脊柱微创治疗脊髓型颈椎病的有限元生物力学分析及精准化运动康复方案  

Finite element biomechanical analysis of minimally invasive treatment of cervical spondylotic myelopathy and accurate exercise rehabilitation

作　　者：刘金玉 张晗硕 崔洪鹏 潘灵之 赵博然 李菲[1] 丁宇[1] Liu Jinyu;Zhang Hanshuo;Cui Hongpeng;Pan Lingzhi;Zhao Boran;Li Fei;Ding Yu(TCM Senior Department of Orthopedics,Sixth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心中医医学部骨伤科,北京市100048

出　　处：《中国组织工程研究》2023年第9期1359-1364,共6页Chinese Journal of Tissue Engineering Research

基　　金：首都临床诊疗技术研究及示范应用项目(Z191100006619028),项目名称:富血小板血浆椎间盘注射联合椎间孔镜技术治疗腰椎间盘突出症及术后康复的临床研究,项目负责人:丁宇。

摘　　要：背景:内镜下椎板开窗减压术导致颈椎骨性结构改变,进而引起责任节段生物力学变化,临床术后康复亟需了解该结构变化引起的生物力学变化,从而建立精准化运动康复方案。目的:应用有限元逆向工程技术建立针对治疗脊髓型颈椎病的三维实体有限元模型,并建立颈椎生理活动下静态的生物力学分析,制定术后精准化运动康复训练对策。方法:获得志愿者颈椎术前及2次手术后的CT薄层平扫数据,分别导入Mimics 20.0软件中,应用术前CT资料建立C4-5节段骨性组织有限元模型M,应用第1次术后CT资料建立单侧C4-5椎板开窗减压术后模型M1,应用第2次术后CT资料建立双侧C4-5椎板开窗减压术后模型M2。将3种骨性模型导入3-matic中进行曲面构建,在C4椎体上表面施加75 N轴向向下压力,记录不同工况下椎间盘受力和椎体位移值。结果与结论:(1)与模型M比较,模型M1右侧弯活动下的椎间盘b、d区域应力增高10%-12%,其他工况下的椎间盘应力无明显差异;模型M2右侧弯活动下的b、d区域压力值增高10%-13%,左侧弯活动下的a、c区域椎间盘压力值增高9%-11%,其他工况下的椎间盘压力值无明显差异;(2)与模型M比较,模型M1右侧弯活动下的位移增加约15%,其他工况下的位移约增高13%;模型M2左右侧弯活动下的位移变化均增加约17%,其他工况下的位移约增高14%;(3)结果提示,全内镜下椎板开窗减压手术治疗脊髓型颈椎病对脊柱整体的生物力学稳定性影响较小,可根据术后骨性结构变化引起的生物力学变化制定精准化运动康复方案:对于单侧术后患者需着重训练手术侧颈半棘肌和头半棘肌,对于双侧术后患者需再训练双侧颈半棘肌和头半棘肌等肌肉组织,从而增加颈椎后方的肌肉强度,通过肌肉力量使颈椎更好地处于中轴线上,达到稳定颈椎目的。BACKGROUND:Endoscopic fenestration and decompression of cervical lamina lead to changes in bony structure of cervical vertebra e,which in turn leads to biomechanical changes of responsible segments.In clinical rehabilitation,it is urgent to understand the biomechanical changes caused by structural changes so as to establish an accurate exercise rehabilitation program.OBJECTIVE:To establish a three-dimensional solid finite element model for the treatment of cervical spondylotic myelopathy by using the finite element reverse enginee ring technology,and to establish the static biomechanical analysis of ce rvical physiological activities,and to formulate the strategy of postoperative accurate exercise rehabilitation training.METHODS:The thin slice plain scan data of cervical vertebrae of volunteers before and after two operations we re obtained and imported into Mimics 20.0 software,respectively.Using the preoperative CT data,the finite element model M of C;segment bone tissue was established.The fenestration model M1 of unilateral C;lamina was established by using CT data after the first operation.The fenestration model M2 of bilate ral C;lamina was established by using CT data after the second ope ration.Three kinds of bone models were introduced into 3-matic for surfa ce construction.A 75 N axial downward pressure was applied on the upper surface of the C4 vertebral body,and the intervertebral disc force and ve rtebral body displacement were recorded under different working conditions.RESULTS AND CONCLUSION:(1) Compared with model M,the stress in interve rtebral disc b and d regions of model M1 increased by 10%-12% during the right bending activity,and there was no significant difference in other physiological activities.The stress in b and d regions of model M2 increased by 10%-13% when the right bend was active,and the stress in a and c regions increased by 9%-11% when the left bend was actove,and there was no significant difference in other physiological activities.(2) Compared with model M,the displacement of

关 键 词：脊髓型颈椎病 脊柱内镜 微创减压 精准化运动康复 有限元分析 生物力学 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R311