中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (9): 1352-1358.doi: 10.12307/2023.212

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

三维有限元法分析不同骨密度对单纯斜外侧腰椎椎间融合后融合器下沉的影响

吴天亮1, 陶秀霞2,徐宏光3   

  1. 华东师范大学附属芜湖市第二人民医院,1脊柱外科,2核医学科,安徽省芜湖市   241001;3皖南医学院第一附属医院弋矶山医院脊柱外科,脊柱研究中心,安徽省芜湖市   241001
  • 收稿日期:2021-12-14 接受日期:2022-01-30 出版日期:2023-03-28 发布日期:2022-07-01
  • 通讯作者: 徐宏光,教授,主任医师,皖南医学院第一附属医院弋矶山医院脊柱外科,脊柱研究中心,安徽省芜湖市 241001
  • 作者简介:吴天亮,男,1983年生,汉族,2020年山东大学毕业,博士,副主任医师,主要从事脊柱微创研究。
  • 基金资助:
    国家自然科学基金面上项目(81972108),项目负责人:徐宏光;皖南医学院弋矶山医院科技创新团队“攀峰”培育计划(腰椎退行性疾病微创团队)(PF2019007),项目负责人:徐宏光;皖南医学院弋矶山医院科研能力“高峰”培育计划项目GF2019T02,GF2019G07,GF2019332),项目负责人:徐宏光

Influence of different bone mineral densities on cage subsidence after stand-alone oblique lateral interbody fusion: three-dimensional finite element analysis

Wu Tianliang1, Tao Xiuxia2, Xu Hongguang3   

  1. 1Department of Spine Surgery, 2Department of Nuclear Medicine, The Second People’s Hospital of Wuhu, East China Normal University, Wuhu 241001, Anhui Province, China; 3Spine Research Center, Department of Spine Surgery, Yijishan Hospital (First Affiliated Hospital), Wannan Medical College, Wuhu 241001, Anhui Province, China
  • Received:2021-12-14 Accepted:2022-01-30 Online:2023-03-28 Published:2022-07-01
  • Contact: Xu Hongguang, Professor, Chief physician, Spine Research Center, Department of Spine Surgery, Yijishan Hospital (First Affiliated Hospital), Wannan Medical College, Wuhu 241001, Anhui Province, China
  • About author:Wu Tianliang, MD, Associate chief physician, Department of Spine Surgery, The Second People’s Hospital of Wuhu, East China Normal University, Wuhu 241001, Anhui Province, China
  • Supported by:
    National Natural Science Foundation of China, No. 81972108 (to XHG); the “Mountain Climbing” Cultivation Plan for the Technological Innovation Team of Yijishan Hospital of Wannan Medical College (Minimally Invasive Team for Lumbar Degenerative Diseases), No. PF2019007 (to XHG); the “Peak” Cultivation Plan of Scientific Research Capacity of Yijishan Hospital of Wannan Medical College, No. GF2019T02, GF2019G07, GF2019332 (to XHG)

摘要:

文题释义:
单纯斜外侧腰椎椎间融合手术:是目前脊柱外科新开展的一项微创侧方腰椎椎间融合手术,该术式从斜外侧进入腹膜外间隙,在左侧腰大肌前缘和腹部大血管鞘之间的间隙处理椎间盘,置入可扩张通道,置入较大号的Cage撑开椎间隙和椎间孔的高度,从而达到间接减压的疗效。
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。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。近几年来被广泛应用于脊柱疾病的研究,目前国际上通用的有限元软件主要有Ansys、ABAQUS、ADINA、MSC等,各个软件的算法基本相同,但各有优缺点。

背景:单纯斜外侧腰椎椎间融合的临床应用受患者骨密度影响较大,但该手术适应的骨密度目前国内外均无相关研究的报道。
目的:比较不同骨密度下单纯斜外侧腰椎椎间融合模型的生物力学性能。
方法:以健康成年男性志愿者的CT数据为基础,建立L3-S1正常对照有限元模型(M0组)、正常骨密度(T值> -1.0 SD)L4-5单纯斜外侧腰椎椎间融合有限元模型(M1组)、骨量减少(-2.5 SD < T值< -1.0 SD) L4-5单纯斜外侧腰椎椎间融合有限元模型(M2组)和骨质疏松(T值≤-2.5 SD) L4-5单纯斜外侧腰椎椎间融合有限元模型(M3组)。在L3椎体表面施加运动力矩10 N•m来模拟人体6种工况下的腰椎生物力学特性,评估L4-5节段的运动范围及骨性终板和Cage应力分布情况。
结果与结论:①相同工况下,与M0组相比,M1、M2和M3组L4-5节段活动度均减少,其中以M3组减少幅度最大;②在前屈、后伸、左右侧弯工况下,与M0组比较,M1、M2、M3组骨性应力均明显增加;在左右旋转工况下,与M0组比较,M1、M2、M3组骨性终板应力不同程度的增加;相同工况下与M1组比较,M2组骨性终板应力降低不明显,M3组骨性终板应力增加明显;③相同工况下与M1组比较,M2组Cage应力降低不明显,M3组Cage应力增加明显;④结果提示,骨质疏松患者进行单纯斜外侧腰椎椎间融合手术存在Cage下沉的风险,对于骨密度T值> -2.5 SD的患者行单纯斜外侧腰椎椎间融合手术可以改善生物力学稳定性。

https://orcid.org/0000-0001-8859-623X(吴天亮)

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: 生物力学测试, 有限元分析, 腰椎, 斜外侧腰椎椎间融合, 沉降, 骨密度

Abstract: BACKGROUND: The clinical application of stand-alone oblique lateral interbody fusion is greatly affected by the bone mineral density of patients, but there is no relevant report on the specific bone mineral density at home and abroad.
OBJECTIVE: To compare the biomechanical performance of an oblique lateral interbody fusion cage among different bone density models.
METHODS:  Based on the CT data of healthy adult male volunteers, there were L3-S1 normal control finite element model (M0 group), the normal bone mineral density (T value>-1.0 SD) L4-5 stand-alone oblique lateral interbody fusion finite element model (M1 group), osteopenia (-2.5 SD<T value<-1.0 SD) L4-5 stand-alone oblique lateral interbody fusion finite element model (M2 group) and osteoporosis (T value≤-2.5 SD) L4-5 stand-alone oblique lateral interbody fusion finite element model (M3 group). A motion torque of 10 N•m was applied on the surface of the L3 vertebra to simulate the biomechanical properties of the lumbar spine under six working conditions of the human body and to evaluate the range of motion of the L4-5 segments and the stress distribution of the bony endplate and cage. 
RESULTS AND CONCLUSION: (1) Under the same working conditions, compared with the M0 group, range of motion of the L4-5 segments of the M1, M2, and M3 groups all decreased, and the M3 group had the largest reduction. (2) Under the conditions of flexion, extension, and lateral bending, compared with the M0 group, the bony stress of the M1, M2, and M3 groups all increased significantly. Under the left and right rotation, compared with the M0 group, the bony endplate stress of the M1, M2, and M3 groups increased to different degrees. Under the same conditions, compared with the M1 group, the bony endplate stress in the M2 group was not significantly decreased, and the bony endplate stress in the M3 group was significantly increased. (3) Compared with the M1 group under the same working conditions, the cage stress in the M2 group was not significantly decreased, and the cage stress in the M3 group was increased significantly. (4) The results suggest that there is a risk of cage subsidence in patients with osteoporosis who undergo stand-alone oblique lateral interbody fusion surgery. For patients with bone mineral density T value>-2.5 SD, stand-alone oblique lateral interbody fusion surgery can improve biomechanical stability.

Key words: biomechanical test, finite element analysis, lumbar vertebra, oblique lateral interbody fusion, subsidence, bone mineral density

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