骨折复位程度和骨水泥注入量对PKP术后邻近椎体应力影响的有限元分析  

Finite element analysis of effects of degree of fracture reduction and bone cement injection on stresses in adjacent vertebral bodies after percutaneous kyphoplasty

作　　者：曾锦源[1] 谢昀[1] 陈春永[1] 林章雄[1] 郑力峰[1] 邱耀宇[1] ZENG Jinyuan;XIE Yun;CHEN Chunyong;LIN Zhangxiong;ZHENG Lifeng;QIU Yaoyu(Department of Trauma Orthopedics,the First Affiliated Hospital of Fujian Medical University,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fuzhou,Fujian 350005,China)

机构地区：[1]福建医科大学附属第一医院创伤骨科,福建医科大学附属第一医院滨海院区国家区域医疗中心骨科,福建福州350005

出　　处：《中国骨与关节损伤杂志》2023年第7期698-702,共5页Chinese Journal of Bone and Joint Injury

基　　金：福建省教育厅中青年教师教育立项科研项目(JAT190209)。

摘　　要：目的采用有限元方法分析骨折椎体复位程度和骨水泥注入量对经皮椎体后凸成形(Percutaneous kyphoplasty,PKP)术后邻近椎体应力的影响。方法选取1例健康中年志愿者行胸腰段脊柱CT扫描,将图像处理后利用Mimics软件进行三维重建,用Geomagic、Abaqus软件对图像中材料属性、接触关系进行设定,建立T_(11)~L_(1)骨质疏松椎体压缩骨折有限元模型,设定T_(12)椎体骨折压缩1/2,经椎弓根单侧PKP术中椎体复位后T_(12)椎体前缘高度恢复到1/2、恢复到3/4或恢复正常,设定分别注入4 mL和5 mL骨水泥,设置载荷进行生物力学分析,分析前屈、后伸、右侧侧屈、右侧旋转情况下T_(11)椎体和L_(1)椎体应力的变化。结果前屈方向:T_(12)椎体前缘高度复位越好,邻近T_(11)椎体和L_(1)椎体应力越小。后伸方向:T_(12)椎体前缘高度未恢复时T_(11)椎体应力最大,T_(12)椎体高度恢复到3/4时T_(11)椎体应力最小;T_(12)椎体前缘高度完全复位时L_(1)椎体应力最大,T_(12)椎体前缘高度恢复到1/2时L_(1)椎体应力最小。右侧侧屈方向:T_(12)椎体前缘复位高度对邻近T_(11)椎体和L_(1)椎体应力没有影响。右侧旋转方向:T_(12)椎体前缘复位到3/4时,邻近T_(11)椎体和L_(1)椎体应力最小,T_(12)椎体前缘高度完全恢复后应力反而更大。T_(12)椎体压缩骨折PKP术中注入4 mL和注入5 mL骨水泥对术后邻近T_(11)椎体和L_(1)椎体应力影响无明显差异。结论适度复位压缩椎体和注入适宜的低剂量骨水泥可以降低PKP术后邻近椎体骨折发生风险。Objective To investigate the effects of degree of fracture reduction and bone cement injection on stresses in adjacent vertebral bodies after percutaneous kyphoplasty(PKP)using finite element method.Methods One healthy middle-aged volunteer was enrolled and exposed to CT scanning of the thoracolumbar spine.After image processing,for three-dimensional reconstruction was achieved using Mimics,and the material properties and contact relationships in the images were set by using use Geomagic and Abaqus.A finite element model was established for T_(11)-L_(1)osteoporotic vertebral compression fractures,and T_(12)fracture compression was set to 1/2.After vertebral reduction during unilateral PKP of vertebral pedicle surgery,the anterior edge height of T_(12)recovered to 1/2,3/4,or returned to normal.Four mL and 5 mL of bone cement were injected respectively,and the load was set for biomechanical analysis to analyze the changes in T_(11)and L_(1)stress under forward flexion,backward extension,right lateral flexion,and right rotation.Results Forward bending direction:the better the height reduction of the leading edge of T_(12),the smaller the stress adjacent to T_(11)and L_(1).Extension direction:when the height of the leading edge of T_(12)was not restored,the stress of T_(11)was the highest,and when the height of T_(12)was restored to 3/4,the stress of T_(11)was the lowest;when the leading-edge height of T_(12)was fully reset,L_(1)had the highest stress,and when the leading-edge height of T_(12)was restored to 1/2,L_(1)had the lowest stress.Right lateral bending direction:the reduction height of the leading edge of T_(12)had no effect on the adjacent T_(11)and L_(1)stress.Right rotation direction:when the leading-edge height of T_(12)was reset to 3/4,the stress adjacent to T_(11)and L_(1)was the smallest,and after the leading-edge height of T_(12)was completely restored,the stress was actually greater.There was no significant difference in the postoperative stress of adjacent T_(11)and L_(1)after injecting 4 mL and 5 m

关 键 词：骨质疏松性椎体压缩骨折 经皮椎体后凸成形术 骨折复位程度 骨水泥注入量 有限元分析 

分 类 号：R687.3[医药卫生—骨科学]