中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (30): 4896-4901.doi: 10.12307/2024.625

• 骨与关节综述 bone and joint review • 上一篇    下一篇

有限元分析在腰椎生物力学方面的应用

樊光亚1，苏文硕1， 钟木森1，董黎强2   

  1. 1浙江中医药大学第二临床医学院，浙江省杭州市   310005；2浙江中医药大学附属第二医院骨伤二科，浙江省杭州市   310005
  • 收稿日期:2023-04-04 接受日期:2023-09-02 出版日期:2024-10-28 发布日期:2023-12-28
  • 通讯作者: 董黎强，硕士，主任中医师，教授，浙江中医药大学附属第二医院骨伤二科，浙江省杭州市 310005
  • 作者简介:樊光亚，男，1997年生，河北省石家庄市人，汉族，浙江中医药大学在读硕士，主要从事脊柱外科学方向的研究。

Application of finite element analysis in lumbar biomechanics

Fan Guangya1, Su Wenshuo1, Zhong Musen1, Dong Liqiang2   

  1. 1Second Clinical School of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China; 2Second Department of Orthopedics and Traumatology, Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
  • Received:2023-04-04 Accepted:2023-09-02 Online:2024-10-28 Published:2023-12-28
  • Contact: Dong Liqiang, Master, Chief physician, Professor, Second Department of Orthopedics and Traumatology, Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
  • About author:Fan Guangya, Master candidate, Second Clinical School of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China

PDF

46

摘要：


文题释义：

有限元分析：通过影像资料提取骨骼模型，将骨骼模型划分为有限个单元，并考虑其材料特性和边界条件，而后模拟施加应力，进行计算，探究生物力学的数学模型法。
生物力学：主要研究生物体的力学行为。它涉及应用力学原理和方法来理解和分析生物体内的各种生物力学现象，包括力的作用、组织和器官的力学特性以及生物系统的运动和变形。


背景：有限元分析是一种分析腰椎生物力学常用的数学模型法，通过将腰椎部位的肌肉、血管、神经等复杂的组织结构建立为有限元模型，并进行力学分析，从而明确腰椎疾患的发病机制及腰椎治疗手段的力学机制。

目的：对有限元分析在腰椎发病机制与治疗方式中的应用进展进行综述，并提出一种新的有限元分析临床化的诊治流程，以期为后续研究提供参考，并促进有限元分析在临床诊治中普及。
方法：以“finite element analysis，lumbar vertebra”为英文检索词检索PubMed数据库，以“有限元分析，腰椎”为中文检索词检索万方和中国知网数据库，最终纳入73篇文献进行综述。

结果与结论：①普通患者的腰椎退变通常起始于纤维环后侧，而腰椎滑脱患者则因其力学机制的失常，退变起始于腰椎小关节；②恢复压缩椎体的椎体高度能够预防相邻节段发生退变，且有限元分析测量出的椎体压缩强度能够代替骨密度成为预测骨折风险的有效工具；③腰椎融合术中应选择高度适中的融合器并将其横向放置能够避免融合器下沉，融合术后相邻节段的椎间应变、环向应力和椎间压力升高可能是导致邻近节段退行性病变发生的机制；④有限元分析结果显示，椎间孔镜术前应规划截骨大小，避免过度破坏关节突，术中优先选择经由上关节突行椎间孔成形术；⑤经皮椎体后凸成形术中应选择双侧椎弓根注入骨水泥，使其分布于椎弓根两侧；骨水泥材料应选择更为先进的无铝玻璃聚链烯酸酯；⑥牵引治疗应根据患者自身情况设计个性化牵引角度、力度等，从而达到最佳疗效；⑦手法治疗能够使腰椎椎间盘突出部分与神经根产生相对位移，从而减轻压迫程度；⑧CT/MR-AI Plus FEA-AI Plus Surgical robots的诊治流程能够使治疗更加精细化。

https://orcid.org/0009-0005-0141-3071 (樊光亚) 

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: 有限元分析, 腰椎, 生物力学, 发病机制, 治疗, 综述

Abstract: BACKGROUND: Finite element analysis is a commonly used mathematical modeling method to analyze the biomechanics of the lumbar spine. By constructing finite element models of the complex tissues such as muscles, blood vessels, and nerves in the lumbar region, mechanical analysis is performed to elucidate the pathogenesis of lumbar spine disorders and the mechanical mechanisms of treatment approaches. 
OBJECTIVE: To review the progress of finite element analysis in understanding the pathogenesis and treatment modalities of lumbar spine disorders, and to propose a new clinical workflow for the implementation of finite element analysis, aiming to provide a reference for future studies and promote the widespread utilization of finite element analysis in clinical diagnosis and treatment.
METHODS: The PubMed database was searched using English keywords “finite element analysis, lumbar vertebra”, while the WanFang and China National Knowledge Infrastructure (CNKI) databases were searched using Chinese keywords “finite element analysis, lumbar vertebra”. A total of 73 articles were included for review. 
RESULTS AND CONCLUSION: (1) Lumbar spine degeneration in non-slipped patients typically originates from the posterior annulus fibrosus, while in patients with lumbar spine spondylolisthesis, degeneration starts from the lumbar facet joints due to abnormal mechanical mechanisms. (2) Restoring vertebral body height can prevent adjacent-level degeneration, and finite element analysis-measured vertebral compression strength can serve as an effective predictor of fracture risk, replacing bone density measurements. (3) In lumbar spine fusion surgery, selecting fusion devices of appropriate height and placing them transversely can prevent device subsidence. Increased intervertebral strain, circumferential stress, and intervertebral pressure in adjacent segments after fusion surgery may contribute to the occurrence of degenerative changes in neighboring segments. (4) Finite element analysis results suggest that preoperative planning for transforaminal endoscopic surgery should include considerations for osteotomy size to avoid excessive destruction of the articular process, and intraoperatively, preferential selection of a technique that traverses the superior articular process for foraminal dilatation. (5) In percutaneous kyphoplasty, bilateral pedicle screw augmentation should be performed, distributing bone cement on both sides of the pedicle. More advanced non-aluminum glass polyalkenoate cement materials should be selected. (6) Traction therapy should be personalized based on individual patient characteristics, including customized traction angles and forces, to achieve optimal therapeutic effects. (7) Manual therapy can induce relative displacement between the herniated intervertebral disc and the nerve root, thereby reducing compression. (8) The workflow involving CT/MR-AI Plus FEA-AI Plus Surgical robots can enable more precise diagnosis and treatment.

Key words: finite element analysis, lumbar spine, biomechanics, pathogenesis, treatment, review

中图分类号: