中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (3): 391-397.doi: 10.12307/2023.016

• 组织工程骨材料 tissue-engineered bone • 上一篇    下一篇

单侧与双侧入路植入骨填充网袋治疗骨质疏松性椎体压缩性骨折的有限元分析与应用

鲁  辉1,2,吴启梅3,刘  融2,4   

  1. 1武汉科技大学医学院,湖北省武汉市  430081;武汉科技大学附属普仁医院,2医学创新与转化研究所,4骨科,湖北省武汉市  430080;3武汉刘三屋中医骨伤医院,湖北省武汉市  431400
  • 收稿日期:2021-09-24 接受日期:2021-12-01 出版日期:2023-01-28 发布日期:2022-05-19
  • 通讯作者: 刘融,博士,副教授,副主任医师,硕士生导师,武汉科技大学附属普仁医院医学创新与转化研究所,湖北省武汉市 430080;武汉科技大学附属普仁医院骨科,湖北省武汉市 430080 吴启梅,副主任医师,武汉刘三屋中医骨伤医院,湖北省武汉市 431400
  • 作者简介:鲁辉,男,1994年生,湖北省荆州市人,汉族,武汉科技大学医学院在读硕士,主要从事智能医学、3D打印及数字骨科研究。
  • 基金资助:
    湖北省自然科学基金委员会一般面上项目(2020CFB548),项目名称:基于拓扑优化技术的3D打印康复辅具设计关键技术的研发,项目负责人:刘融

Finite element analysis and application of unilateral and bilateral bone-filling mesh container in treatment of osteoporotic vertebral compression fracture

Lu Hui1, 2, Wu Qimei3, Liu Rong2, 4   

  1. 1School of Medicine, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China; 2Institute of Medical Innovation and Transformation, 4Department of Orthopedics, Puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China; 3Wuhan Liu Sanwu Traditional Chinese Medicine Bone Injury Hospital, Wuhan 431400, Hubei Province, China
  • Received:2021-09-24 Accepted:2021-12-01 Online:2023-01-28 Published:2022-05-19
  • Contact: Liu Rong, PhD, Associate professor, Associate chief physician, Master’s supervisor, Institute of Medical Innovation and Transformation, and Department of Orthopedics, Puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China Wu Qimei, Associate chief physician, Wuhan Liu Sanwu Traditional Chinese Medicine Bone Injury Hospital, Wuhan 431400, Hubei Province, China
  • About author:Lu Hui, Master candidate, School of Medicine, Wuhan University of Science and Technology, Wuhan 430081, Hubei Province, China; Institute of Medical Innovation and Transformation, Puren Hospital of Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
  • Supported by:
    General Project of Hubei Natural Science Foundation Committee, No. 2020CFB548 (to LR)

摘要:

文题释义:
骨填充网袋植入治疗:通过预先在伤椎内置入骨扩张矫形器使椎体高度部分恢复,并形成空腔,再置入包含有骨水泥的网袋,通过网袋的膨胀作用抬高伤椎,可部分恢复椎体高度,同时利用网袋对骨水泥的阻挡和包裹作用,减少骨水泥渗漏。它是由聚对苯二甲酸乙二醇酯材料制成,不影响细胞,具有良好的生物相容性,能够通过网孔分次缓慢弥散至椎体骨小梁间隙,形成骨水泥与骨组织的绞索结合,能够稳定弥散形态,有效控制骨水泥渗漏,并且骨水泥逐渐填充,网袋使之膨胀,能够逐步抬高终板,并直接留置椎体体内,骨水泥与椎体高度恢复是同步进行,不会出现回弹现象,从而改善椎体高度。   
有限元分析:利用数学近似的方法对真实物理系统(几何和载荷工况)进行模拟,还利用简单而又相互作用的元素,即单元,就可以用有限数量的未知量去逼近无限未知量的真实系统。有限元的概念早在几个世纪前就已产生并得到了应用,例如用多边形(有限个直线单元)逼近圆来求得圆的周长,但作为一种方法而被提出,则是最近的事。它是融合理论知识、数字成像技术、计算机立体三维力学分析方法于一体,其基本理念是把一个复杂整体分解为有限个简单物体的组合来模拟、计算、分析的方法。该方法用于脊柱胸腰段生物力学分析,能模拟人体胸腰段生理状态,分析脊柱胸腰段的应力分布情况。

