骨水泥填充位置对骨质疏松性椎体压缩骨折的生物力学特性影响:一项三维有限元分析  

Biomechanical effects of cement filling location on osteoporotic vertebral compression fracture:a three-dimensional finite element analysis

作　　者：叶林强[1] 卢国樑 江晓兵[1] 李真[2] 翁汭 梁德[1] 黄学成 冯永洪 Ye Linqiang;Lu Guoliang;Jiang Xiaobing;Li Zhen;Weng Rui;Liang De;Huang Xuecheng;Feng Yonghong(Department of Spinal Surgery,First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China;Department of Spinal Surgery,Dongguan Hospital of Guangzhou University of Chinese Medicine,Dongguan 523000,Guangdong Province,China;Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China;Department of Human Anatomy,School of Basic Medical Sciences,Southern Medical University,Guangzhou 510000,Guangdong Province,China)

机构地区：[1]广州中医药大学第一附属医院脊柱骨科,广东省广州市510405 [2]广州中医药大学东莞医院脊柱骨科,广东省东莞市523000 [3]广州中医药大学,广东省广州市510405 [4]南方医科大学基础医学院人体解剖学教研室,广东省广州市510000

出　　处：《中国组织工程研究》2022年第28期4435-4440,共6页Chinese Journal of Tissue Engineering Research

基　　金：广东省医学科学技术研究基金(A2017024),项目负责人:叶林强;广东省中医药局科研项目(20182030),项目负责人:叶林强。

摘　　要：背景:当采用双侧经皮椎体强化治疗骨质疏松性椎体压缩骨折时,骨水泥在骨折椎体内的填充位置包括前外侧、前内侧和后外侧3种,尤其多见于椎体体积相对较大的腰椎。目前尚未发现有相关生物力学研究对比这3种骨水泥填充位置对骨折椎体的生物力学特性影响差异。目的:采用三维有限元分析法比较3种骨水泥填充位置对骨质疏松性椎体压缩骨折的生物力学特性影响。方法:建立L_(1)-L_(5)节段骨质疏松性腰椎三维有限元模型并在L_(3)椎体构建骨质疏松性椎体压缩骨折模型,然后于骨质疏松性椎体压缩骨折模型分别模拟3种骨水泥填充位置:前外侧、前内侧和后外侧,共获得4组模型。在相同边界条件下(前屈、后伸、侧屈、旋转)进行三维有限元分析,计算比较4组模型中L_(3)椎体最大米塞斯应力和骨折区域最大位移。结果与结论:①在前屈加载条件下,前外侧、前内侧和后外侧骨水泥填充后的L_(3)椎体最大米塞斯应力分别约为骨质疏松性椎体压缩骨折模型的18.31%,19.43%,28.31%,骨折区域最大位移分别约为骨质疏松性椎体压缩骨折模型的13.92%,16.49%,29.90%。说明与经皮椎体强化前相比,经皮椎体强化后的最大米塞斯应力和最大位移均显著降低,前外侧骨水泥填充的最大米塞斯应力和最大位移最小;在后伸、侧屈和旋转加载条件下可见类似结果;②结果发现,前外侧骨水泥填充可以更好地恢复骨折椎体的强度和稳定性,建议通过靶向穿刺置管、精准注射骨水泥技术首先保证骨水泥在骨折椎体前外侧骨折区域的填充。BACKGROUND:When bipedicular percutaneous vertebral augmentation is performed for osteoporotic vertebral compression fractures,three types of cement filling location in the vertebral body are commonly seen,including anterolateral,anteromedial,and posterolateral,especially in lumbar spine with big volume of vertebral bodies.At present,no relevant biomechanical research has been found to compare the impact of these three bone cement filling locations on the biomechanical properties of fractured vertebral bodies.OBJECTIVE:To analyze and compare biomechanical effects of three types of cement filling location on osteoporotic vertebral compression fracture using threedimensional finite element analysis method.METHODS:Osteoporotic L_(1)-L_(5) three-dimensional finite element model was constructed and osteoporotic vertebral compression fractures model was simulated in L_(3).Three types of cement filling location,including anterolateral,anteromedial,and posterolateral,were simulated in osteoporotic vertebral compression fractures model,respectively.Four models were got for the test eventually.Maximum von Mises stress of L_(3) veretebral body and maximum displacement of L_(3) fractured area were calculated for the four models under the same loading conditions,including flexion,extension,lateral bending,and rotations.RESULTS AND CONCLUSION:(1)Under flexion,maximum von Mises stress of L_(3) veretebral body in anterolateral,anteromedial,and posterolateral sites was about 18.31%,19.43%,and 28.31%of that in osteoporotic vertebral compression fractures model,respectively.Maximum displacement of L_(3) fractured area was about 13.92%,16.49%,and 29.90%of that in osteoporotic vertebral compression fractures model,respectively.Therefore,compared with percutaneous vertebral augmentation pre-operation,maximum von Mises stress and maximum displacement were decreased significantly after percutaneous vertebral augmentation,with those in anterolateral site being decreased the most significantly.Similar changes could be seen in extension,lat

关 键 词：骨水泥 骨质疏松 椎体压缩骨折 经皮椎体强化 骨水泥填充位置 三维有限元分析 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学]