斜外侧腰椎间融合术中椎间融合器高度对邻近节段退变影响的三维有限元分析  

Effect of cage height on adjacent segment degeneration during oblique lumbar interbody fusion:a 3D finite element study

作　　者：卢枭 邹飞 吕飞舟 马晓生 夏新雷 王洪立 姜建元 Lu Xiao;Zou Fei;Lyu Feizhou;Ma Xiaosheng;Xia Xinlei;Wang Hongli;Jiang Jianyuan(Department of Orthopaedics,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院骨科,上海200040

出　　处：《中华骨科杂志》2022年第19期1301-1311,共11页Chinese Journal of Orthopaedics

基　　金：上海市卫生健康委先进适宜技术推广项目(2019SY023)。

摘　　要：目的探讨斜外侧腰椎间融合术(oblique lumbar interbody fusion,OLIF)中椎间融合器高度对不同退变程度腰椎生物力学的影响,为融合器选择提供参考。方法建立下腰椎(L3~S1)三维有限元模型,并在L3,4节段构建轻、中、重三种不同程度的退变节段,在L4,5节段模拟进行OLIF手术,并分别植入高度为8、10、12、14 mm的融合器;施加7.5 N·m力矩使腰椎产生前屈、后伸、侧弯和轴向旋转运动,分析融合器高度变化对手术邻近节段活动度(range of motion,ROM)、椎间最大应力及关节突软骨最大应力的影响。结果邻近节段活动度及椎间盘的最大应力随着融合器高度的增加而增加,但这一趋势在中、重度退变组不明显。植入四种不同高度(8、10、12、14 mm)的融合器后,L3,4节段均在后伸时ROM达到最大,轻度退变组分别为2.68°、2.71°、2.94°和2.98°,中度退变组为2.33°、2.37°、2.41°和2.49°,重度退变组为1.94°、1.99°、2.14°和2.21°。L3-4椎间盘均在右侧弯时应力达到最大,轻度退变组分别为23.95 MPa、24.60 MPa、24.90 MPa和25.34 MPa,中度退变组为25.57 MPa、25.60 MPa、25.82 MPa和25.89 MPa,重度退变组为25.95 MPa、25.99 MPa、26.48 MPa和27.13 MPa。L3,4节段关节突软骨均在后伸时应力达到最大,轻度退变组分别为15.87 MPa、15.78 MPa、16.29 MPa和16.43 MPa,中度退变组为15.97 MPa、16.31 MPa、16.53 MPa和17.79 MPa,重度退变组为16.17 MPa、16.49 MPa、16.95 MPa和17.35 MPa。结论对需要进行OLIF手术的轻度腰椎退变患者,手术节段的椎间高度不宜过度撑开;而对需要进行OLIF手术的中、重度腰椎退变患者,建议选择椎间融合器高度较原椎间隙高度增加0~2 mm即可。Objective To investigate the influence of interbody cage height during oblique lumbar interbody fusion(OLIF)on lumbar biomechanics with different degrees of degeneration and to provide a reference for cage choice.Methods The finite element model of normal lower lumbar spine(L3-S1)was built and validated,then constructed three different degenerative segments in L3,4,and the cages with different height(8,10,12,14 mm)were implanted into L4,5 disc.All the twelve models were loaded with pure moment of 7.5 N·m to produce flexion,extension,lateral bending and axial rotation motions on lumbar spine,and the effects of cage height on range of motion(ROM),intervertebral pressure in adjacent segments and stress in facet joints were investigated.Results The ROM of adjacent segments and the maximum stress of intervertebral discs increased with the increase of cage height,but this trend was not obvious in moderate and severe degeneration groups.After implantation of 4 different height cages(8,10,12,14 mm),the ROM of L3,4 segment reached the maximum during extension.The ROM of mild degeneration group was 2.68°,2.71°,2.94°,2.98°,moderate degeneration group was 2.33°,2.37°,2.41°,2.49°,and severe degeneration group was 1.94°,1.99°,2.14°,2.21°.The stress of L3,4 intervertebral disc reached the maximum during right bending.The maximum stress of L3,4 intervertebral disc was 23.95 MPa,24.60 MPa,24.90 MPa and 25.34 MPa in mild group,25.57 MPa,25.60 MPa,25.82 MPa and 25.89 MPa in moderate group,and 25.95 MPa,25.99 MPa,26.48 MPa and 27.13 MPa in severe group.The maximum stress of L3,4 facet joint was 15.87 MPa,15.78 MPa,16.29 MPa and 16.43 MPa in mild group,15.97 MPa,16.31 MPa,16.53 MPa and 16.79 MPa in moderate group,and 16.17 MPa,16.49 MPa,16.95 MPa and 17.35 MPa in severe group.Conclusion For patients with mild lumbar degeneration requiring OLIF surgery,the intervertebral height of the surgical segment should not be overstretched.But for patients with moderate to severe lumbar degenerative disease who need to undergo OLIF

关 键 词：腰椎 脊柱融合术 手术后并发症 椎间盘退行性变 有限元分析 生物力学现象 

分 类 号：R687.3[医药卫生—骨科学]