棘突间固定辅助内镜下椎间融合治疗重度腰椎管狭窄症的有限元分析  

Finite element analysis of interspinous fixation-assisted endoscopic interbody fusion in treatment of severe lumbar spinal stenosis

作　　者：刘江 张晗硕[3] 丁逸苇 蒋强 李土胜 黄杰 杨广南[3] 丁宇 Liu Jiang;Zhang Hanshuo;Ding Yiwei;Jiang Qiang;Li Tusheng;Huang Jie;Yang Guangnan;Ding Yu(Naval Clinical College,Anhui Medical University,Beijing 100048,China;The Fifth Clinical Medical College of Anhui Medical University,Hefei 230032,Anhui Province,China;Department of Orthopedics and Traumatology,Division of Traditional Chinese Medicine,Sixth Medical Center,Chinese PLA General Hospital,Beijing 100048,China;School of Biological and Medical Engineering,Beihang University,Beijing 100191,China)

机构地区：[1]安徽医科大学海军临床学院,北京市100048 [2]安徽医科大学第五临床医学院,安徽省合肥市230032 [3]解放军总医院第六医学中心中医医学部骨伤科,北京市100048 [4]北京航天航空大学生物与医学工程学院,北京市100191

出　　处：《中国组织工程研究》2024年第24期3789-3795,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:在临床应用中,不附加椎间融合的单纯棘突间固定与椎弓根钉棒融合内固定具有相似固定效果,且可有效降低责任节段活动度及关节突应力,但单纯放置新型棘突间融合固定装置BacFuse后,棘突根部应力较为集中,易发生棘突骨折,若在置入椎间融合器的同时联合棘突间固定,理论上可以分散Von Mises应力,降低棘突骨折风险,但其在有限元仿真模拟下具体的生物力学情况鲜有报道。目的:观察棘突间固定辅助内镜下椎间融合治疗重度腰椎管狭窄症的生物力学稳定性。方法:取一位26岁成年男性志愿者的腰椎CT资料,排除脊柱病变,并使用Mimics、Geomagic、Solidworks、ANSYS等软件构建腰椎L_(4)-L_(5)节段的正常有限元模型M0,在M0的基础上分别建立内镜减压联合椎间融合术后即时模型M1、内镜减压置入棘突间固定装置(BacFuse)模型M2和棘突间固定(BacFuse)辅助内镜下椎间融合模型M3,在4组模型的L_(4)椎体上表面施以相同应力,在L_(5)椎体下表面采用固定支撑,并分析在前屈、后伸、左/右弯、左/右旋转等6种工况下的活动度和终板下骨、椎体后方韧带复合体Von Mises应力极值。结果与结论:①与模型M0相比,在6种工况下模型M1活动度值大幅增加,模型M2、M3的活动度大幅减小;②与模型M0相比,在6种工况下模型M1椎体最大应力无明显变化,模型M2椎体后方韧带复合体最大应力大幅增加;③与模型M1相比,模型M3在6种工况下椎体后方韧带复合体最大应力无明显变化;与M2模型相比,模型M3在椎体后方韧带复合体最大应力大幅减小;④与模型M0相比,模型M1的L_(4)和L_(5)终板下骨Von Mises应力极值均有明显增高;模型M2、M3的L_(4)和L_(5)终板下骨Von Mises应力极值略微降低;与模型M1相比,模型M2、M3的L_(4)和L_(5)终板下骨Von Mises应力极值明显降低;⑤提示BacFuse的置入能有效降低单纯椎间融合术中的终板下骨应力,降�BACKGROUND:In clinical application,simple interspinous fixation without additional interbody fusion has similar fixation effects to pedicle screw and rod fusion internal fixation,and can effectively reduce the range of motion of the responsible segment and the stress of the articular process.However,after simple placement of the new interspinous fusion fixation device BacFuse,the stress at the root of the spinous process is relatively concentrated,and the spinous fracture is prone to occur.If an intervertebral fusion cage is inserted in conjunction with interspinous fixation,Von Mises stress can theoretically be dispersed to reduce the risk of spinous fracture.However,there are few studies on biomechanics and finite element analysis.OBJECTIVE:To observe the biomechanical stability of interspinous fixation-assisted endoscopic interbody fusion in the treatment of severe lumbar spinal stenosis.METHODS:The normal finite element model M0 of the L_(4)-L_(5)segment of the lumbar spine was established by Mimics,Geomagic,Solidworks,and ANSYS software based on the lumbar CT images of a 26-year-old adult male volunteer excluding spinal diseases.On the basis of M0,the immediate model M1 after endoscopic decompression combined with interbody fusion,the interspinous fixation device(BacFuse)model M2 after endoscopic decompression,and the interspinous fixation(BacFuse)model M3 after endoscopic-assisted interbody fusion were established.The same stress was applied to the upper surface of the L_(4)vertebral body in the four groups,and the lower surface of the L_(5)vertebral body was fixed and supported.The range of motion and the extreme Von Mises stress of the endplate bone and the posterior ligament complex of the vertebral body were analyzed under six working conditions of flexion,extension,left/right bending,and left/right rotation.RESULTS AND CONCLUSION:(1)Compared with model M0,the range of motion value of model M1 increased significantly under six working conditions.Model M2 and model M3 had a significant reduction in range

关 键 词：重度腰椎管狭窄症 脊柱内镜 棘突间固定 椎间融合 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