置入微创椎间融合器高度对青少年腰椎间盘突出症患者腰椎生物力学的影响  

Effect of minimally invasive interbody fusion device height on lumbar biomechanics in patients with adolescent lumbar disc herniation

作　　者：张若帆 关欢欢 何卓群 张云凤[2] 金凤[3] 王志强 王建忠 李筱贺 祝勇 王海燕 张凯 Zhang Ruofan;Guan Huanhuan;He Zhuoqun;Zhang Yunfeng;Jin Feng;Wang Zhiqiang;Wang Jianzhong;Li Xiaohe;Zhu Yong;Wang Haiyan;Zhang Kai(Graduate School of Inner Mongolia Medical University,Hohhot 010010,Inner Mongolia Autonomous Region,China;Department of Imaging,Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010010,Inner Mongolia Autonomous Region,China;Department of Imaging,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010010,Inner Mongolia Autonomous Region,China;Department of Human Anatomy,School of Basic Medicine,Inner Mongolia Medical University,Hohhot 010010,Inner Mongolia Autonomous Region,China;Inner Mongolia Hospital,Peking University Cancer Hospital(Cancer Hospital Affiliated to Inner Mongolia Medical University),Hohhot 010010,Inner Mongolia Autonomous Region,China;Department of Orthopedics,Ulanqab Second Hospital,Ulanqab 012000,Inner Mongolia Autonomous Region,China)

机构地区：[1]内蒙古医科大学研究生院,内蒙古自治区呼和浩特市010110 [2]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010010 [3]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010010 [4]内蒙古医科大学基础医学院人体解剖学教研室,内蒙古自治区呼和浩特市010110 [5]北京大学肿瘤医院内蒙古医院(内蒙古医科大学附属肿瘤医院),内蒙古自治区呼和浩特市010010 [6]乌兰察布市第二医院骨科,内蒙古自治区乌兰察布市012000

出　　处：《中国组织工程研究》2025年第21期4421-4429,共9页Chinese Journal of Tissue Engineering Research

基　　金：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),项目参与人:李筱贺;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(2021),项目负责人:李筱贺;内蒙古自治区高等学校创新团队发展计划项目(NMGIRT2419),项目负责人:王海燕;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项目(NMGIRT2227),项目负责人:李筱贺;2022年“草原英才”工程,项目负责人:张凯;内蒙古自治区2023年自治区重点研发和成果转化计划(科技支撑黄河流域生态保护和高质量发展)项目(2023YFHH0003),项目负责人:李筱贺。

摘　　要：背景:青少年腰椎间盘突出症是引起青少年腰疼的主要病因,目前绝大多数患者通过保守治疗干预,而当长期的非手术治疗尝试后,患者的症状没有得到充分缓解或者当患者出现神经麻痹或马尾神经受压的症状时,手术可能是防止进一步损伤的必要手段,而选择合适的椎间融合器至关重要。目的:探究青少年腰椎间盘突出症患者置入不同高度微创椎间融合器固定后对腰椎生物力学的影响。方法:采集一名17岁男性青少年腰椎间盘突出症患者(L4-5节段突出)的CT扫描资料,MIMICS三维重建后,选择用与实验对象椎间隙等高和高于椎间隙3 mm椎间融合器进行分析,设计重建两种可膨胀混合材料椎间融合器:融合器L前高11 mm、后高9 mm、宽9 mm、长28 mm;融合器H前高14 mm、后高11 mm、宽11 mm、长28 mm,并对腰椎融合器进行建模。将融合器与腰椎模型经过优化处理,逆向建模后导入ABAQUS并最终得到腰椎融合三维模型。模拟人体腰椎后伸、前屈、右侧弯、左侧弯等生理活动,得到相应应力云图,观察L4-5椎体在7种不同工况下的生物力学特征。结果与结论;(1)两种融合器终板最大应力均在前屈和后伸工况,前屈工况H融合器上、下终板应力值为(18.27±3.80)MPa和(15.02±3.24)MPa;L融合器上、下终板应力值为(9.16±0.05)MPa和(9.17±1.83)MPa;后伸工况H融合器上、下终板应力值为(19.11±4.03)MPa和(16.32±3.72)MPa;L融合器上、下终板应力值为(9.13±0.01)MPa和(4.92±1.01)MPa;(2)除中立位L5上终板,其余不同工况下H型融合器终板应力值均大于L型融合器终板,差异有显著性意义(P<0.05);(3)同一椎间隙中选择高度超过椎间隙高度3 mm的椎间融合器更稳定。BACKGROUND:Adolescent lumbar disc herniation is the main cause of low back pain in adolescents.At present,most of them are treated by conservative treatment.When long-term non-surgical treatment attempts,surgery may be necessary to prevent further injury when the patient’s symptoms are not sufficiently relieved or when the patient has symptoms of single nerve paralysis or compression of the cauda equina,it is very important to choose a suitable interbody fusion device for the surgical treatment of the patients.OBJECTIVE:To explore the effects of minimally invasive interbody fusion with different heights on lumbar biomechanics in patients with adolescent lumbar disc herniation.METHODS:CT scans of a 17-year-old male patient with adolescent lumbar disc herniation(L4-5 segment herniation)were collected.After the three-dimensional reconstruction of MIMICS,the interbody fusion device equal to and 3 mm higher than the intervertebral space was selected for analysis,so two expandable mixed material interbody fusion devices were designed and reconstructed.Fusion device L:11 mm high front,9 mm high posterior,9 mm wide,28 mm long,and fusion device H:14 mm high front,11 mm high posterior,11 mm wide,28 mm long and the lumbar fusion device was modeled.The fusion device and lumbar spine model were optimized,inversely modeled,and then imported into ABAQUS,and finally the 3D model of lumbar fusion was obtained.The physiological activities of the human body were simulated,such as lumbar extension,forward bending,right bending,and left bending,to obtain the corresponding stress contours.The biomechanical characteristics of the L4-5 vertebra under seven different working conditions were observed.RESULTS AND CONCLUSION:(1)The maximum stress of the two kinds of fuses was in the condition of forward bending and backward extension,the stress value of H fuses was(18.27±3.80)MPa and(15.02±3.24)MPa;the stress value of L fuses was(9.16±0.05)MPa and(9.17±1.83)MPa.The stress values of the end plate of the H-fusion in the extension statio

关 键 词：青少年腰椎间盘突出症 椎间融合器 内固定 融合器高度 有限元分析 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] R322