中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (27): 4393-4400.doi: 10.12307/2023.388

• 骨与关节综述 bone and joint review • 上一篇    下一篇

青少年特发性脊柱侧凸有限元模型建立与验证的研究现状及进展

彭  路1，2，段治理1，2，李振宇3，4，李俊辉5，李运洪4，王  松1，6，刘伟强1，2，6   

  1. 1清华大学深圳国际研究生院，广东省深圳市   518055；2清华大学机械工程系，北京市   100084；3深圳市第二人民医院，广东省深圳市   518037；4深圳市澳诺医疗科技有限公司，广东省深圳市   518107；5河南省洛阳正骨医院(河南省骨科医院)，河南省郑州市   450002；6深圳清华大学研究院，生物医用材料及植入器械实验室，广东省深圳市   518057
  • 收稿日期:2022-05-27 接受日期:2022-07-14 出版日期:2023-09-28 发布日期:2022-11-08
  • 通讯作者: 王松，博士，清华大学深圳国际研究生院，广东省深圳市 518055；深圳清华大学研究院，生物医用材料及植入器械实验室，广东省深圳市 518057
  • 作者简介:彭路，男，1998年生，安徽省人，汉族，清华大学深圳国际研究生院在读硕士，主要从事青少年特发性脊柱侧凸生物力学分析相关研究。
  • 基金资助:
    广东省自然科学基金(2020B1515120082)，项目负责人：王松；深圳市自然科学基金(JCYJ20190807144001746)，项目负责人：王松

Research status and progress of establishment and validation of finite element model of adolescent idiopathic scoliosis

Peng Lu1, 2, Duan Zhili1, 2, Li Zhenyu3, 4, Li Junhui5, Li Yunhong4, Wang Song1, 6, Liu Weiqiang1, 2, 6   

  1. 1Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; 2Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China; 3Shenzhen Second People’s Hospital, Shenzhen 518037, China; 4Shenzhen Aonuo Medical Technology Company, Shenzhen 518107, China; 5Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Zhengzhou 450002, China; 6Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, China
  • Received:2022-05-27 Accepted:2022-07-14 Online:2023-09-28 Published:2022-11-08
  • Contact: Wang Song, PhD, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, Guangdong Province, China; Biomechanics and Biotechnology Lab, Research Institute of Tsinghua University in Shenzhen, Shenzhen 518057, Guangdong Province, China
  • About author:Peng Lu, Master candidate, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, Guangdong Province, China; Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China
  • Supported by:
    Natural Science Foundation of Guangdong Province, No. 2020B1515120082 (to WS); Shenzhen Natural Science Foundation, No. JCYJ20190807144001746 (to WS)

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摘要：


文题释义：

脊柱有限元模型：将复杂的脊柱结构离散为有限个单元，单元与单元之间通过共节点连接，将载荷和约束施加在节点上，借助节点实现数据的传递，模拟真实生理条件下脊柱的变形、位移、应力分布等特点。
青少年特发性脊柱侧凸：一种常见的脊柱三维畸形，是指脊柱的1个或多个节段偏离身体中线而向侧方弯曲，进而使脊柱形成一个弧状畸形，常伴有矢状面生理曲度改变和椎体旋转。多发生于10-16岁的青少年，发病原因不明，视觉表现包括高低肩、剃刀背等症状。

