有限元分析显微镜下不同比例髓核摘除后的腰椎力学特征陈华星，杨圣，芦健民，于燕南，袁驰，任福泉，刘继峰，赵国权，李树强大连大学附属中山医院骨科，辽宁省大连市116001Lumbarbiomechanicalcharacteristicsaftermicrosurgicallumbardiscectomywithdifferentproportionsofnucleuspulposus:finiteelementanalysisChenHua-xing,YangSheng,LuJian-min,YuYan-nan,YuanChi,RenFu-quan,LiuJi-feng,ZhaoGuo-quan,LiShu-qiangDepartmentofOrthopedics,AffiliatedZhongshanHospitalofDalianUniversity,Dalian116001,LiaoningProvince,China摘要背景：国内腰椎髓核摘除后有限元模型多是建立在正常椎体模型的基础上，去除了完整的髓核组织，但是没有考虑到实际手术过程中髓核只是部分摘除以及椎板开窗同时对脊柱力学产生的影响。目的：精确建立腰椎L4/5节段显微镜辅助下不同比例髓核摘除模型，比较髓核摘除前后的力学特征。方法：选择1例腰间盘突出症患者，获取术前CT数据构建有限元模型并验证其有效性，再获取术后CT数据并构建显微镜辅助下椎板单纯开窗、开窗+髓核摘除1/3及开窗+髓核全部摘除共4种模型，给予特定加载条件下比较其在前屈、后伸、左右侧弯、左右旋转6种载荷下的生物力学特征。结果与结论：精确构建了显微镜下不同比例髓核摘除后腰椎的有限元模型。通过力学特征分析得知，显微镜下不同比例髓核摘除后腰椎在屈伸状态下的稳定性明显降低，应力趋向关节突、椎板峡部等后柱结构集中，在屈伸及椎板开窗对侧弯曲活动时影响较大，髓核摘除程度与其影响有关。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；组织工程全文链接：关键词：植入物；数字化骨科；显微镜；髓核摘除；生物力学；三维有限元；国家自然科学基金；Abstract：BACKGROUND:MostfiniteelementmodelsofmicrosurgicallumbardiscectomyarebuiltonthebasisofnormalvertebralbodiesinChinatoremovethecompletenucleuspulposustissue.However,itdidnotconsidertheonlypartofnucleuspulposusremovalintheprocessofactualoperationandtheimpactofvertebrallaminafenestrationonspinalmechanicsatthesametime.OBJECTIVE:Toestablishpreciselythree-dimensionalfiniteelementmodel(L4/5)tocomparebiomechanicalcharacteristicscausedbythedifferentproportionsofdiscectomyunderamicroscope.METHODS:Onepatientwithlumbarintervertebraldischerniationwasselected.PreoperativeCTdatawereusedtoconstructfiniteelementmodels,anditseffectivenesswasvalidated.PostoperativeCTdatawerecollected.Degenerationmodel,vertebrallaminafenestrationmodel,microsurgicallumbardiscectomymodel(removalofathirdofnucleuspulposus)andallnucleuspulposusresectionmodelwereconstructed.Underspecificloadingconditions,biomechanicalcharacteristicswerecomparedintheflexion-extension,lateralbending,andaxialrotationconditions.RESULTSANDCONCLUSION:Finiteelementmodelsoflumbarvertebraewereaccuratelyestablishedafterdiscectomyatvariousproportionsunderthemicroscope.Mechanicalpropertyanalysisdemonstratedthataftermicrosurgicallumbardiscectomyandremovingdifferentproportionsofnucleuspulposus,underflexion-extensioncondition,theendmax-stressdistributedintheisthmusandthesuperiorarticularfacet,besidesthestabilityofthelumbarspine,wasreduced.Thischangeontheoppositedirectionofvertebrallaminafenestrationwasmostobviouswhenlateral-bendingandbackwardextensioncondition.Theproportionofnucleuspulposusremovalwasassociatedwithitseffects.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；组织工程全文链接：Keywords：lumbarvertebrae;intervertebraldiskdisplacement;microscopy;biomechanics;finiteelementanalysis;中图分类号:R318基金资助:国家自然科学基金资助项目(30870647)通讯作者:杨圣，博士，教授，大连大学附属中山医院骨科，辽宁省大连市116001作者简介:陈华星，男，1983年生，湖北省十堰市人，汉族，2013年大连大学毕业，硕士，医师，主要从事脊柱外科研究。引用本文:陈华星,杨圣,芦健民等.有限元分析显微镜下不同比例髓核摘除后的腰椎力学特征[J].中国组织工程研究,2014,18(17):2659-2666.ChenHua-xing,YangSheng,LuJian-minetal.Lumbarbiomechanicalcharacteristicsaftermicrosurgicallumbardiscectomywithdifferentproportionsofnucleuspulposus:finiteelementanalysis[J].ChineseJournalofTissueEngineeringResearch,2014,18(17):2659-2666.
