骨水泥弥散类型影响胸腰段椎体成形后相邻椎体应力的三维有限元分析  

Three-dimensional finite element analysis of the influence of bone cement dispersion type on the stress of adjacent vertebrae after vertebroplasty

作　　者：陈荣彬 白杰 李勇[1] 张劲新[1] 鲁尧[1] 吴钊钿[1] Chen Rongbin;Bai Jie;Li Yong;Zhang Jinxin;Lu Yao;Wu Zhaodian(Third Department of Orthopedics,Zhuhai Branch of Guangdong Province Hospital of Traditional Chinese Medicine,Zhuhai 519015,Guangdong Province,China;Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China)

机构地区：[1]广东省中医院珠海医院骨三科,广东省珠海市519015 [2]广州中医药大学第二临床医学院,广东省广州市510405

出　　处：《中国组织工程研究》2020年第30期4775-4781,共7页Chinese Journal of Tissue Engineering Research

基　　金：广东省医学科学技术研究基金(A2018165),项目负责人:陈荣彬;广东省中医药管理局(20194010),项目 负责人:李勇.

摘　　要：背景:椎体成形术后出现邻近椎体骨折已得到广泛关注,骨水泥弥散类型影响邻椎应力改变的有限元研究国内外未见报道。目的:利用有限元方法分析3种骨水泥弥散类型对胸腰段椎体成形术后患椎相邻椎体在不同载荷下的应力变化。方法:选取1例L1椎体压缩性骨折患者,以及3例L1椎体成形术后骨水泥呈弥散型、混合型、团块型分布患者的原始CT数据,利用Mimics 19.0、Geomagic Studio 2013及SolidWorks 2017等软件,通过划分网格、定义材料属性、装配模型,建立T11-L2椎体功能单元压缩性骨折及3种骨水泥弥散类型的有限元模型。分别施加0.3 MPa(低压力)、1.0 MPa(中压力)、4.0 MPa(高压力)3级压力和前屈、后伸、侧屈、旋转4种载荷方向,观察模型T12、L2椎体在不同压力、载荷下的应力分布情况。结果与结论:①注入骨水泥后邻椎应力的增加与轴向压力的增加呈正相关;②骨水泥呈团块型分布时,在4种载荷方向下邻椎的最大应力值明显高于弥散型及混合型,其中在前屈、侧弯载荷下,混合型邻椎应力低于团块型、弥散型;③结果发现,骨水泥呈团块型分布是导致邻椎应力增高的重要因素,骨水泥呈混合型分布可能降低了相邻椎体骨折的风险。BACKGROUND:The fracture of adjacent vertebrae after vertebroplasty has been widely concerned.The finite element study of the influence of three cement diffusion types on the stress change of adjacent vertebrae after vertebroplasty has not been reported at home and abroad.OBJECTIVE:To analyze the stress changes of the adjacent vertebrae of the affected vertebrae under different loads using the finite element method.METHODS:Based on the original CT data of one L1 vertebral compression fracture patient and three L1 vertebral consolidation patients with bone cement distributed in the form of dispersion,mixture and agglomeration,the finite elements of T11-L2 vertebral functional unit compression fracture and three types of bone cement dispersion were established by dividing grids,defining material attributes and assembling models,using software such as Mimics 19.0,Geomagic Studio 2013 and SolidWorks 2017.The models underwent three levels of pressure 0.3 MPa(low pressure),1.0 MPa(medium pressure)and 4.0 MPa(high pressure)and four load directions of forward bending,backward extension,lateral bending and rotation,respectively.The stress distribution of T12 and L2 vertebrae under different pressures and loads was observed.RESULTS AND CONCLUSION:(1)The increase of the stress of the adjacent vertebrae was positively correlated with the increase of the axial stress after the injection of bone cement.(2)The maximum stress of the adjacent vertebrae was significantly higher than that of the diffusion type and the mixed type under the four loading directions of the agglomerate type of bone cement,and the stress of the mixed type of the adjacent vertebrae was lower than that of the agglomerate type and the diffusion type under the forward bending and lateral bending loads.(3)The results showed that the agglomerate type of bone cement is an important factor leading to the increase of the stress of the adjacent vertebrae.The mixed cement distribution may reduce the risk of adjacent vertebral fractures.

关 键 词：材料 骨水泥 骨折 弥散 椎体 骨质疏松 应力 有限元 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]