背景：青少年特发性脊柱侧凸在中国发病率高，且病情复杂，对青少年的身心健康具有显著危害。基于患者医学影像建立有限元模型可有效分析脊柱应力，模拟不同治疗方法的恢复效果，为患者治疗方式的选择提供科学依据。但目前有限元模型的建立方式种类繁多，尚未形成统一标准，模型质量参差不齐，验证方法也有待完善。
目的：从软件选择、关键结构建模(椎体、椎间盘、韧带和躯干模型)及材料赋值等方面综述近年来青少年特发性脊柱侧凸模型建立的研究现状，从几何形态、已有文献对比、实验验证等角度概述模型验证的研究进展，总结分析有限元模型的不足与发展方向。
方法：第一作者于2021年12月应用计算机在Web of Science和中国知网数据库检索2010年1月至今发表的相关文献，以“Adolescent idiopathic scoliosis，Finite Element，Biomechanical”为英文检索词，以“青少年特发性脊柱侧凸、有限元、生物力学”为中文检索词，追溯高引用权威参考文献，最终纳入83篇文献进行综述分析。
结果与结论：①有限元法能够重建脊柱的三维模型，通过生物力学分析模拟脊柱的生理状态，为青少年特发性脊柱侧凸的保守治疗和手术治疗提供理论依据和方案参考。②国内外有限元模型建立方式差别较大，中国学者多采用全脊柱CT检测，通过逆向工程重建椎骨，根据椎骨模型反推椎间盘、韧带、上下终板及关节软骨等结构，国外多使用具有多平面自校准X射线的EOS成像系统建立椎骨模型。③尽管模型建立过程中的具体软件选择有所区别，但从软件分类上看均包括医学影像处理软件、三维建模软件和有限元分析软件。④关于椎骨、椎间盘的有限元材料赋值已形成较为统一标准，但韧带模型由于单元设置不同，材料赋值也有所差异，而韧带的赋值会显著影响模型的结果。⑤有限元模型的验证方式主要包括与原始医学影像对比的几何验证、与已有文献结果对比的力学验证以及对有限元分析结果的临床试验验证3大类。
https://orcid.org/0000-0001-5193-4725 (彭路)；https://orcid.org/0000-0002-9647-9188 (王松)

关键词: 青少年特发性脊柱侧凸, 有限元模型, 生物力学, 建模方式, 软件选择, 材料赋值, 有效性验证, 发展方向

Abstract: BACKGROUND: Adolescent idiopathic scoliosis has a high prevalence and complex condition in China and has a significant risk to the physical and mental health of adolescents. The establishment of finite element models based on patient medical images can effectively analyze spinal stresses, simulate the recovery effects of different treatments, and provide a scientific basis for the selection of patient treatment modalities. However, there are many different ways to build finite element models and no unified standard has been formed yet; the quality of models varies and the validation methods need to be improved.  
OBJECTIVE: The current status of modeling studies in adolescent idiopathic scoliosis in recent years is reviewed in terms of software selection, modeling of key structures (vertebral body, disc, ligament, and trunk models), and material allocation. The research progress of model validation is outlined from the perspectives of geometry, comparison of existing literature, and experimental validation. The deficiencies and development directions of finite element models are summarized to provide references for related studies.
METHODS: The first author searched the Web of Science and China National Knowledge Infrastructure databases in December 2021 for relevant literature published from January 2010 to the present, using “adolescent idiopathic scoliosis, finite element, biomechanics” as Chinese and English search terms. The highly cited authoritative articles were traced, and finally 83 articles were included for analysis.  
RESULTS AND CONCLUSION: (1) Finite element analysis method can reconstruct the three-dimensional model of spine, simulate the physiological state of spine through biomechanical analysis, and provide theoretical basis and scheme reference for conservative treatment and surgical treatment of adolescent idiopathic scoliosis. (2) The establishment method of finite element model in China is different from that outside China. Domestic researchers use full spinal CT to reconstruct the vertebrae through reverse engineering and establish intervertebral discs, ligaments, articular cartilage endplate, up and down structure according to the model of vertebrae. However, the foreign researchers use multiple plane X-ray devices such as the EOS imaging system, which is lack of description of the model establishment process. (3) Although the specific software selection in the process of model building is different, the software classification includes medical image processing software, three-dimensional modeling software and finite element analysis software. (4) The finite element material assignment of vertebrae and intervertebral discs has formed a unified standard, but the material assignment of ligament model is also different due to different unit settings, and the assignment of ligament will significantly affect the results of the model. (5) The verification methods of finite element models mainly include geometric verification compared with original medical images, mechanical verification compared with existing literature results and clinical trial verification of finite element analysis results.

Key words: adolescent idiopathic scoliosis, finite element model, biomechanics, modeling method, software selection, material assignment, validity verification, development direction

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