单侧与双侧入路植入骨填充网袋治疗骨质疏松性椎体压缩性骨折的有限元分析与应用  

Finite element analysis and application of unilateral and bilateral bone-filling mesh container in treatment of osteoporotic vertebral compression fracture

作　　者：鲁辉 吴启梅 刘融[2,4] Lu Hui;Wu Qimei;Liu Rong(School of Medicine,Wuhan University of Science and Technology,Wuhan 430081,Hubei Province,China;Institute of Medical Innovation and Transformation,Puren Hospital of Wuhan University of Science and Technology,Wuhan 430080,Hubei Province,China;Wuhan Liu Sanwu Traditional Chinese Medicine Bone Injury Hospital,Wuhan 431400,Hubei Province,China;Department of Orthopedics,Puren Hospital of Wuhan University of Science and Technology,Wuhan 430080,Hubei Province,China)

机构地区：[1]武汉科技大学医学院,湖北省武汉市430081 [2]武汉科技大学附属普仁医院,医学创新与转化研究所,湖北省武汉市430080 [3]武汉刘三屋中医骨伤医院,湖北省武汉市431400 [4]武汉科技大学附属普仁医院,骨科,湖北省武汉市430080

出　　处：《中国组织工程研究》2023年第3期391-397,共7页Chinese Journal of Tissue Engineering Research

基　　金：湖北省自然科学基金委员会一般面上项目(2020CFB548),项目名称:基于拓扑优化技术的3D打印康复辅具设计关键技术的研发,项目负责人:刘融。

摘　　要：背景:骨填充网袋植入治疗骨质疏松性椎体压缩性骨折具有显著的疗效,从手术时间、骨水泥侧漏情况、术中人员受辐射次数等方面考虑,选择单侧入路更佳,但没有研究从生物力学角度比较单侧与双侧骨填充网袋植入的效果,缺乏一定的理论数据支持。目的:探讨单侧与双侧入路植入骨填充网袋治疗骨质疏松性椎体压缩性骨折的生物力学特点和临床效果。方法:①建立有限元模型,模拟单侧和双侧入路植入骨填充网袋治疗骨质疏松性椎体压缩性骨折,在400 N竖直向下的加载力和7.5 N·m弯矩载荷作用时,对比两组4种工况下胸腰段整体有限元模型的位移和应力变化。②回顾性分析武汉市普仁医院2018年1月至2020年8月收治的99例骨质疏松性椎体压缩性骨折患者,其中接受单侧入路植入骨填充网袋治疗49例,接受双侧入路植入骨填充网袋治疗50例,分析两组患者的骨水泥渗漏率、目测类比评分和脊柱侧弯角变化。结果与结论:①有限元模型:两入路组在轴向、前屈、左侧弯和左旋转状态下的最大位移比较差异无显著性意义(P>0.05),在轴向、前屈、左侧弯和左旋转状态下的最大应力比较差异无显著性意义(P>0.05);②临床试验:单、双侧入路组骨水泥渗漏率分别为12%,16%,两组患者术后6个月的目测类比评分与脊柱侧弯角度均较术前明显改善(P<0.001),两组间术后6个月的目测类比评分与脊柱侧弯角度比较差异均无显著性意义(P>0.05);③从生物力学和临床疗效角度来讲,单侧入路植入骨填充网袋较双侧入路植入骨填充网袋治疗骨质疏松性椎体压缩性骨折的效果更佳。BACKGROUND:In the treatment of osteoporotic vertebral compression fracture,bone-filling mesh container has a significant curative effect.Considering the operation time,lateral leakage of bone cement and the number of radiation exposure,unilateral approach is better.However,no study compared unilateral bone-filling mesh container and bilateral bone-filling mesh container from the perspective of biomechanics,lacking certain theoretical data support.OBJECTIVE:To investigate the biomechanical characteristics and clinical effects of unilateral and bilateral bone-filling mesh container approaches in the treatment of osteoporotic vertebral compression fracture.METHODS:(1)A finite element model was established to simulate the treatment of osteoporotic vertebral compression fracture with unilateral and bilateral bone-filling mesh container.The displacement and stress changes of the whole finite element model of thoracolumbar segment in the unilateral bonefilling mesh container group and bilateral bone-filling mesh container group were compared and analyzed under 400 N vertical downward loading force and 7.5 N·m bending moment load under four working conditions.(2)A retrospective analysis was performed on 99 patients with osteoporotic vertebral compression fracture who were treated with bone-filling mesh container from January 2018 to August 2020 in Wuhan Puren Hospital.Of them,49 patients were treated with unilateral bone-filling mesh container and 50 patients were treated with bilateral bone-filling mesh container.Bone cement leakage rate,visual analogue scale score,and Cobb angle change were analyzed between the two groups.RESULTS AND CONCLUSION:(1)Finite element model:There was no significant difference in the maximum displacement between unilateral group and bilateral group under axial,forward flexion,left bending,and left rotation conditions(P>0.05).There was no significant difference in the maximum stress between unilateral group and bilateral group under axial,forward flexion,left bending,and left rotation conditi

关 键 词：骨填充网袋 骨质疏松性 椎体压缩性骨折 有限元分析 生物力学 单侧入路 双侧入路 

分 类 号：R459.9[医药卫生—治疗学] R628[医药卫生—临床医学] R318