中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (22): 4001-4005.doi: 10.3969/j.issn.1673-8225.2012.22.003

• 数字化骨科 digital orthopedics • 上一篇    下一篇

椎体后凸成形椎间盘骨水泥渗漏时行相邻椎体预防性强化的有限元分析★◆

刘仕友1，路青林1，郑  伟2，彭大勇1，张文强1，单仕营1   

  1. 1山东大学附属千佛山医院骨科，山东省济南市   250014；2山东大学材料液固结构演变与加工教育部重点实验室，山东省济南市250061
  • 收稿日期:2011-10-26 修回日期:2011-12-08 出版日期:2012-05-27 发布日期:2012-05-27
  • 通讯作者: 路青林，主任医师，山东大学附属千佛山医院骨科，山东省济南市250014 luqinglin@sdhospital.com.cn
  • 作者简介:刘仕友★，男，1984年生，山东省泰安市人，汉族，山东大学在读硕士，主要从事骨创伤研究。Liushiyou2008090@sina.com

Finite element analysis of prophylactic reinforcement in adjacent vertebral bodies after kyphoplasty with bone cement leakage into the intervertebral discs 

Liu Shi-you1, Lu Qing-lin1, Zheng Wei2, Peng Da-yong1, Zhang Wen-qiang1, Shan Shi-ying1   

  1. 1Department of Orthopedics, Affiliated Qianfoshan Hospital of Shandong University, Jinan  250014, Shandong Province, China; 2Key Laboratory for Liquid-Solid Structural Evolution and Processing of Materials (Ministry of Education), Shandong University, Jinan  250061, Shandong Province, China
  • Received:2011-10-26 Revised:2011-12-08 Online:2012-05-27 Published:2012-05-27
  • Contact: Lu Qing-lin, Chief physician, Department of Orthopedics, Affiliated Qianfoshan Hospital of Shandong University, Jinan 250014, Shandong Province, China luqinglin@sdhospital.com.cn
  • About author:Liu Shi-you★, Studying for master’s degree, Department of Orthopedics, Affiliated Qianfoshan Hospital of Shandong University, Jinan 250014, Shandong Province, China Liushiyou2008090@sina.com

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摘要：

背景：椎体后凸成形术后相邻椎体发生骨折时有报道，很多学者分析椎间盘骨水泥渗漏是相邻椎体继发骨折的重要原因之一。
目的：以有限元方法分析椎体后凸成形并发椎间盘骨水泥渗漏时其相邻椎体生物力学的变化，进而分析相邻椎体继发骨折的原因并寻求补救措施。
方法：利用MIMICS、ABAQUS等软件重建胸腰段(T11~L2)三维有限元模型，模拟L1椎体骨质疏松性压缩性骨折及椎体后凸成形治疗，观察有无T12~L1椎间盘骨水泥渗漏对骨折相邻椎体的生物力学影响；进一步分别模拟以2，3，4 mL骨水泥对T12椎体行预防性强化，观察不同载荷下不同模型整体及各部分的Von Mises应力。
结果与结论：成功建立了相关三维有限元模型。相邻椎体T12及其下终板的最大应力在T12~L1椎间盘有骨水泥渗漏组比无渗漏组的明显增加；T12椎体不同剂量骨水泥预防性强化后最大应力不同程度降低，且小剂量(2~4 mL)骨水泥预防性强化并不明显影响其余椎体、椎间盘的生物力学行为。提示椎体后凸成形并发椎间盘骨水泥渗漏可能会导致相邻椎体继发骨折，同时行相邻椎体预防性强化可能会减少继发骨折的发生。
 

关键词: 骨水泥渗漏, 椎体后凸成形术, 骨质疏松, 预防性强化, 有限元分析

Abstract:

BACKGROUND: Adjacent vertebral fracture after percutaneous kyphoplasty (PKP) has been reported. Many scholars have analyzed that cement leakage into the intervertebral discs is one of the major reasons for subsequent fracture of the adjacent vertebral bodies.
OBJECTIVE: To explore the biomechanical changes of the adjacent vertebral bodies after PKP with bone cement leakage into the intervertebral discs using finite element analysis; to further analyze the causes of adjacent vertebral fractures and to seek for the remedial measures.
METHODS: A three-dimensional finite element model of thoracolumbar spine (T11-L2) was constructed using MIMICS, ABAQUS and other software. Simulation of PKP treatment for L1 vertebral osteoporotic compression fractures was performed to observe whether the cement leakage into the T12-L1 discs has biomechanical effects on the adjacent vertebral bodies of the fractures; a further simulation of prophylactic reinforcement of 2, 3 and 4 mL cement in the vertebral body T12 was performed to observe the Von Mises stress of the ensemble and each of different models under different loads.
RESULTS AND CONCLUSION: The relevant three-dimensional finite element models were successfully established. The maximum Von Mises stress of the adjacent vertebral bodies (T12) and the inferior endplate in the group with cement leakage into the disc(T12-L1) was significantly higher than that in the group without cement leakage. The maximum Von Mises stress of the adjacent vertebral body (T12) decreased to some extent after the prophylactic reinforcement of different doses of bone cement. The prophylactic reinforcement of low dose of bone cement (2-4 mL) did not obviously affect the biomechanical behaviors of the other vertebral bodies and intervertebral discs. These findings indicate that kyphoplasty with bone cement leakage into the intervertebral discs may lead to secondary fractures in the adjacent vertebral bodies; the prophylactic reinforcement of the adjacent vertebral bodies may reduce the occurrence of secondary fractures.
 

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