有限元仿真分析不同矫形方式治疗青少年特发性脊柱侧凸的生物力学特征  

Biomechanical characteristics of different orthopedic modalities for adolescent idiopathic scoliosis based on finite element simulation analysis

作　　者：岳波 曹振华[3,4] 张云凤 许阳阳[6] 金凤 苏宝科[8] 王利东 王星 仝玲 刘清华 方源 沙丽蓉 王海燕 李筱贺 李志军 Yue Bo;Cao Zhenhua;Zhang Yunfeng;Xu Yangyang;Jin Feng;Su Baoke;Wang Lidong;Wang Xing;Tong Ling;Liu Qinghua;Fang Yuan;Sha Lirong;Wang Haiyan;Li Xiaohe;Li Zhijun(Department of Human Anatomy,School of Basic Medicine,Inner Mongolia Medical University(Inner Mongolia Digital Transformation Medical Engineering Technology Research Center),Hohhot 010000,Inner Mongolia Autonomous Region,China;Bayannur Hospital,Bayannur 015000,Inner Mongolia Autonomous Region,China;Postdoctoral Workstation of Chinese PLA General Hospital,Beijing 100000,China;Department of Orthopedics,Third Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,Liaoning Province,China;Department of Imaging,Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010000,Inner Mongolia Autonomous Region,China;School of Biological and Medical Engineering,Beihang University,Beijing 100083,China;Department of Imaging,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010000,Inner Mongolia Autonomous Region,China;Hospital of Traditional Chinese Medicine of Inner Mongolia Autonomous Region,Hohhot 010000,Inner Mongolia Autonomous Region,China;Department of Imaging,International Mongolian Hospital of Inner Mongolia Autonomous Region,Hohhot 010000,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古医科大学基础医学院人体解剖教研室(内蒙古自治区数字转化医学工程技术研究中心),内蒙古自治区呼和浩特市010000 [2]巴彦淖尔市医院,内蒙古自治区巴彦淖尔市015000 [3]中国人民解放军总医院博士后工作站,北京市100000 [4]锦州医科大学第三附属医院骨科,辽宁省锦州市121000 [5]内蒙古医科大学第二附属医院影像科,内蒙古自治区呼和浩特市010000 [6]北京航空航天大学生物与医学工程学院,北京市100083 [7]内蒙古医科大学附属医院影像科,内蒙古自治区呼和浩特市010000 [8]内蒙古自治区中医医院,内蒙古自治区呼和浩特市010000 [9]内蒙古自治区国际蒙医医院影像科,内蒙古自治区呼和浩特市010000

出　　处：《中国组织工程研究》2025年第15期3129-3137,共9页Chinese Journal of Tissue Engineering Research

基　　金：内蒙古自治区自然科学基金项目(2021MS08086),项目负责人:王海燕;2022年度内蒙古自治区卫生健康科技计划项目(202201188),项目负责人:王海燕;内蒙古医科大学2020年度“成果转化”项目(YKD2020CGZH009),项目负责人:王海燕;内蒙古自然科学基金(2020MS08124),项目负责人:李筱贺;内蒙古自治区“草原英才”工程青年创新创业人才项目(2020),项目负责人:李筱贺;内蒙古医科大学后续科研项目(2020),项目负责人:李筱贺;内蒙古科技计划项目(2019GG115),项目负责人:李志军;2021年内蒙古自治区蒙医药协同创新中心科学研究项目,项目负责人:李筱贺;2021年内蒙古医科大学致远人才项目,项目负责人:李筱贺;内蒙古医科大学2021年度校级科研重点项目(YKD2021ZD001),项目负责人:李筱贺;内蒙古教育厅高等学校创新团队发展计划(NMGIRT2227),项目负责人:李筱贺。

