内镜下椎间孔成形和椎板间成形对椎间盘、椎体峡部生物力学特性的影响  

Effects of endoscopic foraminoplasty and laminoplasty on biomechanical properties of intervertebral disc and isthmus

作　　者：张瑞[1,2] 王琨[1,2] 沈子聪 毛路 吴小涛[1,2] Zhang Rui;Wang Kun;Shen Zicong;Mao Lu;Wu Xiaotao(School of Medicine,Southeast University,Nanjing 210009,Jiangsu Province,China;Department of Orthopedics,Zhongda Hospital,Southeast University,Nanjing 210009,Jiangsu Province,China)

机构地区：[1]东南大学医学院,江苏省南京市210009 [2]东南大学附属中大医院骨科,江苏省南京市210009

出　　处：《中国组织工程研究》2024年第6期833-839,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:内镜治疗腰椎间盘突出症较传统开放手术优势明显,为植入工作套管,需切除部分骨质,但目前尚无术中椎间孔成形和椎板间成形两种成形术对腰椎局部结构力学特性影响的研究。目的:比较椎间孔成形和椎板间成形对椎间盘、椎体峡部生物力学特性的影响。方法:取1名健康男性志愿者的腰骶CT图像,建立L_3至骶椎的有限元模型M0。在M0基础上建立L_(5)/S_(1)的椎间孔一级成形模型M1和椎间孔二级成形模型M2、椎板间成形模型M3。施加相同载荷,比较各模型椎体间活动度、椎间盘应力、L_(5)椎体峡部等效应力特性。结果与结论:(1)与M0相比,M1和M2 L_(5)/S_(1)节段的活动度在各方向工况下变化不明显;M2整体活动度在前屈时增加8.60%;M3在L_(5)/S_(1)右侧弯、右扭转时增加8.23%和8.26%,整体活动度在前屈、右侧弯时增加5.39%和5.67%,其余工况活动度无明显变化;(2)与M0相比,M1 L_(5)/S_(1)椎间盘最大应力极值变化不明显,M2在前屈、后伸、左扭转、右扭转时增加11.06%,12.50%,18.32%,15.48%,M3在前屈、后伸、左扭转、右扭转时增加12.22%,19.54%,10.05%,9.97%,其余工况和L_(4/5)椎间盘最大应力无明显变化;(3)与M0相比,M1的L_(5)左侧峡部最大应力在左侧弯时增加12.43%,右侧峡部在后伸、右侧弯、左扭转、右扭转时增加18.38%,13.29%,13.62%,40.00%;M2的L_(5)左侧峡部最大应力在前屈、后伸、左侧弯、右侧弯时增加38.87%,42.63%,16.95%,19.35%,右侧峡部在前屈、后伸、左侧弯、左扭转时增加12.58%,33.70%,12.92%,17.42%;M3的L_(5)左侧峡部最大应力在前屈、后伸、左侧弯、右侧弯、右扭转时增加67.07%,78.14%,32.33%,62.94%,89.99%;(4)结果提示,椎间孔成形和椎板间成形对脊柱活动度影响较小,椎板间成形和二级椎间孔成形手术节段椎间盘应力极值轻度增加,相邻节段椎间盘应力极值变化不明显,椎板间成形模型手术同侧峡部应力增加明显。BACKGROUND:Endoscopic treatment of lumbar disc herniation has obvious advantages over traditional open surgery.Endoscopic surgery involves the implantation of a working cannula,which requires only partial bone removal,and there are no studies on the effects of two types of intraoperative foraminoplasty and laminoplasty on the mechanical properties of the local structure of the lumbar spine.OBJECTIVE:To compare the effect of foraminoplasty and laminoplasty on the biomechanical properties of disc and isthmus of the responsible segment.METHODS:The lumbosacral CT images of a healthy male volunteer were taken,and a finite element model M0 of the L3 to sacral vertebrae was established,on which the primary and secondary foraminoplasty models M1 and M2 of the L_(5)/S_(1) and the laminoplasty model M3 were built.The same load was applied to compare the intervertebral motion range,disc Von Mises stress and equivalent stress characteristics of L_(5) vertebral isthmus with each model.RESULTS AND CONCLUSION:(1)Compared with M0,M1 and M2 motion range in L_(5)/S_(1) segment did not change significantly in all directions;M2 overall motion range increased by 8.60%in flexion;M3 increased by 8.23%and 8.26%in L_(5)/S_(1) right bending and right torsion,and 5.39%and 5.67%in overall motion range in flexion and right bending,with no significant changes in motion range in the rest of working conditions.(2)Compared with M0,M1 showed no significant change in the extremes of Von Mises stress at L_(5)/S_(1) disc;M2 increased 11.06%,12.50%,18.32%,and 15.48%in flexion,extension,left torsion,and right torsion;M3 increased 12.22%,19.54%,10.05%,and 9.97%in flexion,extension,left torsion,and right torsion,and the rest working conditions and L4/5 disc maximum Von Mises stress did not change significantly.(3)Compared to M0,the maximum Von Mises stress in the left isthmus of L_(5) of M1 increased by 12.43%in left bending,18.38%,13.29%,13.62%,and 40.00%in the right isthmus in extension,right bending,left torsion,and right torsion.The maximum Von Mise

关 键 词：脊柱内镜 腰椎间盘突出 椎间孔成形 椎板间成形 生物力学 有限元分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.3