经皮椎体后凸成形术中提取表征骨健康状况的力学指标  

A Mechanical Index Extracted from Percutaneous Kyphoplasty for Bone Health Status Characterization

作　　者：卢笙 刘盼[2] 白旭锋 李震子 李浩[1] 张作启 朱晓彬[3] 祝少博[4] LU Sheng;LIU Pan;BAI Xufeng;LI Zhenzi;LI Hao;ZHANG Zuoqi;ZHU Xiaobin;ZHU Shaobo(School of Civil Engineering,Wuhan University,Wuhan 430072,China;School of Mechanics and Safety Engineering,Zhengzhou University,Zhengzhou 450001,China;Department of Spine Surgery and Musculoskeletal Tumor,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Orthopedics,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学土木建筑工程学院,武汉430072 [2]郑州大学力学与安全工程学院,郑州450001 [3]武汉大学中南医院脊柱与骨肿瘤科,武汉430071 [4]武汉大学中南医院创伤骨科,武汉430071

出　　处：《医用生物力学》2025年第1期72-79,共8页Journal of Medical Biomechanics

基　　金：国家自然科学基金项目(12272279,11720101002,11772240);湖北省重点研发项目(2021BCA106);中央高校基本科研业务费专项资金(2042024kf0034);广西口腔颌面修复与重建研究重点实验室开放课题(GXKLRROM2102)。

摘　　要：目的基于经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)的手术环境,提出一种表征松质骨健康状态的力学方法和指标,并验证其可行性和一致性。方法通过弹性力学理论推导给出力学指标K的表达式和物理意义,然后利用临床影像腰椎L4开展三维有限元仿真分析,验证理论结果的有效性,并对不同球囊形状和手术路径验证该方法和指标的一致性。结果注入液体体积与球囊内压之间呈线性关系,力学指标K与剪切模量密切相关,而且和骨质疏松程度线性负相关。球囊形状对指标K计算结果的影响很小,椭球形和圆柱形对比相对差别小于2%。手术入路路径对指标K计算结果的影响很小,经椎弓根入路和椎弓根外侧缘路径对比相对差别在0.5%以内。结论该临床在体力学测试方法和指标K能够表征患者骨的健康状态,且具有很好的一致性。研究结果对于指导PKP手术方案优化和术后康复、收集在体松质骨力学性能数据以及改进骨质疏松症的诊疗标准具有重要意义。Objective To propose a novel mechanical method and index to in-vivo characterize the health status of cancellous bone during the percutaneous kyphoplasty(PKP),and validate its feasibility and consistency.Methods According to the theory of elasticity,the expression and physical significance of the mechanical index K were given.Then using clinical images of the lumbar spine L4,three-dimensional finite element simulations were conducted to verify the validity of the theoretical results,as well as the consistency of the methodology and the indexes were verified for studies of different balloon shapes and puncture routes.Results The internal pressure of the balloon linearly varied with the injected fluid volume.The mechanical index K was closely related to the bone shear modulus and could well reflect the health status of cancellous bones.The balloon shape had a trivial influence on the K results,and the relative difference between the cylindrical and ellipsoidal shapes was less than 2%.The influence of surgical access route on the K results was also very small,and the relative difference between the routes by vertebral pedicle and by lateral margin of vertebral pedicle was less than 0.5%.Conclusions The in-vivo mechanical method and the mechanical index K can characterize the bone health of patients with good consistency.This study has a great significance for providing guidelines of the optimization of PKP operation plan and postoperative rehabilitation,collecting in vivo data of bone mechanical properties,and improving the diagnosis and treatment of osteoporosis in clinic.

关 键 词：骨质疏松症 经皮椎体后凸成形术 力学评估 在体检测 有限元分析 理论推导 

分 类 号：R318.01[医药卫生—生物医学工程]