰椎椎间盘摘除术,构建模型M2;以圆柱体代替环锯模拟切除L_5上关节突部分骨质行椎间孔扩大成形,构建一级椎间孔成形模型M3(环锯直径5.0 mm)、二级椎间孔成形模型M4(环锯直径6.5 mm)和三级椎间孔成形模型M5(环锯直径7.5 mm)。给予特定加载条件,比较模型在前屈、后伸、左右侧曲、左右旋转6种工况下L_4/L_5关节突关节应力变化。结果建立的L_(3~5)三维有限元模型有效。M1模型在各种工况下L_4/L_5关节突关节的应力左侧较右侧大。M2模型在前屈工况下左侧L_4/L_5关节突关节应力下降,右侧应力上升;在后伸工况下左侧应力上升,右侧应力下降;在右旋工况下,左侧应力变化不明显,右侧应力稍下降;在左侧屈及左旋工况下两侧应力均上升;在右侧屈工况下左侧应力稍下降,右侧应力变化不明显。除M5模型左旋工况下右侧应力增加明显外,其他各种工况下M3、M4、M5模型应力变化不明显。结论椎间盘摘除后引起病变节段关节突关节面所承载的负荷不对称;在精确穿刺的指引下,环锯直径5.0、6.5、7.5 mm行椎间孔成形对病变节段关节突关节应力变化无显著影响。Objective To analyze the stress distribution of the L4/L5facet joint after foraminoplasty in different amplitudes based on a three-dimensional finite element model of L3-5segments of the lumbar spine.Methods To select a20-year-old Chinese male volunteer who has no history of lumbar disease,obtain CT data to build the finite element model and verify its validity.On the L4/L5intervertebral disc moderate degeneration mode(model1,M1),the lumbar discectomy simulate dpercutaneous transforaminal endoscopic technique to establish a channel between the midpoint of the tip of the protruding points and the top of the L5vertebral body,and about1/4middle of the fiber ring at the left posterior side of the intervertebral disc and a quarter of the nucleus pulposus were removed(M2).The model of the first-stage foraminoplasty(M3,diameter5.0mm),the second-stage foraminoplasty(M4,diameter6.5mm)and three-stage foraminoplasty(M5,diameter7.5mm)were established by using the cylinder instead of the trepan to simulae removing the superior facet bone for foraminoplasty.Under specific loading conditions,the stress distribution of the L4/L5facet joint of6kinds of loads(flextion,extension,left and right lateral bending,left and right rotation)were compared.Results An effective L3-5three-dimensional finite element model was established.In the M1model,the stress on the L4/L5left facet joints was larger than the right side under various conditions.In the M2model,under flexion status,the stress decreased on left side,and the stress increased on right side;under extension under,the stress increased on left side,but decreased on right side;under right rotation status,the stress had no obvious change on left side,and the stress decreased slightly on right side;under left lateral bending and left rotation status,the stress increased on both sides;under right lateral bending status,the stress decreased slightly on left side,and the stress had no obvious change on right side.In addition to the stress on right side increased obviously underleft rotatio

关 键 词：腰椎 椎关节突关节 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]