不同方法治疗骨质疏松性胸腰椎压缩骨折椎体力学稳定性变化差异的有限元分析  

Finite element analysis of different treatments in mechanical stability of osteoporotic vertebral compression fractures

作　　者：秦大平 张晓刚 权祯 张华 曹林忠 陈钵 徐斌 徐世伟 QIN Da-ping;ZHANG Xiao-gang;QUAN Zhen;ZHANG Hua;CAO Lin-zhong;CHEN Bo;XU Bin;XU Shi-wei(Clinical College of Traditional Chinese Medicine,Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of Spine Surgery,Affiliated Hospital of Gansu University of Chinese Medicine,Lanzhou 730020,China)

机构地区：[1]甘肃中医药大学中医临床学院,兰州730000 [2]甘肃中医药大学附属医院脊柱外科,兰州730020

出　　处：《中华中医药杂志》2021年第8期4886-4895,共10页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金项目(No.81760873);甘肃省高等学校创新基金项目(No.2020A-073);甘肃中医药大学附属医院青年创新基金(No.gzfy-2018-11)。

摘　　要：目的:通过有限元分析不同微创治疗方法对骨质疏松性椎体压缩骨折(OVCF)伤椎高度恢复不全状态下与人体正常模型、骨质疏松症(OP)患者模型进行对比分析,结合临床实际针对T12、L1椎体在骨折治疗后椎体高度丢失相同状态下不同工况条件对脊柱及相邻椎体附属结构的应力变化差异进行有限元分析,为OVCF的治疗筛选最佳的治疗策略和生物力学变化特征提供依据。方法:选择健康志愿者2人,X线检查排除胸腰椎相关病变,无明显畸形、增生、退变等,同时排除其他脊柱疾患病史、脊柱手术病史。另外选择2例住院老年骨质疏松女性胸腰椎CT及MRI扫描资料,通过PACS影像系统对符合条件的经过PKP、中医过伸复位法配合PKP、PVP治愈的临床真实病例6例,提取其CT及MRI资料,建立T11~L2三维有限元模型并验证模型有效性。施加生理正常载荷大小的轴向、前屈、后伸、侧屈载荷后求解,分析不同运动状态下的生物力学变化。对8组模型之间椎体、纤维环、椎间盘、髓核的Von Mises应力及椎体最大位移进行比对分析,同时对应力云图进行比对分析其生理与病理关节应力区域变化。结果:从椎体应力结果分析看,与正常人体脊柱胸腰段模型应力变化比较,经椎体强化术后PKP、PVP治疗在脊柱前屈、后伸、左右侧弯、左右旋转、轴向7种不同运动状态下,其椎体结构包括椎体、椎间盘、纤维环、髓核的Von Mises应力有明显增大趋势,而OP者上述指标有明显降低趋势,椎体最大位移呈现增大趋势。对于T12椎体压缩性骨折经骨水泥强化术后,其在左右旋转运动状态下椎体、关节突关节应力明显增大。纤维环、椎间盘的应力变化略低于正常人,其中T12~L1纤维环、椎间盘应力在L1椎体压缩性骨折经PKP治疗后明显高于正常人。髓核应力变化OP患者明显低于正常人,椎体强化术后高于正常人。对终板的应力�Objective:By means of finite element analysis of different minimally invasive treatment methods,the finite element analysis of the difference of stress changes in spine and adjacent vertebral appendage structure in different working conditions of T12 and L1 vertebral body under the same condition of vertebral body height loss was carried out in combination with the normal model of human body and the model of osteoporosis(OP)patients under the condition of finite element analysis.Methods:Two healthy volunteers were selected,and X-ray examination excluded thoracic and lumbar spine related lesions,no obvious deformity,hyperplasia,degeneration,and the history of other spinal diseases and spinal surgery was excluded.In addition,2 CT and MRI scanning data of hospitalized elderly osteoporosis were selected,and 6 qualified clinical real cases cured by PKP,TCM overextension and PKP,PVP were selected through PACS imaging system,their CT and MRI data were extracted,the T11~L2 three-dimensional finite element model was established and the effectiveness of the model was verified.Apply axial,forward,rear extension and lateral yield load with physiological normal load size and analyze biomechanical changes in different moving states.The Von Mises stress of vertebral body,fiber ring,disc,nucleus and vertebral maximum displacement were analyzed,and the physiological and pathological joint stress regional changes were analyzed.Results:From the analysis of the vertebral stress results,after vertebral reinforcement PKP and PVP treatment was compared with the stress changes of the normal human spine chest and waist model in the spinal anterior flexion,posterior extension,left and right bending,left and right rotation,and axial movement states.The Von Mises stress of the vertebral structure includes vertebral,disc,fiber ring,and nucleus,OP patients were compared with normal human spine chest and waist section in 7 different exercise states,including spinal anterior flexion,posterior extension,left and right rotation,left and right rot

关 键 词：胸腰椎体 骨质疏松性椎体压缩骨折 椎体力学 稳定性 有限元分析 骨质疏松症 过伸复位法 

分 类 号：R580[医药卫生—内分泌] R683[医药卫生—内科学]