胸椎骨质疏松性压缩骨折经皮椎体成形术中骨水泥渗漏致邻椎骨折风险的有限元分析  

FEA on the risk of adjacent vertebral fractures caused by leakage of bone cement in PKP for thoracic vertebra OVCF

作　　者：张高翔 张庆国[2] Zhang Gaoxiang;Zhang Qingguo(School of Clinical Medicine,Shandong Second Medical University,Weifang 261000,China;Department of Orthopedics,Jinan Central Hospital Affiliated to Shandong First Medical University,Jinan 250013,China)

机构地区：[1]山东第二医科大学临床医学院,潍坊261000 [2]山东第一医科大学附属济南市中心医院骨科,济南250013

出　　处：《中国医学装备》2025年第3期29-36,42,共9页China Medical Equipment

基　　金：国家自然科学基金面上项目(82274553);山东省医药卫生科技发展计划(202104070847)。

摘　　要：目的:应用有限元分析(FEA)研究胸椎骨质疏松性压缩骨折患者行经皮脊柱后凸成形术(PKP)中,椎体前上方骨水泥渗漏后相邻椎体应力的变化及邻椎骨折的风险。方法:收集2023年5月至2023年9月山东第一医科大学附属济南市中心医院收治的1例82岁女性行两次PKP的胸椎骨质疏松性压缩骨折患者资料。患者2023年5月胸10(T10)椎体骨折,PKP治疗中椎体前上方骨水泥渗漏;2023年9月相邻胸9(T9)椎体发生骨折,且T9椎体前下方MRI信号异常,与骨水泥渗漏位置接近。依据手术前后两次CT图像分别应用Mimics21.0、Geomagic Studio2014和HyperMesh14.0软件共建立3组模型,即术前模型组、术后骨水泥渗漏模型组和术后骨水泥未渗漏模型组。使用MSC.Patran2019和MSC.Nastran2019软件优化3组模型,对比分析直立、前屈、后伸、左右侧屈和左右旋转7个状态下骨折相邻椎体及骨水泥渗漏相关椎体所受应力及其差异。结果:骨水泥固定成形节段的相邻椎体、终板及椎间盘应力均呈现PKP术后骨水泥渗漏模型组高于术后骨水泥未渗漏模型组,且高于PKP术前模型组。PKP术后骨水泥渗漏模型组在椎体T9、T10、T11上的应力增量分别为29.61%~110.81%、7.11%~166.01%、51.49%~123.88%,明显高于术后骨水泥未渗漏模型组,其中T9椎体在前屈、后伸、左右旋转状态下,以及T10椎体在左右旋转和T11椎体在前屈、左侧弯、左右旋转状态下应力增量均为显著。术后骨水泥渗漏模型组对应的相邻终板以及相邻椎间盘的应力增量明显高于术后骨水泥未渗漏模型组,其中T9下终板在直立、前屈、后伸、左右旋转状态下和T10上终板在左侧弯、左右旋转、T10下终板在右旋转、T9~T10椎间盘在前屈、左右旋转以及T10~T11椎间盘在直立、左侧弯、右旋转状态下应力增量更加明显。结论:PKP术中骨水泥前上方渗漏导致相邻椎体生物力学改变,受到的应力发生变化,并�Objective:To research the change of adjacent vertebral stress and the risk of adjacent vertebral fracture after the front upper bone cement of vertebra occurred leakage when patients with osteoporotic vertebral compression fracture(OVCF)on thoracic vertebra underwent percutaneous kyphoplasty(PKP)by using finite element analysis(FEA).Methods:The data of a 82 years old female patient with OVCK on thoracic vertebra who admitted to the Affiliated Hospital of Jinan Central Hospital Affiliated to Shandong First Medical University from May to September 2023 were collected.The patient occurred fracture at the thoracic 10(T10)vertebra.During the progress of PKP treatment,the front upper bone cement occurred leakage,followed by a subsequent fracture occurred at the adjacent T9 vertebra,and the magnetic resonance imaging(MRI)revealed abnormal signals at the front lower region of T9,which closed to the leakage site of bone cement.The pre-and postoperative computed tomography(CT)images were respectively used to construct three groups of models by using Mimics 21.0,Geomagic Studio 2014 and HyperMesh 14.0 software,which were preoperative model group,postoperative model group with leakage of bone cement,and postoperative model group without leakage of bone cement.The three groups of models were optimized by using MSC.Patran 2019 and MSC.Nastran 2019 software.The suffered stresses of adjacent vertebra of fracture and the relevant vertebras with the leakage of bone cement,and the difference of them under 7 kinds of situations,which included upright,forward bending,backward extension,left and right lateral bending,and left and right rotation,were compared and analyzed.Results:The overall stresses on adjacent vertebra of the fixed forming segment by bone cement,endplates and intervertebral discs of PKP postoperative model group with leakage of bone cement were all higher than those of postoperative model group without leakage of bone cement,and were higher than PKP preoperative model group.The increased amount of stress in PKP posto

关 键 词：胸椎骨质疏松性压缩骨折 经皮穿刺脊柱后凸成形术 骨水泥渗漏 有限元分析 

分 类 号：R683.1[医药卫生—骨科学]