北京生物醫(yī)學(xué)工程

經(jīng)皮椎體成形術(shù)椎間盤骨水泥滲漏對相鄰椎體的生物力學(xué)影響的有限元分析

Finite element analysis of biomechanical effect of intervertebral disc cement leakage on adjacent vertebrae after percutaneous vertebroplasty

作者：付海軍馮毅武太勇李健

單位：山西醫(yī)科大學(xué)(太原 030001) 山西醫(yī)科大學(xué)第二醫(yī)院(太原 030001) 通信作者：馮毅。E-mail：[email protected]

關(guān)鍵詞：經(jīng)皮椎體成形術(shù)；骨水泥滲漏；有限元；三維模型；生物力學(xué)

分類號：R318.01

出版年·卷·期（頁碼）：2022·41·2（140-147）

摘要：

目的利用3D模型及生物力學(xué)模擬分析軟件進(jìn)行經(jīng)皮椎體成形術(shù)椎間盤骨水泥滲漏對相鄰椎體的生物力學(xué)影響進(jìn)行有限元分析。方法通過CT數(shù)據(jù)，運(yùn)用Mimics Research 21.0、ANSYS 17.0有限元分析軟件，建立骨質(zhì)疏松壓縮骨折PVP術(shù)后的椎體模型，通過數(shù)字化模擬制作出骨水泥滲漏至上（實(shí)驗(yàn)?zāi)Ｐ蚢）、下（實(shí)驗(yàn)?zāi)Ｐ蚥）和上下（實(shí)驗(yàn)?zāi)Ｐ蚦）均滲漏的3種模型，并進(jìn)一步編輯處理模擬控制骨水泥滲出量為1 mL、1.5 mL、2 mL，相應(yīng)命名為為低滲漏量組、中滲漏量組、高滲漏量組。分析相鄰椎體的前皮質(zhì)柱、前1/3皮質(zhì)柱和品質(zhì)中心柱應(yīng)力分布變化情況。結(jié)果在得出的3組數(shù)據(jù)組內(nèi)比較中，與對照模型相比，實(shí)驗(yàn)?zāi)Ｐ蚑12、L2椎體應(yīng)力均增大，且差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；并且各椎體不同力柱之間應(yīng)力對比，三組T12椎體、L1椎體前1/3柱＞前皮質(zhì)柱＞中心柱（P＜0.05）；每組T12椎體應(yīng)力實(shí)驗(yàn)?zāi)Ｐ蚢與c顯著大于實(shí)驗(yàn)?zāi)Ｐ蚥（P＜0.05）；L2椎體應(yīng)力實(shí)驗(yàn)?zāi)Ｐ蚥與c顯著大于實(shí)驗(yàn)?zāi)Ｐ蚢（P＜0.05）。在組與組之間的比較中，可以看出，各椎體應(yīng)力變化：高滲漏量組＞中滲漏量組＞低滲漏量組（P＜0.05）。結(jié)論 PVP術(shù)中骨水泥發(fā)生椎間盤滲漏對比未發(fā)生滲漏來說，相鄰椎體應(yīng)力改變相對較大，發(fā)生骨折的可能性更大，而且椎體前1/3皮質(zhì)柱應(yīng)力變化最明顯，PVP手術(shù)發(fā)生椎間盤骨水泥滲漏視作術(shù)后相鄰椎體發(fā)生骨折的一個(gè)重要危險(xiǎn)因素，骨水泥滲漏量也與相鄰椎體的應(yīng)力呈正相關(guān)。

Objective The 3D model and biomechanical simulation software were used to analyze the biomechanical effect of intervertebral disc cement leakage on adjacent vertebrae in percutaneous vertebroplasty. Methods Based on the CT data, the vertebral body model of osteoporotic compression fracture after PVP was established by using Mimics Research 21.0, finite element analysis software ANSYS 17.0. Three models of bone cement leakage above (experimental model a), lower (experimental model b) and upper and lower (experimental model c) were made by digital simulation, and the amount of bone cement leakage was controlled by 1 mL, 1.5 mL and 2 mL. It is named as low leakage group, medium leakage group and high leakage group. The changes of stress distribution in the anterior cortical column, the front 1/ 3 cortical column and the mass center column of the adjacent vertebrae were analyzed. Results In the comparison of the three groups of data, compared with the control model, the stress of T12 and L2 vertebrae in the experimental model was significantly higher than that in the control model (P < 0.05), and the stress in the anterior 1/3 column > anterior cortical column > central column in the three groups of T12 and L1 vertebrae in the three groups, and the stress in the experimental model an and c in each group was significantly larger than that in the experimental model b (P<0.05). The experimental model b and c of L2 vertebral body stress were significantly larger than those of the experimental model a (P < 0.05). In the comparison between groups, it can be seen that the stress changes of each vertebral body are as follows: high leakage group > medium leakage group > low leakage group (P < 0.05). Conclusions Compared with no intervertebral disc leakage during PVP, the stress change of adjacent vertebral body is relatively larger, and the possibility of fracture is greater, and the stress change of cortical 1/3 column in front of vertebral body is the most obvious. Intervertebral disc cement leakage during PVP operation is regarded as an important risk factor for fracture of adjacent vertebral body, and the amount of bone cement leakage is also positively correlated with the stress of adjacent vertebral body.

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