中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (24): 3789-3795.doi: 10.12307/2024.611

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

棘突间固定辅助内镜下椎间融合治疗重度腰椎管狭窄症的有限元分析

刘  江1，2，3，张晗硕3，丁逸苇4， 蒋  强3，李土胜3，黄  杰3，杨广南 3，丁  宇1，2，3   

  1. 1安徽医科大学海军临床学院，北京市   100048；2 安徽医科大学第五临床医学院，安徽省合肥市   230032；3 解放军总医院第六医学中心中医医学部骨伤科，北京市   100048；4 北京航天航空大学生物与医学工程学院，北京市   100191
  • 收稿日期:2023-05-05 接受日期:2023-07-27 出版日期:2024-08-28 发布日期:2023-11-20
  • 通讯作者: 丁宇，教授，博士，主任医师，安徽医科大学海军临床学院，北京市 100048；安徽医科大学第五临床医学院，安徽省合肥市 230032；解放军总医院第六医学中心中医医学部骨伤科，北京市 100048
  • 作者简介:刘江，男，1995年生，重庆市人，土家族，硕士，主要从事微创脊柱外科、医学有限元研究。

Finite element analysis of interspinous fixation-assisted endoscopic interbody fusion in treatment of severe lumbar spinal stenosis

Liu Jiang1, 2, 3, Zhang Hanshuo3, Ding Yiwei4, Jiang Qiang3, Li Tusheng3, Huang Jie3, Yang Guangnan3, Ding Yu1, 2, 3   

  1. 1Naval Clinical College, Anhui Medical University, Beijing 100048, China; 2The Fifth Clinical Medical College of Anhui Medical University, Hefei 230032, Anhui Province, China; 3Department of Orthopedics and Traumatology, Division of Traditional Chinese Medicine, Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China; 4School of Biological and Medical Engineering, Beihang University, Beijing 100191, China
  • Received:2023-05-05 Accepted:2023-07-27 Online:2024-08-28 Published:2023-11-20
  • Contact: Ding Yu, Professor, MD, Chief physician, Naval Clinical College, Anhui Medical University, Beijing 100048, China; The Fifth Clinical Medical College of Anhui Medical University, Hefei 230032, Anhui Province, China; Department of Orthopedics and Traumatology, Division of Traditional Chinese Medicine, Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
  • About author:Liu Jiang, Master, Naval Clinical College, Anhui Medical University, Beijing 100048, China; The Fifth Clinical Medical College of Anhui Medical University, Hefei 230032, Anhui Province, China; Department of Orthopedics and Traumatology, Division of Traditional Chinese Medicine, Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China

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摘要：


文题释义：

棘突间固定装置BacFuse：是一种新型的棘突间固定装置，能够通过棘突间撑开，扩大椎管容积，实现间接减压；同时可使上下棘突固定，维持责任节段的稳定性。


背景：在临床应用中，不附加椎间融合的单纯棘突间固定与椎弓根钉棒融合内固定具有相似固定效果，且可有效降低责任节段活动度及关节突应力，但单纯放置新型棘突间融合固定装置BacFuse后，棘突根部应力较为集中，易发生棘突骨折，若在置入椎间融合器的同时联合棘突间固定，理论上可以分散Von Mises应力，降低棘突骨折风险，但其在有限元仿真模拟下具体的生物力学情况鲜有报道。

目的：观察棘突间固定辅助内镜下椎间融合治疗重度腰椎管狭窄症的生物力学稳定性。
方法：取一位26岁成年男性志愿者的腰椎CT资料，排除脊柱病变，并使用Mimics、Geomagic、Solidworks、ANSYS等软件构建腰椎L4-L5节段的正常有限元模型M0，在M0的基础上分别建立内镜减压联合椎间融合术后即时模型M1、内镜减压置入棘突间固定装置(BacFuse)模型M2和棘突间固定(BacFuse)辅助内镜下椎间融合模型M3，在4组模型的L4椎体上表面施以相同应力，在L5椎体下表面采用固定支撑，并分析在前屈、后伸、左/右弯、左/右旋转等6种工况下的活动度和终板下骨、椎体后方韧带复合体Von Mises应力极值。

