骨质疏松性椎体压缩骨折不同骨水泥分布的临床观察及生物力学的有限元分析  

Clinical observation and biomechanical finite element analysis of different bone cement distribution in osteoporotic vertebral compression fractures

作　　者：赵研 宋启春[1] 李东 刘兆盈 张广阳 张三朋 樊立宏[1] 时志斌[1] 党晓谦[1] Zhao Yan;Song Qichun;Li Dong;Liu Zhaoying;Zhang Guangyang;Zhang Sanpeng;Fan Lihong;Shi Zhibin;Dang Xiaoqian(Department of Orthopedics,Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;School of Mechanical Engineering,Xi’an Jiaotong University,Xi’an 710049,China;Operating Room,Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)

机构地区：[1]西安交通大学第二附属医院骨一科,西安710004 [2]西安交通大学机械学院,西安710049 [3]西安交通大学第二附属医院手术室,西安710004

出　　处：《创伤外科杂志》2022年第11期818-824,836,共8页Journal of Traumatic Surgery

基　　金：国家自然科学基金(82002311);中国博士后科学基金第69批面上项目(2021M692575)。

摘　　要：目的研究在经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)中两种不同分布骨水泥对术后骨折椎体及邻近椎体的临床及生物力学结果。方法回顾性分析西安交通大学第二附属医院2018年9月—2020年11月51例单节段骨质疏松性椎体压缩骨折患者,男性21例,女性30例;年龄61~82岁,平均68.1岁;受伤椎体均为腰椎。根据术后患者影像学资料,按椎体中的双侧骨水泥是否连接分为两组,未连接组32例,连接组19例。比较两组患者的围术期资料,同时应用L_(2)~L_(4)的椎体三维有限元模型进行有限元分析验证。设定站立位状态下脊柱承受的轴向压缩生理载荷和边界条件,分别在5种运动状态(压缩、前屈、后伸、侧弯和旋转)中加载模型进行受力分析,并比较在不同骨水泥分布下连接组、未连接组两组模型之间骨折椎体及邻近椎体的应力差。结果51例患者平均随访时间14.4(6~24)个月。末次随访时,两组患者后凸角(Cobb)和视觉模拟评分的术后改善程度相似,组间差异无统计学意义(P>0.05)。相邻椎体骨折共8例(16%,8/51),其中未连接组2例(6%,2/32),连接组6例(32%,6/19);骨水泥渗漏10例(20%,10/51),其中未连接组3例(9%,3/32),连接组7例(37%,7/19);末次随访时椎体再压缩骨折5例(10%,5/51),其中未连接组1例(3%,1/32),连接组4例(21%,4/19);两组差异有统计学意义(P<0.05)。有限元分析结果显示:在压缩、前屈、后伸、侧弯4种运动状态下,两组模型所受最大应力比较差异无统计学意义(P>0.05);在旋转状态下,连接组模型最大应力为9.6N,未连接组模型最大应力为18.4N。同时在5种运动状态下的连接组模型椎体所受平均应力均大于未连接组模型平均应力,两者比较差异有统计学意义(P<0.05)。结论无论是否连接双侧骨水泥,PKP均可改善患者局部Cobb角和疼痛情况,提高生活质量。如果PKP术中骨水泥分布于椎体两侧可能会使骨折椎体及邻近椎�Objective To evaluate the clinical and biomechanical results of the fractured and adjacent vertebrae with different distribution of bone cement in percutaneous kyphoplasty(PKP).Methods A retrospective analysis was conducted on 51 patients with single-segment osteoporotic vertebral compression fractures from Sep.2018 to Nov.2020,including 21 males and 30 females aged 61-82 years,mean 68.1 years.All the injured vertebrae were lumbar vertebrae.According to the postoperative imaging data,the patients were divided into two groups according to whether the bilateral bone cement in the vertebral body was connected or not:unconnected group(n=32)and connected group(n=19).The perioperative data of the two groups were compared,and the three-dimensional finite element(FE)model of L_(2)-L_(4) was used for FE analysis and verification.Firstly the axial compression physiological load and boundary conditions that the spine loaded in the standing position were set;and then the model in 5 motion states(compression,flexion,extension,lateral bending and rotation)was loaded for force analysis.The stress loaded on the fractured and adjacent vertebral bodies was also compared between the connected and unconnected groups.Result The average follow-up time of the 51 patients was 14.4(6-24)months.At the last follow-up,the improvement of kyphosis angle(Cobb)and the postoperative improvement of visual analogue scale(VAS)were similar between two groups(P>0.05).There were 8 cases(16%,8/51)of adjacent vertebral body fractures,including 2 cases(6%,2/32)in the unconnected group and 6 cases(32%,6/19)in the connected group;10 cases(20%,10/51)of bone cement leakage,including 3 cases(9%,3/32)in the unconnected group and 7 cases(37%,7/19)in the connected group;and 5 cases(10%,5/51)of vertebral body recompression at last follow-up,including 1 case(3%,1/32)in the nonconnected group and 4 cases(21%,4/19)in the connected group.All the complications revealed statistically significant difference between two groups(all P<0.05).FE analysis showed that there wa

关 键 词：椎体压缩骨折 椎体后凸成形术 骨质疏松 骨水泥 生物力学 有限元分析 

分 类 号：R687.3[医药卫生—骨科学]