中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (24): 3850-3854.doi: 10.12307/2021.091

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

有限元分析全可视化内镜下椎板开窗减压治疗脊髓型颈椎病的生物力学特点

刘金玉1，丁逸苇2，卢正操1，高天君1，崔洪鹏1，李  雯1，杜  薇1 ，丁  宇1   

  1. 1解放军总医院中医医学部骨伤科，北京市   100048；2纽约大学工程学院2019级，美国纽约市   NY 11201
  • 收稿日期:2020-09-17 修回日期:2020-09-19 接受日期:2020-10-24 出版日期:2021-08-28 发布日期:2021-03-08
  • 通讯作者: 丁宇，主任医师，解放军总医院中医医学部骨伤科，北京市 100048
  • 作者简介:刘金玉，男，1992年生，河北省张家口市人，汉族，医师，主要从事微创脊柱外科与生物力学研究。 丁逸苇，男，1997年生，北京市人，汉族，纽约大学工程学院在读硕士，主要从事生物医学工程与脑机结合研究。
  • 基金资助:
    首都临床诊疗技术研究及示范应用项目“富血小板血浆椎间盘注射联合椎间孔镜技术治疗腰椎间盘突出症及术后康复的临床研究”(Z191100006619028)，项目负责人：丁宇

Finite element biomechanical study of full endoscopic fenestration decompression for cervical spondylotic myelopathy

Liu Jinyu1, Ding Yiwei2, Lu Zhengcao1, Gao Tianjun1, Cui Hongpeng1, Li Wen1, Du Wei1, Ding Yu1   

  1. 1Department of Orthopedics of TCM Clinical Unit, PLA General Hospital, Beijing 100048, China; 2School of Engineering Grade 2019, New York University, New York 11201, NY, USA
  • Received:2020-09-17 Revised:2020-09-19 Accepted:2020-10-24 Online:2021-08-28 Published:2021-03-08
  • Contact: Ding Yu, Chief physician, Department of Orthopedics of TCM Clinical Unit, PLA General Hospital, Beijing 100048, China
  • About author:Liu Jinyu, Physician, Department of Orthopedics of TCM Clinical Unit, PLA General Hospital, Beijing 100048, China Ding Yiwei, Master candidate, School of Engineering Grade 2019, New York University, New York 11201, NY, USA
  • Supported by:
    the Capital Clinical Diagnosis and Treatment Technology Research and Demonstration Application Project, No. Z191100006619028 (to DY)

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摘要：

文题释义：
颈椎有限元手术模拟建模：模型首先通过获取人体腰椎CT资料，以DICOM 格式导入Mimics 软件中建立C4-7模型，再运用3-matic 建立椎间盘和手术模型。将建好的模型进行网格划分，在Ansysworkbench 18.0中进行材料赋值及韧带添加，同时进行相关力学分析。
脊髓型颈椎病：是指由于颈椎管狭窄、椎体后缘骨赘增生、后纵韧带钙化、椎间隙狭窄和椎间盘突出压迫脊髓而导致的临床综合征，以40-60岁多见，起病慢，约20%有外伤史，产生机制是由于致压物对椎体束(皮质脊髓束)的直接压迫或局部血供减少引起，临床表现先从单侧或双侧下肢发沉、无力、发麻开始，随之出现行走困难、双足踩棉花感觉、胸腹束带感等。

背景：颈椎内镜下椎板开窗减压术中切除椎板及小关节时如处理不当易导致颈椎结构改变，进而引起节段生物力学变化，远期发生颈椎退变加速、椎体不稳等情况，临床亟需了解颈椎全内镜下椎板开窗减压术对节段生物力学的影响及其相关解剖关系。
目的：应用有限元逆向工程技术精准模拟内镜下椎板开窗减压术治疗脊髓型颈椎病的三维有限元模型，进行生理状态下的颈椎生物力学研究。
方法：获得1名志愿者的颈椎CT平扫数据，导入MIMICS 20.0软件中，建立C4-7有限元模型M。将模型M导入3-matic软件，模拟单侧C4-5椎板开窗模型M1及双侧C4-5椎板开窗模型M2。在ANSY Sworkbench 18.0软件中对以上3种模型施加生理活动时同等载荷的压力和扭矩，对比分析6种工况(左/右侧弯、前屈、后伸、左/右向旋转运动)下的生物力学变化。
结果与结论：①与模型M椎间盘所受应力比较，模型M1在右侧弯时椎间盘B、D区域应力值增高10%-16%，模型M2在右侧弯时椎间盘B、D区域应力值增高10%-15%，在左侧弯时椎间盘A、C区域应力值增高10%-14%；与模型M椎间盘位移比较，模型M1在左侧弯时椎间盘位移值增高10%-17%，模型M2在左/右侧弯时椎间盘位移值增高10%-18%；其他工况下3个模型C4-5椎间盘所受应力及位移值均无明显差异；②结果表明，经皮内镜下颈椎椎板开窗减压术治疗脊髓型颈椎病可实现精准可控，单侧或双侧切除部分椎板及关节突关节1/2以内对手术节段生物力学稳定性影响小，无需辅助内固定重建节段稳定性。
https://orcid.org/0000-0002-9345-0515 (刘金玉) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨, 脊髓型颈椎病, 脊柱内镜, 微创减压, 椎板开窗减压, 有限元分析, 生物力学

Abstract: BACKGROUND: Improper treatment of the lamina and facet joints during the cervical spine fenestration decompression can easily lead to cervical structure transformation, which causes segmental biomechanical change, and in turn results in cervical vertebra degeneration acceleration and instability in the long run. Clinically, we need to understand how the endoscopic cervical spine fenestration decompression affects the segmental biomechanics and the related anatomic relevance.
OBJECTIVE: The finite element reverse engineering technology is used to accurately simulate the three-dimensional finite element model for the treatment of cervical spondylotic myelopathy with endoscopic cervical spine fenestration decompression, in order to study the biomechanics of cervical spine under physiological conditions.
METHODS: A volunteer’s cervical vertebrae CT data were obtained and imported into MIMICS 20.0 software to establish C4-7 finite element model M. The model M was imported into 3-matic software to simulate unilateral C4-5 fenestration model M1 and bilateral C4-5 fenestration model M2. ANSY Sworkbench 18.0 software was used to apply same physiological conditions’ pressures and torques for the above three models, and the biomechanical changes under six different working conditions, i.e., left/right bending, forward bending, backward extension and left/right rotation, were analyzed.
RESULTS AND CONCLUSION: (1) Compared with the intervertebral disc stress in model M, the stress value increased by 10% to 16% at intervertebral disc region B and D in model M1 at right bending, while increased by 10% to 15% in model M2 at right bending and increased by 10% to 14% at intervertebral disc region A and C at left bending. Compared with the intervertebral disc displacement in model M, the displacement of the intervertebral disc in model M1 increased by 10%-17% at left bending, and in model M2, the displacement of intervertebral disc increased by 10%-18% at left/right bending. The stress and displacement values of the C4-5 intervertebral discs in the three models showed no significant difference under other working conditions. (2) The results showed that the treatment of cervical spondylotic myelopathy with endoscopic cervical spine fenestration decompression could achieve accurate control, and there have little impact on the biomechanical stability of the surgical segment in both unilateral or bilateral decompressiom when removing partial lamina and facet joint within 1/2, and thus no auxiliary internal fixation is required to reconstruct segmental stability.  

Key words: bone, cervical spondylotic myelopathy, spinal endoscopy, minimally invasive surgery, fenestration decompression, finite element analysis, biomechanics

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