结果与结论：①与模型M0相比，在6种工况下模型M1活动度值大幅增加，模型M2、M3的活动度大幅减小；②与模型M0相比，在6种工况下模型M1椎体最大应力无明显变化，模型M2椎体后方韧带复合体最大应力大幅增加；③与模型M1相比，模型M3在6种工况下椎体后方韧带复合体最大应力无明显变化；与M2模型相比，模型M3在椎体后方韧带复合体最大应力大幅减小；④与模型M0相比，模型M1的L4和L5终板下骨Von Mises应力极值均有明显增高；模型M2、M3的L4和L5终板下骨Von Mises应力极值略微降低；与模型M1相比，模型M2、M3的L4和L5终板下骨Von Mises应力极值明显降低；⑤提示BacFuse的置入能有效降低单纯椎间融合术中的终板下骨应力，降低融合器沉降及减压侧小关节骨折的风险，为椎间融合提供良好的稳定环境；椎间融合器的放置能减低棘突根部的应力，有利于降低棘突根部骨折的风险。

https://orcid.org/0000-0001-9548-0075 (刘江) 

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: 重度腰椎管狭窄症, 脊柱内镜, 棘突间固定, 椎间融合, 生物力学, 有限元分析

Abstract: BACKGROUND: In clinical application, simple interspinous fixation without additional interbody fusion has similar fixation effects to pedicle screw and rod fusion internal fixation, and can effectively reduce the range of motion of the responsible segment and the stress of the articular process. However, after simple placement of the new interspinous fusion fixation device BacFuse, the stress at the root of the spinous process is relatively concentrated, and the spinous fracture is prone to occur. If an intervertebral fusion cage is inserted in conjunction with interspinous fixation, Von Mises stress can theoretically be dispersed to reduce the risk of spinous fracture. However, there are few studies on biomechanics and finite element analysis. 
OBJECTIVE: To observe the biomechanical stability of interspinous fixation-assisted endoscopic interbody fusion in the treatment of severe lumbar spinal stenosis. 
METHODS: The normal finite element model M0 of the L4-L5 segment of the lumbar spine was established by Mimics, Geomagic, Solidworks, and ANSYS software based on the lumbar CT images of a 26-year-old adult male volunteer excluding spinal diseases. On the basis of M0, the immediate model M1 after endoscopic decompression combined with interbody fusion, the interspinous fixation device (BacFuse) model M2 after endoscopic decompression, and the interspinous fixation (BacFuse) model M3 after endoscopic-assisted interbody fusion were established. The same stress was applied to the upper surface of the L4 vertebral body in the four groups, and the lower surface of the L5 vertebral body was fixed and supported. The range of motion and the extreme Von Mises stress of the endplate bone and the posterior ligament complex of the vertebral body were analyzed under six working conditions of flexion, extension, left/right bending, and left/right rotation.    
RESULTS AND CONCLUSION: (1) Compared with model M0, the range of motion value of model M1 increased significantly under six working conditions. Model M2 and model M3 had a significant reduction in range of motion. (2) Compared with model M0, the maximum stress of the vertebral body in model M1 did not change significantly under the six working conditions. The maximum stress at the rear of the M2 vertebral body increased significantly. (3) Compared with model M1, the maximum stress of model M3 did not change significantly under the six working conditions. Compared with model M2, the maximum stress of model M3 decreased significantly. (4) Compared with the model M0, the extreme Von Mises stress of the L4 and L5 endplates of the model M1 was significantly increased. The extreme Von Mises stress in L4 and L5 endplates of models M2 and M3 decreased slightly. Compared with model M1, the Von Mises stress of the bone under the L4 and L5 endplate of models M2 and M3 was significantly reduced. (5) It is concluded that the implantation of BacFuse can effectively reduce the bone stress under the endplate during simple interbody fusion, decrease the risk of cage subsidence, diminish the risk of facet joint fracture on the decompression side, and provide a good stable environment for interbody fusion. The placement of an intervertebral fusion cage can reduce the stress of the root of the spinous process, which is beneficial to decrease the risk of fracture of the root of the spinous process. 

Key words: severe lumbar spinal stenosis, spinal endoscopy, interspinous fixation, interbody fusion, biomechanics, finite element analysis

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