中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (27): 4366-4372.doi: 10.3969/j.issn.2095-4344.2017.27.018

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

三维有限元法分析先天性脊柱侧凸冠状面腰骶段的柔韧性

李 晔1，王以朋1，贾少薇2，武晓丹2，张顺心2，韩 立3，4   

  1. 1中国医学科学院，北京协和医院骨科，北京市 100005；2河北工业大学机械学院，天津市 300130；3天津医科大学医学影像学院，天津市 300203；4 Radiology Department, University of Michigan, Ann Arbor, MI 48109, USA
  • 出版日期:2017-09-28 发布日期:2017-10-24
  • 通讯作者: 韩立，天津医科大学医学影像学院，天津市 300203
  • 作者简介:李晔，男，1981年生，河北省涿州市人，汉族，2016年北京协和医学院毕业，博士，副主任医师，主要从事关节、脊柱常见疾病的诊治。
  • 基金资助:

    天津市自然科学基金(17JCZDJC32500)

Flexibility of the coronal lumbosacral region of congenital scoliosis: a three-dimensional finite element analysis

Li Ye1, Wang Yi-peng1, Jia Shao-wei2, Wu Xiao-dan2, Zhang Shun-xin2, Han Li3, 4   

  1. 1Department of Orthopedics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China; 2School of Mechanical Engineering, Hebei University of Technology, Tianjin 300130, China; 3School of Medical Imaging, Tianjin Medical University, Tianjin 300203, China; 4Radiology Department, University of Michigan, Ann Arbor, MI 48109, USA
  • Online:2017-09-28 Published:2017-10-24
  • Contact: Han Li, School of Medical Imaging, Tianjin Medical University, Tianjin 300203, China; Radiology Department, University of Michigan, Ann Arbor, MI 48109, USA
  • About author:Li Ye, M.D., Associate chief physician, Department of Orthopedics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China
  • Supported by:

    the Natural Science Foundation of Tianjin, No. 17JCZDJC32500

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摘要：

文章快速阅读：

 

文题释义：
先天性脊柱侧凸腰骶段柔韧性：先天性脊柱侧凸是由于胚胎期脊柱发育异常导致的三维畸形，其发病率高达千分之一，是造成青少年残疾的主要疾病之一，具有进展快、畸形重、并发症多等特点，由于脊柱运动单元发育存在缺陷，先天性脊柱侧凸患者椎体活动柔韧性相对较差，术前如不能准确的判断作为矫形基础的腰骶段脊柱生物力学特点，则术后出现不可自行代偿的躯干偏移等临床并发症的概率会明显增加。
刚度：是指材料或结构在受力时抵抗弹性变形的能力，是材料或结构弹性变形难易程度的表征。在相同力的作用下，刚度越大，变形越困难。在同等载荷作用下，位移变化越大的模型刚度就越小。
 
摘要
背景：先天性脊柱侧凸患者脊柱运动单元发育存在缺陷，椎体活动柔韧性相对较差，在临床工作中发现此类患者冠状面腰骶段(L4-S1)的脊柱代偿能力和术后是否会出现不可自行代偿的躯干偏移存在一定关联。
目的：建立正常人和先天性脊柱侧凸患者冠状面腰骶段不同柔韧性的三维有限元模型，通过比较3种模型在不同载荷下的形变、位移、应力和刚度等力学数值变化而完成有限元分析。
方法：分别以1名正常人和术前冠状面腰骶段柔韧性不同(随访中是否发生不可代偿的躯干偏移)的2名先天性脊柱侧凸患者为建模样本，通过螺旋CT扫描获得腰骶段DICOM格式的图像数据，将其导入到三维重建软件MIMICS中，根据选取CT图像中各组织的灰度值不同，通过阈值来提取相应的组织，生成3D模型，并将通过GEOMAGIC进行简化处理后的腰骶段三维模型导入到有限元软件ABAQUS中进行不同载荷状态下的力学指标分析。
结果与结论：①3种模型在受不同侧向力的情况下，最大应力分布区域都集中在L4皮质骨前部，而最大位移分布区域主要集中在L5上；②不可代偿性模型(随访中发生不可代偿的躯干偏移)和可代偿性模型(随访中发生可代偿的躯干偏移)在受不同侧向力的情况下，应力分布几乎没有变化，但可代偿性模型在同样载荷作用下会产生更大的位移变化，而且刚度也明显小于不可代偿性模型，即可代偿模型在受到同等力的作用下更容易变形；③结果提示，通过三维有限元模型可以完成对先天性脊柱侧凸冠状面腰骶段柔韧性的生物力学分析，而且生物力学结果也与作者的临床设想一致，即可代偿性先天性脊柱侧凸患者腰骶段椎体间角度变化的幅度更大，提示其腰骶段柔韧性更好。

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
ORCID: 0000-0003-0640-0227(李晔)

关键词: 骨科植入物, 数字化骨科, 先天性脊柱侧凸, 腰骶段柔韧性, 有限元分析, 天津市自然科学基金

Abstract:

BACKGROUND: In the patients with congenital scoliosis, the spinal motor units exhibit developmental disorders and poor range of motion. It has been found that the compensation ability of coronal lumbosacral region (L4-S1) is associated with the occurrence of non-compensable trunk migration postoperatively.

OBJECTIVE: To establish the three-dimensional finite element models of coronal lumbosacral region of normal and patients with congenital scoliosis and to compare the strain, displacement, stress and stiffness under different loading conditions among models.
METHODS: One normal subject and two congenital scoliosis patients with different coronal lumbosacral region flexibility were selected, DICOM image datawere obtained by spiral CT scanning at the lumbosacral region, and then imported into MIMICS software, and a three-dimensional model was established according to the gray values of each tissue on CT, followed by simplified by GEOMAGIC, and finally imported into ABAQUS foftware to conduct a mechanic analysis under different loading conditions.
RESULTS AND CONCLUSION: (1) Under different lateral forces, in the three models, the maximum stress mainly distributed on the frontal region of L4 cortical bone, and maximum displacement concentrated on L5. (2) There was no significant change in the stress distribution in the two scoliosis models, but the compensable model showed larger displacement change, and its stiffness was significantly less than that of the non-compensable model, indicating that the compensable model is easy to deform. (3) These findings suggest that three-dimensional finite element model is helpful to perform a biomechanical analysis for coronal lumbosacral region of congenital scoliosis, among which, a compensable model exhibits large displacement, suggesting a good flexibility.

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

Key words:  Scoliosis, Finite Element Analysis, Biomechanics, Tissue Engineering

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