双侧经皮椎体强化术中不同骨水泥填充量及分布形态的有限元分析  

A finite element analysis of different bone cement injection volumes and distribution patterns in bilateral percutaneous vertebral augmentation

作　　者：包雄 吴枭 唐锡杰 张友高 蔡进奎 李章华 Bao Xiong;Wu Xiao;Tang Xijie;Zhang Yougao;Cai Jinkui;Li Zhanghua(Zhongnan Hospital of Wuhan University,Wuhan 430062,Hubei Province,China;School of Medicine,Wuhan University of Science and Technology,Wuhan 430081,Hubei Province,China;Department of Orthopedic Center,Wuhan Third Hospital,Wuhan 430074,Hubei Province,China)

机构地区：[1]武汉大学中南医院,湖北省武汉市430062 [2]武汉科技大学医学院,湖北省武汉市430081 [3]武汉市第三医院骨科,湖北省武汉市430074

出　　处：《中国组织工程研究》2025年第10期2006-2014,共9页Chinese Journal of Tissue Engineering Research

基　　金：湖北省卫生健康委科研项目(WJ2021M010),项目负责人:李章华;武汉市科技局知识创新专项项目(2022020801010547),项目负责人:李章华。

摘　　要：背景:采用双侧经皮椎体强化治疗骨质疏松性椎体压缩骨折中,作者发现当骨水泥注射总量达4 mL及以上时会在X射线片上呈现不同的分布形态,然而关于骨水泥分布形态对骨折椎体生物力学特性的影响鲜有报道。目的:利用有限元法进一步探讨骨水泥填充量及分布形态对骨折椎体生物力学的影响。方法:建立L_1-L_3骨质疏松有限元模型,在L_2节段模拟椎体压缩骨折,在骨质疏松性椎体压缩骨折模型上分别模拟4 mL及6 mL骨水泥注入量及双侧部分融合(FH型)、完全融合(FO型)、对称分离(SA型)、非对称分离(SN型)4种骨水泥分布形态,共获得9组模型。在相同边界条件下进行三维有限元求解,比较L_2骨折椎体的应力及位移。结果与结论:(1)9组模型的最大应力均集中于L_2骨折区域,各骨水泥填充骨折模型的L_2最大应力和最大位移均小于无骨水泥填充骨折模型,说明骨水泥填充治疗骨质疏松性椎体压缩骨折有效;(2)与4 mL骨水泥填充相比,6 mL骨水泥填充在提高骨折椎体稳定性的同时可显著降低骨折椎体应力,增强椎体强度;(3)在相同运动状态下,FH型组骨折椎体应力均为最小,其次为SA型组,该两组接近,FO型组骨折椎体应力最大,在侧弯动作中尤为明显,可能与骨水泥团块形状导致侧方应力集中有关;FH型组骨折椎体位移最小,FO型组骨折椎体位移最大;(4)结果显示,增加骨水泥注入剂量可以降低骨折椎体应力,提高稳定性,但会增加渗漏风险;双侧对称弥散分布骨水泥(FH型、SA型)在恢复椎体强度及稳定性上均优于完全融合、非对称分离骨水泥,因此,临床上行双侧经皮椎体强化治疗骨质疏松性椎体压缩骨折时,首先保证双侧对称弥散分布,优先推荐双侧部分融合型分布,可获得合适的应力刺激及较好的稳定性。BACKGROUND:The authors found that when the bilateral percutaneous vertebral augmentation is used to treat osteoporotic vertebral compression fractures with a total bone cement injection of 4 mL or more,different distribution patterns were usually presented on the X-rays;however,there were few reports addressing the effects of these patterns of bone cement distribution on the biomechanical properties of fractural vertebrae.OBJECTIVE:To further explore the biomechanical effects of different bone cement filling doses and distribution patterns on biomechanics of the fractural vertebrae using the finite element method.METHODS:The L1-L3 finite element models of osteoporosis were established,and the vertebral compression fractures were simulated in L2.Four distribution patterns bilateral partial fusion(FH type),full fusion(FO type),symmetrical separation(SA type),and asymmetric segregation(SN type)were simulated in 4 and 6 mL injections in the osteoporotic vertebral compression fracture models,respectively,and a total of nine sets of models were obtained.These models were solved under the same boundary conditions and compared with the stress and displacement of the L2 fractural vertebra.RESULTS AND CONCLUSION:(1)The maximum stresses of the nine groups of models were concentrated in the L2 fractural area,and the maximum stress and maximum displacement of each filling model were lower than in the osteoporotic vertebral compression fracture model,indicating the effectiveness of bone cement filling in the treatment of osteoporotic vertebral compression fracture.(2)Compared with 4 mL bone cement filling,6 mL bone cement filling could significantly reduce the stress of fractured vertebrae and enhance the strength of fractured vertebrae while improving the stability of fractured vertebrae.(3)In the same state of movement,the FH type stress was the least,followed by the SA type,both of which were close.FO type stress was the largest,especially in the lateral bend,which might be associated with its cluster shape resulting in the

关 键 词：骨水泥 骨质疏松 椎体压缩骨折 经皮椎体强化 有限元分析 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学] R615