中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (9): 2145-2152.doi: 10.12307/2025.873

• 骨与关节有限元分析Finite element analysis of bones and joints •    下一篇

椎体成形中拖尾锚定治疗伴裂隙征骨质疏松性椎体压缩骨折的有限元分析

陈惠挺，曾伟权，周剑鸿，王 杰，庄聪颖，陈培友，梁泽乾，邓伟明   

  1. 广州市增城区中医医院脊柱骨科，广东省广州市 510000
  • 收稿日期:2024-08-30 接受日期:2025-01-17 出版日期:2026-03-28 发布日期:2025-08-20
  • 通讯作者: 邓伟明，主治医师，广州市增城区中医医院脊柱骨科，广东省广州市 510000
  • 作者简介:陈惠挺，男，1982 年生，广东省广州市人，汉族，2007 年湖北民族学院毕业，副主任医师，主要从事脊柱疾病诊疗方面的研究。
  • 基金资助:

Tail anchoring technique of vertebroplasty in treatment of osteoporotic vertebral compression fractures with intravertebral cleft: a finite element analysis

Chen Huiting, Zeng Weiquan, Zhou Jianhong, Wang Jie, Zhuang Congying, Chen Peiyou, Liang Zeqian, Deng Weiming   

  1. Department of Spine Orthopedics, Zengcheng District Traditional Chinese Medicine Hospital, Guangzhou 510000, Guangdong Province, China
  • Received:2024-08-30 Accepted:2025-01-17 Online:2026-03-28 Published:2025-08-20
  • Contact: Deng Weiming, Attending physician, Department of Spine Orthopedics, Zengcheng District Traditional Chinese Medicine Hospital,Guangzhou 510000, Guangdong Province, China
  • About author:Chen Huiting, Associate chief physician, Department of Spine Orthopedics, Zengcheng District Traditional Chinese Medicine Hospital, Guangzhou 510000,Guangdong Province, China

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摘要：


文题释义：
伴裂隙征的骨质疏松性椎体压缩骨折：骨质疏松椎体压缩骨折是导致老年人腰背痛最常见的疾病之一，经皮椎体成形术治疗骨质疏松椎体压缩骨折具有微创、稳定椎体，快速缓解疼痛的特点，但对于伴裂隙征的压缩骨折，由于骨折裂隙缺损大、骨小梁及骨皮质丢失较多，骨折压缩严重，使用椎体成形术治疗时骨水泥松动风险显著增加，因此，如何微创有效治疗伴裂隙征的椎体压缩骨折，成为脊柱骨科医生的难点之一。
椎体成形术中拖尾锚定技术：椎体成形术是指通过向病变椎体内推注骨水泥，从而达到强化稳定椎体的一种微创手术方式。然而，对于伴裂隙征的椎体压缩骨折，传统的椎体成形技术可能面临骨水泥渗漏及移位的风险。拖尾锚定技术是指在椎体成形过程中，骨水泥推注结束前，特意将部分骨水泥推注拖尾在椎弓根内，通过增加骨水泥使用量和骨水泥-椎弓根的锚定体积，从而增加骨水泥在椎体内的稳定性，降低术后骨水泥松动或移位的概率。

摘要

背景：经皮椎体成形是治疗骨质疏松性椎体压缩骨折的有效方式，但对于伴裂隙征的椎体压缩骨折患者，如何减少椎体成形术后骨水泥松动移位，成为脊柱外科治疗的难点之一。
目的：探讨拖尾锚定技术治疗伴裂隙征椎体压缩骨折的生物力学稳定性。 
方法：通过1例骨质疏松性椎体压缩骨折患者的胸腰椎CT扫描数据，建立T10-L2节段有限元模型。在Solidwork软件上，模拟椎体内裂隙征，分别构建5组模型：①伴裂隙征的骨质疏松性椎体压缩骨折模型；②2.5 mL骨水泥的经皮椎体成形模型；③2.5 mL骨水泥+拖尾锚定的经皮椎体成形模型；④4.6 mL骨水泥的经皮椎体成形模型；⑤4.6 mL骨水泥+拖尾锚定的经皮椎体成形模型。随后将各模型导入Ansys软件，添加韧带等结构，并赋值进行有限元分析。其中载荷条件为：在T10椎体上表面施加400 N垂直向下的载荷模拟身体上半身重力，并在不同方向上施加7.5 N·m的力矩，模拟脊柱屈伸旋转等各方向的运动，比较不同模型间骨折椎体的活动度、形变程度、最大等效应力以及骨水泥应力的差异。 
结果与结论：①在骨折椎体的活动度上，伴裂隙征骨质疏松性椎体压缩骨折模型的活动度最大，在各方向上活动度可达4°-7°；2.5 mL骨水泥模型和2.5 mL骨水泥+拖尾锚定模型虽然能部分减少骨折椎的异常活动，但其稳定性依然较差，在屈伸旋转时，活动度可达3°-4°；而在4.6 mL骨水泥+拖尾锚定模型中，骨折椎体的活动度明显减少，相对较为稳定，较伴裂隙征骨质疏松性椎体压缩骨折模型分别减少81%，83%，77%，69%，76%和79%，说明其生物力学稳定性最好；②在骨折椎体最大等效应力和形变程度上，其结果为裂隙征的骨质疏松性椎体压缩骨折模型> 2.5 mL骨水泥模型> 2.5 mL骨水泥+拖尾锚定模型> 4.6 mL骨水泥模型> 4.6 mL骨水泥+拖尾锚定模型，说明在骨水泥量较少的时候，单纯拖尾锚定技术并不能达到有效稳定骨折椎的目的；而在椎体前方骨水泥量达到4.6 mL时，再联合拖尾锚定技术则能明显降低椎体的最大等效应力和形变程度；③值得注意的是，两组拖尾锚定模型中骨水泥最大等效应力都出现了明显增大，且主要集中在拖尾骨水泥的中后部；④总的来说，在椎体内具有一定量骨水泥的前提下，拖尾锚定技术能够明显增强骨折椎的稳定性，减少其异常活动和椎体内的应力集中，是一种值得尝试的手术技术；但应注意拖尾锚定部分的骨水泥应力明显增大，若患者术后不注意保护，可能存在拖尾骨水泥断裂的风险。

