骨水泥不同弥散方式对椎体成形术后生物力学影响的有限元分析  

Biomechanical effects of different bone cement diffusion patterns after vertebroplasty:finite element analysis

作　　者：姚龚 沈忆新[1] 李敏 蔡兵 YAO Gong;SHEN Yi-xin*;LI Min;CAI Bing(Department of Orthopaedics,the Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu,China;不详)

机构地区：[1]苏州大学附属第二医院骨科,江苏苏州215004 [2]上海交通大学医学院附属第九人民医院黄浦分院骨科,上海200011

出　　处：《中国骨伤》2021年第8期732-737,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨术中骨水泥不同弥散方式在治疗骨质疏松性椎体压缩骨折中的生物力学影响。方法:选取老年骨质疏松性压缩骨折志愿者1例,男性,68岁,身高172 cm,体重60 kg。既往身体健康,行X线片及胸腰部CT检查,诊断为L_1椎体压缩性骨折。从T_(10)-L_(5)之间使用CT扫描,采用Mimics软件提取CT数据,使用Geomagic wrap及Solidworks建模,建立术前胸腰段骨质疏松性椎体压缩骨折三维有限元模型(T_(12)-L_(2)),同样地模拟出椎体成形术中骨水泥弥散的形态,根据不同的弥散方式(分为骨水泥与上下终板均不接触、骨水泥仅与上终板接触及骨水泥与上下终板同时接触3种情况),对模型施加直立、直立+前屈、直立+后伸、直立+左侧弯、直立+右旋转5种载荷,同时与术前的无骨水泥腰椎模型进行对比,记录并比较各个模型载荷下的变形和应力分布。结果:建立了胸腰段骨质疏松性椎体压缩骨折的三维有限元模型后发现,在骨水泥与上下终板均不接触、骨水泥仅与上终板接触、骨水泥与上下终板同时接触3种不同的模型下,其变形情况差异不大。在L_1松质骨中,无骨水泥腰椎组的Von Mises应力明显高于骨水泥组。在3组不同的骨水泥注入方式中,骨水泥和上下终板均接触组的Von Mises应力水平最低,仅和上终板接触组其次,未与上下终板接触组最高。在骨水泥应力比较中,骨水泥和上下终板均接触组的Von Mises应力分别为直立12.375 MPa、直立+前屈16.411 MPa、直立+后伸16.801 MPa、直立+左侧弯13.425 MPa、直立+右旋转13.014 MPa,显著高于另外两组,其次为仅与上终板接触组,不与上下终板接触的Von Mises应力最低。结论:骨水泥和上下终板均接触,可有效吸收并传递载荷带来的应力水平,降低松质骨的应力水平,减少手术椎体再骨折的可能。Objective:To investigate the biomechanical effects of different bone cement diffusion patterns in the treatment of osteoporotic vertebral compression fractures.Methods:One volunteer with L1 osteoporotic vertebral compression fracture was selected,male,aged 68 years old,heighed 172 cm,weighted 60 kg,and healthy before.CT scans were used from T_(10)-L_(5),CT data was extracted with Mimics software,and Geomagic wrap and Solidworks were used to model,and the three-dimensional finite element model(T_(12)-L_(2))of preoperative osteoporotic vertebral compression fractures in the thoracolumbar segment was established.Similarly,the situations of bone cement dispersion in vertebroplasty were simulated(the situations of bone cement dispersion had the three kinds,including the bone cement not contacts with upper and lower endplates,the bone cement only contacts with upper endplates,and the bone cement contacts with upper and lower endplates).According to different diffusion situations,five types of loads were applied to the model:upright,upright plus forward flexion,upright plus backward extension,upright plus left bending,upright plus right rotation.Meanwhile,the model was compared with the cementless lumbar spine model,and the deformation and stress distribution of each model under load were recorded and compared.Results:After the establishing the finite element model of osteoporotic vertebral compression fracture in the thoracolumbar segment,it was found that the deformation of three different bone cement distribution models above was not significantly different.In L1 cancellous bone,the Von Mises stress of the cementless lumbar spine group was significantly higher than that of the cemented group.Among the three groups of different bone cement injection situations,the Von Mises stress in the group of bone cement contacts with upper and lower endplates was the lowest,followed by the group of bone cement only contacts with upper endplates,and the highest Von Mises stress was the group that bone cement contacts neither the u

关 键 词：经皮椎体成形术 骨水泥 有限元分析 

分 类 号：R681.5[医药卫生—骨科学]