背景:骨填充网袋植入治疗骨质疏松性椎体压缩性骨折具有显著的疗效,从手术时间、骨水泥侧漏情况、术中人员受辐射次数等方面考虑,选择单侧入路更佳,但没有研究从生物力学角度比较单侧与双侧骨填充网袋植入的效果,缺乏一定的理论数据支持。
目的:探讨单侧与双侧入路植入骨填充网袋治疗骨质疏松性椎体压缩性骨折的生物力学特点和临床效果。
方法:①建立有限元模型,模拟单侧和双侧入路植入骨填充网袋治疗骨质疏松性椎体压缩性骨折,在400 N竖直向下的加载力和7.5 N·m弯矩载荷作用时,对比两组4种工况下胸腰段整体有限元模型的位移和应力变化。②回顾性分析武汉市普仁医院2018年1月至2020年8月收治的99例骨质疏松性椎体压缩性骨折患者,其中接受单侧入路植入骨填充网袋治疗49例,接受双侧入路植入骨填充网袋治疗50例,分析两组患者的骨水泥渗漏率、目测类比评分和脊柱侧弯角变化。
结果与结论:①有限元模型:两入路组在轴向、前屈、左侧弯和左旋转状态下的最大位移比较差异无显著性意义(P > 0.05),在轴向、前屈、左侧弯和左旋转状态下的最大应力比较差异无显著性意义(P > 0.05);②临床试验:单、双侧入路组骨水泥渗漏率分别为12%,16%,两组患者术后6个月的目测类比评分与脊柱侧弯角度均较术前明显改善(P < 0.001),两组间术后6个月的目测类比评分与脊柱侧弯角度比较差异均无显著性意义(P > 0.05);③从生物力学和临床疗效角度来讲,单侧入路植入骨填充网袋较双侧入路植入骨填充网袋治疗骨质疏松性椎体压缩性骨折的效果更佳。

https://orcid.org/0000-0001-5919-8259 (鲁辉) 

中国组织工程研究杂志出版内容重点:生物材料;骨生物材料口腔生物材料纳米材料缓释材料材料相容性组织工程

关键词: 骨填充网袋, 骨质疏松性, 椎体压缩性骨折, 有限元分析, 生物力学, 单侧入路, 双侧入路

Abstract: BACKGROUND: In the treatment of osteoporotic vertebral compression fracture, bone-filling mesh container has a significant curative effect. Considering the operation time, lateral leakage of bone cement and the number of radiation exposure, unilateral approach is better. However, no study compared unilateral bone-filling mesh container and bilateral bone-filling mesh container from the perspective of biomechanics, lacking certain theoretical data support.
OBJECTIVE: To investigate the biomechanical characteristics and clinical effects of unilateral and bilateral bone-filling mesh container approaches in the treatment of osteoporotic vertebral compression fracture.
METHODS: (1) A finite element model was established to simulate the treatment of osteoporotic vertebral compression fracture with unilateral and bilateral bone-filling mesh container. The displacement and stress changes of the whole finite element model of thoracolumbar segment in the unilateral bone-filling mesh container group and bilateral bone-filling mesh container group were compared and analyzed under 400 N vertical downward loading force and 7.5 N·m bending moment load under four working conditions. (2) A retrospective analysis was performed on 99 patients with osteoporotic vertebral compression fracture who were treated with bone-filling mesh container from January 2018 to August 2020 in Wuhan Puren Hospital. Of them, 49 patients were treated with unilateral bone-filling mesh container and 50 patients were treated with bilateral bone-filling mesh container. Bone cement leakage rate, visual analogue scale score, and Cobb angle change were analyzed between the two groups. 
RESULTS AND CONCLUSION: (1) Finite element model: There was no significant difference in the maximum displacement between unilateral group and bilateral group under axial, forward flexion, left bending, and left rotation conditions (P > 0.05). There was no significant difference in the maximum stress between unilateral group and bilateral group under axial, forward flexion, left bending, and left rotation conditions (P > 0.05). (2) Clinical trial: The bone cement leakage rates in the unilateral and bilateral approach groups were 12% and 16%, respectively, and the visual analogue scale score and scoliosis angle at 6 months after surgery were significantly improved compared with those before operation in both groups (P < 0.001). There was no significant difference in visual analogue scale score and scoliosis angle between the two groups at 6 months after operation (P > 0.05). (3) From the perspective of biomechanics and clinical efficacy, unilateral bone-filling mesh container approach is more effective than bilateral bone-filling mesh container approach in treating osteoporotic vertebral compression fracture. 

Key words: bone-filling mesh container, osteoporotic, vertebral compression fracture, finite element analysis, biomechanics, unilateral approach, bilateral approach

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