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: 骨质疏松, 胸腰椎压缩骨折, 椎体内裂隙征, 拖尾征, 有限元分析, 骨科植入物

Abstract:

BACKGROUND: Percutaneous vertebroplasty is an effective surgical method for treating osteoporotic vertebral compression fractures. However, for patients with vertebral compression fractures accompanied by intravertebral clefts, how to reduce cement loosening and displacement after vertebroplasty has become one of the difficulties for spinal surgeons.
OBJECTIVE: To explore the biomechanical stability of tail anchoring technique in the treatment of vertebral compression fractures with intravertebral cleft. 
METHODS: A finite element model of the T10-L2 segment was established using CT scan data from a patient with osteoporotic vertebral compression fractures. On Solidwork software, the intravertebral intravertebral cleft was simulated and five sets of three-dimensional models were constructed: (1) osteoporotic vertebral compression fractures model with intravertebral cleft; (2) percutaneous vertebroplasty model of 2.5 mL bone cement; (3) 2.5 mL bone cement + percutaneous vertebroplasty model with trailing anchoring; (4) percutaneous vertebroplasty model of 4.6 mL bone cement; (5) 4.6 mL bone cement + trailing anchored percutaneous vertebroplasty model. Then, the model was imported into Ansys software, and structures such as ligaments were added and assigned values for finite element analysis. The loading conditions were as follows: a 400 N vertical downward load was applied to the upper surface of T10 vertebral body to simulate the weight of the upper body, and a moment of 7.5 N·m was applied in different directions to simulate movements such as spinal flexion, extension, and rotation. The differences in motion range, deformation degree, maximum equivalent stress, and bone cement stress were compared between different models. 
RESULTS AND CONCLUSION: (1) In terms of the range of motion of fractured vertebral bodies, osteoporotic vertebral compression fractures models with intravertebral clefts had the greatest range of motion, reaching 4°-7° in all directions. Although the 2.5 mL bone cement model and the 2.5 mL bone cement + trailing anchor model could partially reduce abnormal movement of fractured vertebrae, their stability was still poor, with a motion range of up to 3°-4° during flexion, extension, and rotation. In the 4.6 mL bone cement + trailing anchor model, the mobility of fractured vertebral bodies was significantly reduced and relatively stable. The motion range of fractured vertebrae decreased by 81%, 83%, 77%, 69%, 76%, and 79% compared with the osteoporotic vertebral compression fractures model with intravertebral cleft, indicating that it had the best biomechanical stability. (2) In terms of the maximum equivalent stress and deformation degree of fractured vertebral bodies, the results were as follows: osteoporotic vertebral compression fractures model with intravertebral cleft > 2.5 mL bone cement model > 2.5 mL bone cement + trailing anchor model > 4.6 mL bone cement model > 4.6 mL bone cement + trailing anchor model, indicating that when there was a small amount of bone cement, the use of only trailing anchoring technology could not effectively stabilize fractured vertebrae. When the amount of bone cement in front of the vertebral body reached 4.6 mL, combined with trailing anchoring technology, it could significantly reduce the maximum equivalent stress and deformation degree of the vertebral body. (3) It is noteworthy that in both sets of tail-anchored models, the maximum equivalent stress of bone cement significantly increased, primarily concentrated in the mid-to-posterior region of the trailing bone cement. (4) In general, with a certain amount of bone cement in the vertebral body, the trailing anchoring technique could significantly enhance the stability of fractured vertebrae and reduce their abnormal movement and stress concentration within the vertebral body. It is a surgical technique worth trying. However, it should be noted that the stress of bone cement in the trailing anchoring part increases significantly. If patients do not pay attention to protection after surgery, there may be a risk of fracture of bone cement at the anchoring site.

Key words: osteoporosis, thoracolumbar compression fracture, intravertebral cleft, tail anchoring sign, finite element analysis, orthopedic implant

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