腰椎经皮穿刺球囊扩张椎体成形手术理想骨水泥形态分布及注射量的有限元分析  

A finite element analysis on ideal bone cement forms and injection volumes in percutaneous kyphoplasty

作　　者：张勋 孟凡超[1] 庞倩文 徐嘉星[2] 赵伟[1] ZHANG Xun;MENG Fan-chao;PANG Qian-wen;XU Jia-xing;ZHAO Wei(Department of Orthopedics,The First Affiliated Hospital of Harbin Medical University,Harbin 150077,China;Central Operating Room,Qunli Hospital,The First Affiliated Hospital of Harbin Medical University,Harbin 150077,China)

机构地区：[1]哈尔滨医科大学附属第一医院群力院区骨科,黑龙江哈尔滨150077 [2]哈尔滨医科大学附属第一医院中心手术室,黑龙江哈尔滨150077

出　　处：《哈尔滨医科大学学报》2022年第1期36-41,共6页Journal of Harbin Medical University

摘　　要：目的探讨不同骨水泥形态分布及注射量对腰椎骨质疏松椎体力学特征的影响。方法选取男性健康志愿者一名,CT扫描L_(1)~L_(3)椎体,将得到的CT图像导入Mimics 21.0等软件,建立骨质疏松椎体模型。随后选取3例不同穿刺方式女性患者的CT图像,将3种骨水泥形态置入骨质疏松模型中,将模型分为单穿型双穿一体型、双穿分离型3组,每组注入骨水泥量分别为2 mL.4 mL和6 mL。在所有模型中,垂直压缩载荷为500N,前屈和后伸分别施加7.5Nm的力矩,其中85%施加在前中柱,15%施加在后柱,计算不同条件下邻近椎体间的应力变化。结果当L_(2)椎体行成形术后,L_(1)~L_(3)椎体应力明显大于正常椎体,且L_(3)椎体所受应力最大;当前屈和站立时,L_(3)上终板所受应力最大,而在后伸时,L_(1)下终板所受应力最大;当直立时,3种不同注入方式及不同骨水泥注入量之间的椎间结构所受应力区别不大;当前屈及后伸时,双穿一体型组注入4 mL骨水泥时,相邻椎体及椎间结构所受应力小于其余两组。结论双穿一体型骨水泥形态分布是一种适宜的骨水泥注入形态,且当注入量为4 mL时,在保持注入椎体稳定的同时,邻近节段所受应力较小。Objective To explore the effects of different bone cement forms and injection volumes on the mechanical characteristics of osteoporotic vertebrae.Methods A male healthy volunteer was selected,L_(1),to L_(3) vertebrae were scanned by CT,and the obtained CT images were imported into software such as Mimics 21.0.The vertebral model of osteoporotic was established.Three CT images of female patients with different puncture methods were subsequently selected,and three bone cement forms were placed into the osteoporosis model.Then the models were divided into three groups:unilateral group,bilateral integration group and the bilateral separation group,with each group injected 2,4,6 mL of bone cement,respectively.In all models,a vertical compressive load of 500 N,anterior flexion and posterior extension were applied with a moment of 7.5 Nm,of which 85%was applied to the anterior mid-column and 15%to the posterior column.The stress changes between adjacent vertebrae under different conditions were calculated.Results When percutaneous kyphoplasty was applied to the L_(2)vertebral body,the stresses on the L_(1) to L_(3) vertebrae were significantly greater than those on normal vertebrae,and the L_(3) vertebrae were subjected to the greatest stresses;In anterior flexion and standing,the stress on the upper endplate of L_(3) was the highest;While in posterior extension,the stress on the lower endplate of L_(1)was the highest;When upright,there was little difference in the stresses on the intervertebral structures between the three different injection methods and the different amounts of bone cement injected;In anterior flexion and posterior extension,when 4 mL of bone cement was injected in the bilateral integration group,the adjacent vertebral body and intervertebral structures were subjected to less stress than the other groups.Conclusion Bilateral integration bone cement is a suitable form of cement injection,and when the injection volume is 4 mL.the stress on the adjacent segment is less while maintaining the stability of

关 键 词：腰椎 经皮穿刺球囊扩张椎体成形术 骨质疏松 骨水泥 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]