腰椎硬脊膜粘连对神经受压应力分布影响的有限元分析  

Effects of lumbar epidural adhesion on stress distribution to nerve by finite element analysis

作　　者：尹帮德 范国鑫 廖翔 程飚 YIN Bang-de;FAN Guo-xin;LIAO Xiang;CHENG Biao(Department of Orthopedics,Shanghai Tenth People’s Hospital,Shanghai,200072,China;Tongji University School of Medicine,Shanghai,200092,China;Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging,School of Biomedical Engineering,Shenzhen University Health Science Center,Guangdong,518060,China;Department of Pain Medicine,Huazhong University of Science and Technology Union Shenzhen Hospital,Guangdong,518052,China;Department of Joint and Sports Medicine,Tongji Hospital of Tongji University,Shanghai,200065,China)

机构地区：[1]同济大学附属第十人民医院骨科,上海200072 [2]同济大学医学院,上海200092 [3]深圳大学医学部生物医学工程学院,医学超声关键技术国家地方联合工程实验室,广东省生物医学信息检测及超声成像重点实验室,广东深圳518037 [4]华中科技大学协和深圳医院疼痛科,广东深圳518052 [5]同济大学附属同济医院关节与运动医学科,上海200065

出　　处：《颈腰痛杂志》2023年第3期320-323,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：广东省基础与应用基础研究基金(编号:2019A1515111171);广东省医学科学技术研究基金(编号:A2023195)。

摘　　要：目的通过有限元模拟阐述腰椎管内周围组织粘连对神经受压的生物力学影响,为神经粘连松解的重点区域选择提供参考。方法以L 4-5节段为例,利用有限元方法建立后纵韧带、黄韧带和硬脊膜的有限元模型。固定后纵韧带及黄韧带,改变接触面条件以模拟不同组织粘连,在各模型上模拟椎间盘突出对硬脊膜的压迫作用,分析不同组间硬膜表面应力分布和位移变化。结果以结构间的摩擦系数不同共生成了四组模型,包括不粘连组(A组)、后纵韧带粘连组(B组)、黄韧带粘连组(C组)和全粘连组(D组)。该模型结果中,硬脊膜的应力分布和最大主应变分别在A、B两组和C、D两组间呈现出不同的趋势,后两组显著高于前两组。当摩擦系数设置为0.05时,C组的硬脊膜应力峰值(0.487 MPa)和最大主应变(0.364 mm)最高,分别为A组的1.3倍和1.8倍;摩擦系数增大,模拟粘连的严重程度加大对神经受压的影响则越小,此时神经松解的潜在获益与风险比呈下降趋势。结论本研究提示,手术医生在行硬脊膜粘连松解术时,需重点松解黄韧带与硬脊膜的粘连,但严重粘连时不宜强行分离松解。Objective To illustrate the biomechanical effects of lumbar epidural adhesion to nerve compression by finite element simulation,and to provide selection of priority areas for adhesiolysis.Methods The model of a L 4-5 spine canal was constructed which contained the posterior longitudinal ligament,the ligamentum flavum and the dura mater.The posterior longitudinal ligament and the ligamentum flavum were fixed,and the contact surface conditions were changed to simulate different tissue adhesions.The compression effect of disc herniation on the dura mater was simulated on each model,and the stress distribution and displacement changes of the dural surface were analyzed among different groups.Results Four groups of models were generated with different friction coefficients,including no adhesions(group A),adhesion in the posterior longitudinal ligament(group B),adhesion in the ligamentum flavum(group C),and all model adhesions(group D).The equivalent stress distribution and maximum principal strain of the dura mater in the results of this model showed different trends between the groups A,B and groups C,D,with the latter two groups being significantly higher than the former two groups.When the friction coefficient was set to 0.05,the peak von mises stress of dura(0.487 MPa)and the maximum principal strain(0.364 mm)were highest in group C,which were 1.3 and 1.8 times higher than those in group A,respectively.The results also revealed that an increase in the friction coefficient had a smaller decrease in the effect on nerve compression,implying a decreasing trend in the potential benefit-to-risk ratio of nerve release at this time.Conclusion It suggests that the surgeryshould focus on releasing the adhesions between the ligamentum flavum and the dura mater during adhesiolysis,but it should not be forcibly released in cases of severe adhesions.

关 键 词：腰椎退行性疾病 生物力学模拟 有限元 松解术 硬脊膜粘连 

分 类 号：R681.5[医药卫生—骨科学]