动力位下早期脊髓型颈椎病患者脊髓致压特点的有限元分析  

Finite element analysis of characteristics of spinal cord compression in patients with early cervical spondylotic myelopathy under dynamic position

作　　者：李承蔚 张翼升 李智斐[2] 钟远鸣[2] 蒙纪文 梁钦秋 陈华龙 Li Chengwei;Zhang Yisheng;Li Zhifei;Zhong Yuanming;Meng Jiwen;Liang Qinqiu;Chen Hualong(Graduate School of Guangxi University of Chinese Medicine,Nanning 530000,Guangxi Zhuang Autonomous Region,China;First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530000,Guangxi Zhuang Autonomous Region,China;Yulin Orthopedic Hospital of Integrated Traditional Chinese and Western Medicine,Xilin 537000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西中医药大学研究生学院,广西壮族自治区南宁市530000 [2]广西中医药大学第一附属医院,广西壮族自治区南宁市530000 [3]玉林市中西医结合骨伤医院,广西壮族自治区西林市537000

出　　处：《中国组织工程研究》2024年第33期5257-5264,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(82260942),项目负责人:钟远鸣;广西中医药大学第一附属医院院级科研项目(2020QN040),项目负责人:张翼升。

摘　　要：背景:脊髓型颈椎病是导致中老年人功能障碍的进行性加重疾病,早期诊断困难,近年来临床上有学者发现动态磁共振成像(dMRI)技术可更早期发现动力位下的脊髓受压,但其具体生物力学机制亟待阐明。目的:探讨早期脊髓型颈椎病患者在动力位(过伸过屈位)下脊髓的生物力学致压特点,验证颈椎dMRI对早期脊髓型颈椎病诊断的有效性。方法:回顾性分析2022年1-6月在广西中医药大学第一附属医院骨科就诊并拍摄过颈段dMRI患者的病历资料,共纳入16例,分为2组,病理组为8例以黄韧带肥厚为主要征象的早期脊髓型颈椎病患者,男5例,女3例;正常组为8例正常退变人群,男4例,女4例。所有患者均已拍摄颈椎CT平扫、MRI平扫、dMRI平扫。此次研究分为以下3个部分实验进行阐述:①采集两组受试者dMRI图像的DCOM数据,并采集其颈椎CT、中立位MRI图像DCOM数据了解两组受试者在中立位下的骨质及软组织情况;②基于MRI及CT平扫的图像DCOM数据,使用逆向工程软件分别建模正常退变人群、脊髓型颈椎病早期患者的下颈椎(C3-7)三维有限元模型,分析脊髓、硬膜后部的等效应力、等效弹性应变数值,观察应力、应变分布情况;③得出应力、应变数据后进行组间数据对比,分析出早期脊髓型颈椎病在动力位下脊髓致压的力学特点,验证dMRI对早期脊髓型颈椎病诊断的有效性。结果与结论:①两组受试者下颈椎(C3-7)模型在模拟后伸、前屈、中立位时,其脊髓后部的应力、应变数值从大到小依次为后伸位>前屈位>中立位(P<0.05),应变数值从大到小依次为后伸位>前屈位>中立位(P<0.05);②与正常退变人群模型比较,病理组模型在前屈、后伸2种自由度下,其脊髓的等效应力、应变均较正常组模型增大(P<0.05),且脊髓后部应力、应变分布区域不规则;③在中立位下,两组模型脊髓的应变数值无明显差异(P>0.05),应变分BACKGROUND:Cervical spondylotic myelopathy is a progressive disease leading to dysfunction in the middle-aged and elderly,and early diagnosis is difficult.In recent years,some clinical scholars have found that dynamic magnetic resonance imaging technology can detect spinal cord compression in a dynamic position earlier,but its specific biomechanical mechanism needs to be clarified.OBJECTIVE:To investigate the biomechanical compression characteristics of early cervical spondylotic myelopathy in hyperextension and flexion position,and to verify the effectiveness of dynamic magnetic resonance imaging in the diagnosis of early cervical spondylotic myelopathy.METHODS:A retrospective analysis was made on the patients who underwent cervical dynamic magnetic resonance imaging in the Department of Orthopedics of First Affiliated Hospital of Guangxi University of Chinese Medicine from January to June 2022.16 subjects were selected and divided into two groups.The pathological group included 8 patients with early cervical spondylotic myelopathy with hypertrophy of ligamentum flavum as the main sign,with 5 male patients and 3 female patients.The normal group included 8 normal degenerative people,with 4 male patients and 4 female patients.All patients were photographed with cervical CT plain scan,magnetic resonance imaging plain scan,and dynamic magnetic resonance imaging plain scan.This study was divided into the following three parts:(1)collect the dynamic magnetic resonance imaging image DCOM data of two groups of subjects,and collect the cervical vertebra CT and neutral magnetic resonance imaging image DCOM data to understand the bone and soft tissue of the two groups of subjects in the neutral position.(2)Based on the DCOM data of magnetic resonance imaging and CT plain scan,the three-dimensional finite element models of lower cervical vertebra(C3-7)of normal degenerative population and early cervical spondylotic myelopathy patients were established by reverse engineering software.The equivalent stress and equivalent elas

关 键 词：脊髓型颈椎病 动态MRI(dMRI) 动力位 早期诊断 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] R681.5