后方韧带复合体损伤对腰椎后路椎间融合术后邻近节段影响的有限元分析  

The quantitative assessment of impact of posterior ligament complex injury on adjacent segments after posterior lumbar interbody fusion

作　　者：魏巍 王天昊 刘建恒 毛克亚 李慧 潘春昂 赵永飞 WEI Wei;WANG Tian-hao;LIU Jian-heng;MAO Ke-ya;LI Hui;PAN Chun-ang;ZHAO Yong-fei(Medical School of Chinese PLA,Beijing,100853,China;Department of Orthopaedics,the First Medical Centre,Chinese PLA General Hospital,Beijing,100853,China;Beijing Engineering and Technology Research Center for Medical Endoplants,Beijing,100094,China;Beijing Engineering Laboratory of Functional Medical Materials and Instruments,Beijing,100094,China)

机构地区：[1]解放军医学院,北京100853 [2]中国人民解放军总医院第一医学中心骨科,北京100853 [3]北京市医用内植物工程技术研究中心,北京100094 [4]功能性医用材料与器械北京市工程实验室,北京100094

出　　处：《颈腰痛杂志》2023年第3期324-328,334,共6页The Journal of Cervicodynia and Lumbodynia

基　　金：国家自然科学基金(编号:82272127,82102184);军委科技委基础加强计划技术领域基金项目(编号:2019-JCJQ-JJ-150,2020-JCJQ-JJ-356)。

摘　　要：目的利用三维有限元分析方法量化评价后方韧带复合体损伤(posterior ligament complex,PLC)对腰椎后路椎间融合术后邻近节段椎间盘和小关节的生物力学影响。方法建立正常的腰骶椎(L_(1)-S_(1))三维有限元模型(normal model,Nm),分别建立单纯融合模型(fusion model,Fm)、腰椎后路椎间融合模型(posterior lumbar interbody fusion model,PLIFm)、切除上邻近节段PLC的腰椎后路椎间融合模型(PLC resection and posterior lumbar interbody fusion model,PR&PLIFm),在相同的预载荷和力矩加载下进行前屈、后伸、侧弯和扭转运动,分析比较4组模型手术及邻近节段的活动度(range of motion,ROM)、椎间盘应力和小关节接触力变化。结果成功建立了正常有效的腰骶椎有限元模型及3种融合模型。3种融合模型均出现邻近节段ROM和椎间盘应力的不同程度增加,PLIFm和PR&PLIFm在邻近节段ROM、椎间盘应力和小关节接触力的增加更显著,切除PLC在前屈时对上邻近节段所受影响更大。结论腰椎融合导致邻近节段活动度、椎间盘应力和小关节负荷的增加,切除后方韧带复合体导致邻近节段的应力增加,邻近节段退变的风险增加。Objective To evaluate the biomechanical effects of posterior lumbar interbody fusion with posterior ligament complex(PLC)injury on adjacent segments with three-dimensional finite element analysis.Methods A normal lumbosacral vertebral(L_(1)-S_(1))three-dimensional finite element model(normal model,Nm)was established.Fusion only model(fusion model,Fm),posterior lumbar interbody fusion model(PLIFm),PLC on upper adjacent segment resection and posterior lumbar interbody fusion model(PLC resection and posterior lumbar interbody fusion model,PR&PLIFm)were established,respectively.The same preload and torque were applied on four models performing flexion,extension,lateral bending and torsion.The range of motion(ROM),intradiscal pressure and facet-joint contact force of operated and adjacent segments were compared,separately.Results A normal and valid finite element model of lumbosacral vertebral(L_(1)-S_(1))and three different fusion models were established successfully.The ROM and intradiscal pressure of adjacent segments increased in the three fusion models.The PLIFm and the PR&PLIFm had more significant increases in the ROM,intradiscal pressure and facet-joint contact force in adjacent segments,and the resection of PLC had a greater impact on the upper adjacent segment during flexion.Conclusion Posterior lumbar interbody fusion results in increased ROM,intradiscal pressure and facet-joint contact force in adjacent segments,and the resection of PLC will further aggravate biomechanical changes in adjacent segments,potentially leading to an increased risk of adjacent segment degeneration.

关 键 词：腰椎 后方韧带复合体 脊柱融合术 生物力学 邻近节段退变 有限元分析 

分 类 号：R687.3[医药卫生—骨科学]