韧带损伤影响腰椎稳定性的生物力学特征  

Biomechanical characteristics of ligament injury affecting lumbar spine stability

作　　者：李银倩 吕杰 丁立军 王多多 郭潘靖 曹金凤 周楠[5] 吕强[5] Li Yinqian;Lyu Jie;Ding Lijun;Wang Duoduo;Guo Panjing;Cao Jinfeng;Zhou Nan;Lyu Qiang(College of Rehabilitation Sciences,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China;College of Medical Instrumentation,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China;School of Health Science and Engineering,University of Shanghai for Science and Technology,Shanghai 200093,China;Periodicals Agency of Shanghai University,Shanghai 200444,China;Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海健康医学院康复学院,上海市201318 [2]上海健康医学院医疗器械学院,上海市201318 [3]上海理工大学健康科学与工程学院,上海市200093 [4]上海大学期刊社,上海市200444 [5]上海中医药大学附属岳阳中西医结合医院,上海市200437

出　　处：《中国组织工程研究》2024年第21期3286-3292,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金面上项目(82074571),项目负责人:周楠。

摘　　要：背景:韧带是维持腰椎稳定的重要结构,由于产生的机械应力这些结构容易退化,而对于韧带损伤的研究较少。目的:基于三维有限元模型模拟韧带损伤,确定各个韧带在运动状态下的活动度及应力方面的作用,系统探讨韧带受损对腰椎稳定性的影响和生物力学意义。方法:建立腰椎L4-L5有限元模型,约束L5下表面所有自由度,施加5 N·m力矩模拟腰椎的各个运动状态,通过改变韧带弹性模量模拟韧带渐进式受损。结果与结论:①大部分韧带损伤伸展活动度都出现了明显的增大;相比之下侧弯活动度无明显变化。②关节囊韧带受损后前屈、后伸和侧弯的活动度明显增大;前纵韧带受损后伸展活动度明显增大;横突韧带损伤导致侧弯活动度明显增大。③单韧带损伤后,伸展时活动度变化最为显著;单韧带受损后剩余韧带应力增大,尤其是关节囊韧带;整体来看棘间韧带和黄韧带应力变化最不明显;韧带应力在侧弯状态下变化最小,而扭转状态下变化最大。④韧带受损并未导致椎间盘压力发生重大变化,提示韧带损伤导致腰椎活动度增大,影响腰椎稳定性。⑤关节囊韧带稳定前屈、后伸和侧弯;前纵韧带稳定后伸;横突韧带稳定侧弯。⑥后伸运动对韧带损伤敏感,可通过后伸运动检查韧带病理变化。⑦单韧带损伤后剩余韧带给予应力补偿以维持腰椎稳定性。⑧棘间韧带和黄韧带损伤对周围韧带影响最小,关节囊韧带损伤对周围韧带影响最大。⑨韧带损伤对侧弯运动下的剩余韧带应力影响最小,而对扭转运动下的韧带应力影响最大,韧带损伤患者应避免扭转运动;韧带损伤不影响椎间盘压力。BACKGROUND:Ligaments are important structures in maintaining the stability of the lumbar spine,and these structures are prone to degradation due to the generated mechanical stress.However,there are few studies on ligament injuries.OBJECTIVE:To determine the range of motion and stress of each ligament in the state of motion based on a three-dimensional finite element model,and to systematically explore the influence of ligament injury on the stability of the lumbar spine and its biomechanical significance.METHODS:The L4-L5 lumbar finite element model was established.All free forces on the lower surface of L5 were constrained,and a torque of 5 N·m was applied to simulate the motion states of the lumbar spine.Progressive ligament damage was simulated by changing Young’s modulus of the ligament.RESULTS AND CONCLUSION:(1)The extension range of motion of most ligament injuries increased significantly.In contrast,there was no significant change in the lateral bending range of motion.(2)The range of motion of capsular ligament injury increased significantly in flexion,extension and lateral bending.The extension range of motion increased significantly after the anterior longitudinal ligament injury.Intertransverse ligament injury resulted in a significant increase in the lateral bending range of motion.(3)After a single ligament injury,the most significant change in range of motion was observed during extension.After a single ligament injury,the stress of the remaining ligaments increased,especially the capsular ligament.The stress changes of the interspinous ligament and ligamentum flavum were the least obvious.Ligament stress changes least in lateral bending and most in torsion.(4)Ligament damage did not result in major changes in disc pressure,indicating that ligament injury leads to an increased range of motion of the lumbar spine and affects the stability of the lumbar spine.(5)Capsular ligament was stable in flexion,extension and lateral bending.The anterior longitudinal ligament showed a stable extension;the int

关 键 词：有限元 腰椎 韧带 渐进性损伤 生物力学 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R496