经皮椎体成形术后矢状面有限元分析  

A finite element analysis on variation in sagittal plane secondary to percutaneous kyphoplasty

作　　者：何立江[1] 黄杰苗[1] 林其仁[1] 吴文华[1] 姚金志[1] 柯呈辉 HE Li-jiang;HUANG Jie-miao;LIN Qi-ren;WU Wen-hua;YAO Jin-zhi;KE Cheng-hui(Department of Spinal Orthopedics,The Second Affiliated Hospital,Fujian Medical University,Quanzhou 362046,China)

机构地区：[1]福建医科大学附属第二医院脊柱骨科,福建泉州362046

出　　处：《中国矫形外科杂志》2020年第16期1500-1504,共5页Orthopedic Journal of China

摘　　要：[目的]探讨经皮椎体成形术后脊柱矢状面参数变化。[方法]选取1例68岁脊柱矢状面形态为Roussouly分型Ⅱ型的L1椎体骨质疏松性骨折的男性志愿者,全脊柱CT扫描,数据经处理建立胸腰椎和骨盆的三维模型,分别建立正常对照、轻度后凸和中度后凸的三维有限元模型,测量计算脊柱在肌力正常和肌力减小工况下各椎体的应力变化。[结果]SVA值轻度后凸模型为54.27 mm,中度后凸模型为81.37 mm。T5~9各椎体的Mises应力均依次为:对照模型<轻度后凸模型<中度后凸模型(P<0.05)。肌力正常组,三种模型椎体Von Mises应力自T5~9依次显著增大(P<0.05);肌力减小组中,T7的Von Mises应力显著大于T5、T6、T8、T9椎体(P<0.05)。肌力减小组中T7的Von Mises应力显著大于肌力正常组(P<0.05)。L1椎体的Mises应力显著大于L2-5椎体的Mises应力(P<0.05),并且中度后凸模型显著大于轻度后凸模型和对照模型(P<0.05)。肌力正常组的L2~5椎体的Mises显著小于肌力减小组(P<0.05)。[结论]PKP术后残存的后凸畸形会导致脊柱矢状面偏移增加,引发非相邻椎体的应力集中。[Objective]To explore the variations in sagittal plane secondary to percutaneous kyphoplasty(PKP).[Methods]A 68-year-old male who underwent PKP for Roussouly typeⅡosteoporotic fracture of L1 received total spine CT scanning.After data processing,the 3 D models of thoracolumbar and pelvis were created.After that,finite element models of normal control,mild and moderate kyphosis were established respectively to measure the stress on each vertebral body under compensatory and decompensated conditions.[Results]The deviation to SVA was of 54.27 mm in the mild kyphosis,whereas 81.37 mm in the moderate kyphosis.In compensatory and decompensated conditions,the Von Mises stresses on the T5 to T9 ranked in sequences of the control model<the mild kyphosis<the moderate kyphosis(P<0.05).The Von Mises stresses significantly increased from T5 to T9 in compensatory condition(P<0.05),whereas were the greatest on T7 compared with those on T5,T6,T8 and T9 vertebral bodies in decompensated condition(P<0.05).Compared between two conditions,the Von Mises stress on T7 was significantly greater in decompensated conditions than those in compensatory condition(P<0.05).With respect to lumbar spine,the L1 had significantly greater stress compared with those in the L2 to L5 in compensatory and decompensated conditions(P<0.05).The stresses in moderate kyphosis were significantly greater than those in the control and mild kyphosis(P<0.05),which also were greater in decompensated condition from L2 to L5 than those in compensatory condition(P<0.05).[Conclusion]The residual kyphosis after PKP lead to the increase of deviation in sagittal plane,which cause the stress concentration on non-adjacent vertebrae.

关 键 词：经皮椎体成形术 脊柱矢状位 有限元分析 

分 类 号：R687[医药卫生—骨科学]