脊柱内镜下腰椎间盘切除范围对腰椎稳定性影响的有限元分析  

Finite Element Analysis of the Influence of Lumbar Discectomy Range on Lumbar Stability under Spinal Endoscope

作　　者：王鹏 卢火炎 赵崇程 郭肖楠 赵若琦 赵建[1] WANG Peng;LU Huoyan;ZHAO Chongcheng;GUO Xiaonan;ZHAO Ruoqi;ZHAO Jian(The First Affiliated Hospital of Hebei University of Chinese Medicine,Shijiazhuang 050011,China)

机构地区：[1]河北中医学院第一附属医院,石家庄050013

出　　处：《中国中医骨伤科杂志》2021年第12期12-16,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：全国老中医药专家学术经验继承工作(国中医药人教发[2017]29号);河北省重点研发计划项目(203777110D);河北省中医药管理局课题(2020067)。

摘　　要：目的:分析脊柱内镜下腰椎间盘切除范围对腰椎稳定性的影响,明确脊柱内镜下腰椎间盘切除最合适的范围。方法:选取12例行腰椎L_(4~5)节段脊柱内镜手术患者MRI影像,测量术后腰椎间盘切除范围,设定健康模型组、部分切除组1、部分切除组2、部分切除组3和假设模型组。应用健康人体的CT数据建立健康组有限元模型,在此基础上分别建立部分切除1、2、3组和假设模型组有限元模型,研究在直立、前屈、后伸、侧弯和旋转七种工况下L_(4~5)节段腰椎稳定性与脊柱内镜下腰椎间盘切除范围的关系。结果:有限元分析得到腰椎L_(4~5)节段关节活动度(Range of Motion, ROM)、L_(4)轴向位移和腰椎间盘切除范围正相关,即腰椎L_(4~5)节段稳定性与腰椎间盘切除范围负相关。结论:脊柱内镜下腰椎间盘切除范围对腰椎稳定性的影响十分明显,考虑纤维环后缘变薄和椎间隙变窄的影响,在脊柱内镜术中除了切除腰椎间盘的突出部分,并预留纤维环瘢痕增生的空间外,应尽可能减小髓核和纤维环的切除范围,以减少腰椎稳定性的丢失。Objective:To investigate the efficacy of the range of endoscopic lumbar discectomy on lumbar stability and determine the most appropriate range of endoscopic lumbar disc resection.Methods:A total of 12 MRI images of patients undergoing lumbar L_(4~5)segment endoscopic surgery were selected to measure the postoperative lumbar discectomy range.Healthy model group, partial resection group 1,partial resection group 2,partial resection group 3 and hypothetical model group were set.The finite element model of the health group was established using the CT data of one healthy subject.On this basis, the finite element models of the partial resection groups 1,2,3 and the hypothetical group were established respectively to study the relationship between the stability of the L_(4~5)lumbar spine and the scope of endoscopic lumbar disc resection under seven operating conditions: upright standing, anterior flexion, posterior extension, lateral bending and torsion.Results:The finite element analysis revealed that the range of motion(ROM) and axial displacement of L_(4~5)segment of lumbar spine were positively correlated with the range of lumbar discectomy, this is, there was a negative correlation between the stability of the lumbar L_(4~5)segment and the lumbar disc resection range.Conclusion:The efficacy of the discectomy range of lumbar intervertebral disc under spinal endoscopy on the stability of the lumbar spine is very obvious.Considering the thinning of the posterior edge of the annulus fibrosus and the narrowing of the intervertebral space, the discectomy range of nucleus pulposus and annulus fibrosus should be reduced as much as possible in addition to removing the protruding part of the lumbar intervertebral disc and reserving the space for scar proliferation of the annulus fibrosus to reduce the loss of stability of the lumbar spine.

关 键 词：脊柱内镜 腰椎间盘突出症 腰椎稳定性 有限元分析 

分 类 号：R681.5[医药卫生—骨科学]