摘　　要：背景:青少年特发性脊柱侧凸不对称的生物力学环境会导致椎体进一步楔形变,严重时或可影响心肺功能,压迫神经。不同侧凸程度的青少年特发性脊柱侧凸应进行运动、支具或手术治疗,然而,因患者的个体差异性,选择不同矫形方式的力学机制仍不明确。目的:基于青少年特发性脊柱侧凸患者的脊柱模型,探究不同矫形方式治疗的生物力学机制,为临床治疗方式的选择提供依据。方法:基于1例青少年特发性脊柱侧凸患儿脊柱CT图像,于Mimics软件中三维重建出脊柱侧凸模型(C7-L5),在T8/T9胸廓处施加横向侧推力,在C7椎体上方施加纵向撑开力,力的大小为20,40,60,80,100,120 N,分析两种矫形方式下椎间盘凹凸侧应力、椎体凹凸侧位移和脊柱Cobb角变化。结果与结论:①横向侧推力下,C7T1-T7T8椎间盘应力无明显变化,T7T8-L4L5节段凹凸侧应力随着侧推力的增加先减小后增大,侧推力对T8T9附近节段的矫正效果明显,随着节段延伸至头端和尾端,矫正效果减弱;侧推120 N时,胸部Cobb角由53.2°变为32.5°,腰部Cobb角由50.2°变为43.9°;②纵向撑开力下,胸椎椎间盘应力先减小后增大,腰椎椎间盘应力均减小,C7位移最明显,节段延伸至尾端,矫正效果逐渐减弱;撑开力120 N时,胸部Cobb角由53.2°变为39.4°,腰部Cobb角由50.2°变为47.6°;③提示两种矫形方式均对脊柱侧凸程度有一定改善,胸部矫正大于腰部矫正,同时凹凸侧不对称的应力分布也得到改善,这有助于骨逐渐恢复正常生长;脊柱侧凸Cobb角较大时,适合采用纵向撑开方式,脊柱侧凸Cobb角较小时,适合采用横向侧推方式;研究结果有助于理解脊柱矫形机制并为矫形方式的选择提供理论依据。BACKGROUND:The asymmetrical biomechanical environment of adolescent idiopathic scoliosis can lead to further wedge deformation of the vertebral body,which may affect cardiopulmonary function and compress nerves in severe cases.Adolescent idiopathic scoliosis with different degrees of scoliosis should be treated with exercise,bracing,and surgery.However,the mechanical mechanism of selecting an orthopedic approach remains unclear due to the individual variability of patients.OBJECTIVE:To investigate the biomechanical mechanism of different orthopedic modalities for the treatment of adolescent idiopathic scoliosis to provide a basis for clinical selection of treatment modalities based on the spine model of adolescent idiopathic scoliosis patients.METHODS:Based on the CT images of an adolescent idiopathic scoliosis patient,a scoliosis model(C7-L5)was reconstructed in Mimics software in three dimensions,and lateral thrust force was applied at the T8/T9 thorax and vertical distraction force was applied over the C7 vertebra with the magnitude of 20,40,60,80,100,and 120 N.The intervertebral disc stress and vertebral displacement in concave and convex sides,and Cobb angle of the spine were analyzed under two orthopedic modalities.RESULTS AND CONCLUSION:(1)With lateral thrust,there was no significant change in the C7T1-T7T8 intervertebral disc.The concave and convex stress of T7T8-L4L5 segment decreased first and then increased with the increase of lateral thrust force.The correction effect of lateral thrust on the segment near T8T9 was obvious and weakened with the extension of the segment to the cephalic and caudal ends.At 120 N of lateral thrust,the thoracic Cobb angle changed from 53.2°to 32.5°and the lumbar Cobb angle changed from 50.2°to 43.9°.(2)With the vertical distraction,the thoracic intervertebral disc stresses first decreased and then increased,and all the lumbar disc stresses decreased.The C7 displacement was the most obvious,and the correction effect gradually diminished with the segment extended to the

关 键 词：青少年特发性脊柱侧凸 横向侧推力 纵向撑开力 不对称应力分布 骨的机械调节原理 矫形生物力学 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R68