腰椎病变融合器注入骨水泥后不同置入及固定方法的生物力学变化  

Biomechanical changes in different implantation and fixation methods of lumbar fusion cage

作　　者：聂文忠 李晓萱 曾嘉艺 石常强 Nie Wenzhong;Li Xiaoxuan;Zeng Jiayi;Shi Changqiang(School of Mechanical Engineering,Shanghai Institute of Technology,Shanghai 201418,China)

机构地区：[1]上海应用技术大学机械工程学院,上海市201418

出　　处：《中国组织工程研究》2022年第10期1505-1509,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:腰椎退行性滑脱、节段性不稳、椎间盘源性疾病等对非手术治疗无效者一般都需进行腰椎固定融合术,单侧内固定和双侧内固定是治疗腰椎退行性疾病的两种主要的内固定方法。目的:采用有限元方法从生物力学的角度探究骨水泥注入前后不同固定方式对腰椎的影响。方法:选择“数字航天人”国家973项目的CT数据中的L1-S段共计632张,层间距为0.625 mm。利用医学图像处理软件Mimics 10.0读入扫描得到的DICOM文件重建下腰椎L1-S的模型。运用UG、MIMICS等软件建立L3-5正常、单纯融合器单侧固定和双侧内固定、融合器-骨水泥灌注单侧固定和双侧内固定的5种人体腰椎三维模型。通过有限元分析方法比较5种模型在模拟人体腰椎前屈、后伸、侧屈、旋转时,L3-4椎体关节活动度、L3-4纤维环最大应力、L3-4髓核内压、L4下终板应力峰值、椎弓根内固定系统应力峰值。结果与结论:①相较于正常模型,单纯融合器放置组单侧固定在后伸状态下纤维环压力增加54%;后伸时,单纯融合器单侧固定时纤维环压力最大;融合器-骨水泥灌注组双侧内固定比单纯融合器双侧固定在前屈、后伸、侧屈、旋转状态下髓核内压分别降低了2%,7%,3%,3%;融合器-骨水泥灌注组双侧内固定在前屈、后伸、侧屈、旋转状态下比单侧的椎弓根应力减少了8%,3%,3%,5%;②结论:在有融合器支撑的情况下,单侧固定与双侧固定在稳定性上差距并不大,置入融合器注入骨水泥后可以基本保证融合节段的稳定性。BACKGROUND:For lumbar degenerative spondylolisthesis,segmental instability,and discogenic diseases,lumbar fixation and fusion are generally required for non-operative treatment.Unilateral internal fixation and bilateral internal fixation are the two main internal fixation methods for the treatment of degenerative diseases of the lumbar spine.OBJECTIVE:To explore the influence of different fixation methods before and after bone cement injection on the lumbar spine from the perspective of biomechanics by finite element method.METHODS:A total of 632 pieces of L1-S segments in the CT data of the National 973 Project of the“Digital Astronaut”were selected,and the interval between layers was 0.625 mm.The medical image processing software Mimics 10.0 was used to read in the scanned DICOM files to reconstruct the model of the lower lumbar spine L1-S.UG,MIMICS and other software were used to establish five kinds of human lumbar spine three-dimensional models with L3-5 normal,single fusion cage unilateral fixation and bilateral internal fixation,cage-bone cement perfusion unilateral fixation and bilateral internal fixation.Through the finite element analysis method,range of motion of L3-4 vertebral body joint,L3-4 fibrous annulus maximum stress,L3-4 nucleus pulposus internal pressure,the peak stress of the lower endplate of L4 and the peak stress of the pedicle internal fixation system were compared in the five models to simulate the human lumbar spine flexion,extension,lateral flexion,and rotation.RESULTS AND CONCLUSION:(1)Compared with the normal model,the pressure of the posterior extension of the fiber ring was increased by 54%in the simple fusion cage placement group.The pressure of the fiber ring was the highest when the single fusion cage was fixed in one side.In the fusion-cement perfusion group,bilateral internal fixation was reduced by 2%,7%,3%,and 3%,respectively,compared with that in the simple fusion-cement infusion group.In the fusion-cement perfusion group,the stress of the vertebral pedicle was reduced

关 键 词：骨水泥 注入 后路腰椎椎间融合术 有限元分析 内固定方法 生物力学 融合节段 稳定性 

分 类 号：R459.9[医药卫生—治疗学] R318.01[医药卫生—临床医学]