椎体成形术对相邻椎体生物力学影响的有限元分析  

Effect of vertebroplasty on the biomechanics of adjacent vertebrae:a finite element analysis

作　　者：李安明 史国号[2] 王国柱[2] 陈志辉[2] 欧国峰[2] 朱峰峰 LI Anming;SHI Guohao;WANG Guozhu;CHEN Zhihui;OU Guofeng;ZHU Fengfeng(Department of Orthopedics,the Second Hospital of Hanbin,Ankang,Shaanxi 725000,China;Department of Orthopedics,the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang,Shaanxi 712000,China;Department of Orthopedics,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang,Shaanxi 712000,China)

机构地区：[1]陕西省安康市汉滨区第二医院骨科,725000 [2]陕西中医药大学第二附属医院骨科,陕西咸阳712000 [3]陕西中医药大学附属医院骨病科,陕西咸阳712000

出　　处：《重庆医学》2021年第2期215-219,共5页Chongqing medicine

基　　金：全国名老中医药专家传承工作室建设项目(国中医药人教发[2018]134号);关中李氏骨伤流派传承工作室项目(陕中医药发[2018]40号)。

摘　　要：目的采用数字仿真评估椎体成形术骨水泥注入量及弥散范围对邻近椎体生物力学平衡的影响。方法选取30例骨质疏松性腰2椎体压缩骨折患者行CT三维重建,利用有限元分析软件进行优化设计和测试,模拟椎体在人日常生活中进行各种运动的受力情况,选择施加500 N的轴向压力,观察注入骨水泥前后相邻椎体终板的应力分布及所受最大应力变化情况。结果应力的分布与集中部位有所不同,最大应力均与术前相比有明显差异(P<0.05)。注入大剂量骨水泥时[腰1椎体(2.93±0.56)Mpa、腰3椎体(5.45±1.00)Mpa]应力最大值大于注入小剂量骨水泥时[腰1椎体(2.58±0.44)Mpa、腰3椎体(5.23±0.98)Mpa],单侧弥散时[腰1椎体(3.03±0.49)Mpa、腰3椎体(5.25±0.67)Mpa]应力最大值大于双侧弥散时[腰1椎体(2.58±0.44)Mpa、腰3椎体(5.23±0.98)Mpa]。结论椎体成形术后的骨水泥注入量和弥散分布范围可对相邻椎体所受应力变化产生直接影响,在有效治疗剂量内选取较小剂量的骨水泥并使骨水泥呈双侧弥散分布对相邻椎体应力分布可产生相对有利的影响。Objective To evaluate the effect of amount of bone cement injected and the diffusion range of vertebroplasty on the biomechanical balance of adjacent vertebrae using digital simulation.Methods A total of 30 cases of lumbar 2 osteoporotic compression fracture patients were selected for CT three-dimensional reconstruction.The finite element analysis software was used for optimization design and testing.Force situation of vertebrae during various kinds of sports in daily was simulated,and 500N axial pressure was chosen,the distribution and the change of maximum adjacent vertebral lamina force of bone cement was observed.Results The force distribution varies depending on where it is concentrated.The maximum force was significantly different from that before operation(P<0.05).When high-dose bone cement[lumbar 1 vertebrae(2.93±0.56)Mpa,waist 3 vertebrae(5.45±1.00)Mpa]was injected,the maximum force were greater than those caused by low-dose bone cement injection[lumbar 1 vertebrae(2.58±0.44)Mpa,lumbar 3 vertebrae(5.23±0.98)Mpa].Also,the degree of change and the maximum force caused by unilateral diffusion[lumbar 1 vertebrae(3.03±0.49)Mpa,lumbar 3 vertebrae(5.25±0.67)Mpa]were both greater than bilateral diffusion[lumbar 1 vertebrae(2.58±0.44)Mpa,lumbar 3 vertebrae(5.23±0.98)Mpa].Conclusion The amount of bone cement injected and the diffusion range of vertebroplasty had a direct effect on the biomechanical balanceof adjacent vertebrae.Selecting a small dose of bone cement within the effective therapeutic dose and making the bone cement distributed in bilateral diffusion can conduct a relatively favorable effect on the force distribution of adjacent vertebrae.

关 键 词：骨质疏松性骨折 椎体成形术 生物力学 有限元分析 

分 类 号：R687.3[医药卫生—骨科学]