椎间孔镜术后腰椎间盘突出复发与后纵韧带完整性关系的有限元生物力学研究  

Finite element biomechanical study on the relationship between recurrence of lumbar disc herniation after posterior intervertebral foramen surgery and integrity of posterior longitudinal ligament

作　　者：刘金玉 崔洪鹏 丁宇[1] 卢正操 杜薇 李雯[1] 赵博然 余淑娟 周维金 LIU Jin-yu;CUI Hong-peng;DING Yu;LU Zheng-cao;DU Wei;LI Wen;ZHAO Bo-ran;YU Shu-juan;ZHOU Wei-jin(Orthopedics of TCM Clinical Unit,The Sixth Medical Center,Chinese PLA General Hospital,Beijing,100048,China)

机构地区：[1]解放军总医院第六医学中心中医学部骨伤科,北京100048 [2]北京弘格瑞达中医诊所,102400

出　　处：《中国骨与关节杂志》2021年第7期508-514,共7页Chinese Journal of Bone and Joint

基　　金：首都临床诊疗技术研究及示范应用项目(Z191100006619028)。

摘　　要：目的建立椎间孔镜手术治疗腰椎间盘突出症(lumbar disc herniation,LDH)对后纵韧带不同处理方式的有限元模型,完成对正常活动的生物力学分析,并探讨该手术对腰椎后纵韧带不同处理方式对术后复发的影响。方法获得男性志愿者的CT平扫数据,导入Mimics 20.0软件中,建立志愿者L_(4~5)节段有限元模型M。将模型M导入3-matic中进行椎间孔镜手术模拟,右侧入路切除部分上关节突后正位到达棘突连线,摘除右后侧1/4髓核组织,在Ansys Workbench 18.0中建立后纵韧带结构并模拟手术中切除部分后纵韧带,形成模型M1。将模型M导入3-matic中进行椎间孔镜手术模拟,右侧入路切除部分上关节突后正位到达同侧椎弓根连线,摘除等量右后侧1/4髓核组织,在Ansys Workbench 18.0中建立后纵韧带结构而不做切除形成模型M2。在Ansys Workbench 18.0软件中对3种模型进行正常日常活动同等压力载荷的椎间盘受压及同等扭矩下的前屈、后伸、左侧弯、右侧弯、左旋转、右旋转6种工况活动的力学对比分析。结果与M模型比较,M2模型在6种工况下活动度(range of motion,ROM)值相近;但M1模型ROM值在左侧屈及前屈动作下,为M模型ROM的120%~135%。椎间盘应力方面,M2模型与M模型相比在椎间盘各区6种工况下等效应力上升趋势不明显;而M1与M模型相比,在6种活动下椎间盘左前侧区域等效应力出现明显增加,并可见椎间盘向右后侧凸出变形挤压剩余髓核组织。结论椎间孔镜手术对LDH的治疗精准可控,手术对腰椎稳定结构破坏少,对相应节段的生物力学稳定性影响较小,较少出现医源性节段不稳,但在手术时,要考虑尽量不破坏后纵韧带结构,以降低术后复发的概率。Objective To establish finite element models of different managements of posterior longitudinal ligament by percutaneous transforaminal endoscopic surgery for lumbar disc herniation(LDH),complete the biomechanical analysis of normal activities,and explore the influence of different managements of lumbar posterior longitudinal ligament on postoperative recurrence.Methods CT scan data of a male volunteer was imported into Mimics 20.0 software to establish volunteer L4-5 finite element model M.The model M was imported into the 3-matic for the simulation of percutaneous transforaminal endoscopic surgery.Part of the superior articular process was removed to the line of the spinous process through the right approach,and the right posterior 1/4 of the nucleus pulposus was removed.The posterior longitudinal ligament structure was established in Ansys Workbench 18.0 and part of it was simulated to be removed during surgery,that was model M1.The model M was imported into the 3-matic for the simulation of percutaneous transforaminal endoscopic surgery.Part of the superior articular process was removed to the line of the vertebral pedicle through the right approach,and the right posterior 1/4 of the nucleus pulposus was removed.The posterior longitudinal ligament structure was established in Ansys Workbench 18.0and no any part of it was simulated to be removed during surgery,that was model M2.In the Ansys Workbench 18.0software,mechanical comparative analysis was conducted on 3 models under normal daily activities of disc compression under the same pressure load and 6 working conditions of forward bend/backward stretch/left bend/right bend/left rotate/right rotate under the same torque.Results Compared with M model,the ROM(range of motion)of M2 model was similar in six working conditions,but the ROM of M1 model was 120%-135%of the ROM of M model in the working conditions of left bend and forward bend.The M2 model showed no obvious upward trend of the equivalent stress in six working conditions in each region of intervertebra

关 键 词：椎间盘移位 腰椎 有限元分析 模型 理论 

分 类 号：R687.4[医药卫生—骨科学]