椎体成形术后残余后凸畸形的有限元分析  

A finite element analysis on residual kyphosis secondary to vertebroplasty

作　　者：赵龙[1] 王剑[1] 韩正才 张月洋 ZHAO Long;WANG Jian;HAN Zhengcai;ZHANG Yue-yang(Department of Orthopedics,The First Hospital,Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院骨科,甘肃兰州730000

出　　处：《中国矫形外科杂志》2020年第22期2082-2086,共5页Orthopedic Journal of China

基　　金：2014兰州市科学技术研究与发展计划项目(编号:20142045)

摘　　要：[目的]应用有限元分析的方法,探讨椎体成形术后残余后凸畸形对伤椎及邻椎应力影响。[方法]选取楔形L1椎体压缩性骨折老年患者为研究对象,采集患者螺旋CT图像在Mimics 17.0、Geomagic Studio10.0、Hyper⁃mesh13.0建立残留15%(A模型)、30%(B模型)、45%(C模型)三种后凸畸形的有限元模型。[结果]前屈、后伸、侧弯载荷下,楔形变组与塌陷压扁组模型T12/L1及L1、2节段产生的位移量较正常高度组模型显著增加(P<0.05)。前屈及侧弯载荷下,塌陷压扁组T12下终板和L2上终板的应力显著大于楔形变和正常高度组,差异有统计学意义(P<0.05)。骨水泥应力比较,塌陷压扁组>楔形变组>正常高度组,差异有统计学意义(P<0.05),楔形变组组内比较C模型骨水泥应力显著大于B模型和A模型,差异有统计学意义(P<0.05)。[结论]椎体成形术残留的后凸畸形会影响脊柱矢状面稳定,应采取积极干预措施,以避免再骨折或后凸畸形加重。[Objective]To study the influence of residual kyphosis after vertebroplasty on the stress of injured vertebra and adjacent vertebra by a finite element analysis.[Methods]An elderly patient with wedge-shaped L1 vertebral compression frac⁃tures were selected for the spiral CT scanning.The imaging data were processed with Mimics 17.0,Geomagic Studio 10.0 and HyperMesh 13.0 software to establish the finite element models of normal,wedge-shaped and flattened L1 vertebrae with 15%(A model subgroup),30%(B model subgroup)and 45%(C model subgroup)residual kyphotic deformities secondary to vertebro⁃plasty.[Results]The displacement of T12L1 and L1、2 in the wedge-shaped group and flattened group increased significantly com⁃pared with the normal control group.Under the flexion and rotation load,the stress on T12 lower end plate and L2 upper end plate in flattened group was significantly higher than those in wedge-shaped group and normal control group(P<0.001).The stress on bone cement ranked up-down in the sequence of the flattened group>the wedge-shaped group>the normal control group with significant differences(P<0.001).In addition,in the wedge-shaped group,C model subgroup had significantly higher stress on bone cement than those in the B model and A model subgroups(P<0.001).[Conclusion]The residual kyphosis after vertebroplasty might affect the stability on sagittal plane,prophylactic intervention should be taken to avoid the aggravation of refracture or kyphosis.

关 键 词：骨质疏松性椎体骨折 椎体成形术 后凸畸形 有限元分析 

分 类 号：R687[医药卫生—骨科学]