腰椎经皮内镜下不同部位关节突成形对椎间盘力学影响的三维有限元分析
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摘要
目的利用三维有限元法评估腰椎经皮内镜下不同的关节突成形部位对椎间盘力学的影响。方法建立正常的L_(3~5)三维有限元模型,模拟腰椎经皮内镜技术分别在L_5上关节突"尖部"或"基底部"做直径7.5mm的圆柱状骨切除以模拟椎间孔成形,从而获得正常L_(3~5)模型、关节突尖部成形模型和关节突基底部成形模型3种模型。给予特定加载条件,比较3种模型在前屈、后伸、左右侧曲、左右旋转工况下L_(4/5)、L_(3/4)椎间盘应力变化情况。结果 L_5上关节突尖部成形后在左右旋转及后伸状态下L_(4/5)椎间盘的最大应力均较正常明显增大,以后伸状态最为明显;L_5上关节突基底部成形后在左右旋转状态下L_(4/5)椎间盘的最大应力较正常稍增大。L_5上关节突尖部、基底部成形后在6种不同运动状态下均对临近节段L_(3/4)椎间盘的应力变化影响均较小。结论腰椎经皮内镜技术下,L_5上关节突尖部成形较基底部成形对L_(4/5)椎间盘的生物力学影响较大。L_5上关节突成型对临近节段L_(3/4)椎间盘的应力变化的影响较小。
Objective To evaluate the influence of facet joint arthroplasty of different parts under lumber percutaneous on adjacent segment disc by using three-dimensional finite element method.Methods Established a normal 3D finite element mode of L_(3-5),simulate lumbar percutaneous endoscopy by doing cylindrical excision of bone whose diameter was 7.5 mm on the tip and basal part of L_5 facet joint respectively so that obtained three models,the first one was normal lumbar vertebra mode,the second one was the tip of the facet joint was shaped,the third one was the basal part of the facet joint was shaped.Compared the stress of intervertebral disc of L_(3/4) and L_(4/5) when they were in the states of flexion,extension,left and right lateral flexion,left and right rotation on specific loading conditions.Results When the second model of which the L_5 facet joint tip was shaped was in the states of extension,left rotation and right rotation,the stress of the intervertebral disc of L_(4/5) were more bigger than normal model,especially in the states of extension.When the third model of which the L_5 facet joint basal part was shaped in the states of left and right rotation,the biggest stress of the intervertebral disc of L_(4/5) was increased slightly.However,the model of L_5 facet joint tip or basal was shaped,the influence on the stress of the intervertebral disc of L_(3/4) was small,when the model was in the six states.Conclusion There would be more biomechanical influence on the intervertebral disc of L_(4/5) when the tip of L_5 facet joint is shaped than the basal of the L_5 facet joint is shaped under lumber percutaneous endoscopy.And the influence of L_5 facet joint arthroplasty on the stress of intervertebral disc of L_(3/4) is small.
Objective To evaluate the influence of facet joint arthroplasty of different parts under lumber percutaneous on adjacent segment disc by using three-dimensional finite element method.Methods Established a normal 3D finite element mode of L_(3-5),simulate lumbar percutaneous endoscopy by doing cylindrical excision of bone whose diameter was 7.5 mm on the tip and basal part of L_5 facet joint respectively so that obtained three models,the first one was normal lumbar vertebra mode,the second one was the tip of the facet joint was shaped,the third one was the basal part of the facet joint was shaped.Compared the stress of intervertebral disc of L_(3/4) and L_(4/5) when they were in the states of flexion,extension,left and right lateral flexion,left and right rotation on specific loading conditions.Results When the second model of which the L_5 facet joint tip was shaped was in the states of extension,left rotation and right rotation,the stress of the intervertebral disc of L_(4/5) were more bigger than normal model,especially in the states of extension.When the third model of which the L_5 facet joint basal part was shaped in the states of left and right rotation,the biggest stress of the intervertebral disc of L_(4/5) was increased slightly.However,the model of L_5 facet joint tip or basal was shaped,the influence on the stress of the intervertebral disc of L_(3/4) was small,when the model was in the six states.Conclusion There would be more biomechanical influence on the intervertebral disc of L_(4/5) when the tip of L_5 facet joint is shaped than the basal of the L_5 facet joint is shaped under lumber percutaneous endoscopy.And the influence of L_5 facet joint arthroplasty on the stress of intervertebral disc of L_(3/4) is small.
引文
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[11]HOOGLAND T,VAN DEN BREKEL DIJKSTRA K,SCHUBERT M,et al.Endoscopic transforaminal discectomy for recurrent lumbar disc herniation:aprospective,cohort evaluation of 262consecutive cases[J].Spine,2008,33(9):973-978.
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[13]阮朝阳,何永春,曾强华,等.腰椎椎间孔成形幅度对关节突压力变化的有限元分析[J].脊柱外科杂志,2017,15(6):357-360.
[14]李振宙,侯树勋,吴闻文,等.经皮侧后路腰椎间孔成形术对腰椎解剖及生物力学影响的实验研究[J].中国骨与关节杂志,2010,9(6):503-508.
[15]李嵩鹏,周游,李定,等.椎间孔境(TESSYS)入路相关L5-S1阶段椎间孔解剖学观察[J].中国临床解剖学杂志,2015,30(2):129-133.
[2]LI Z Z,HOU S X,SHANG W L et al.Modified percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar discectomy:instrument design,technique notes,and 5years follow-up[J].Pain Physician,2017,20(1):E85-98.
[3]HASSAN A,GUS V,ANDREW P,et al.Biomechanics of the posterior lumbar articulating elements[J].Neurosurg Focus,2007,22(1):E1-6.
[4]唐谨,刘鏐,李莹,吴从俊,等.腰椎间盘突出症椎间孔镜术后复发的原因分析及相关预防对策[J].中国中医骨伤科杂志,2017,25(2):75-78.
[5]ZHANG Q H,TEO E C,NG W H,et al.Finite element analysis of momentroation relationships for human cerical spine[J].J Biomech,2006,39(1):189-193.
[6]苏晋,赵文志,陈秉智,等.建立全腰椎有限元接触模型[J].医用生物力学,2010,25(3):200-205.
[7]黄菊英,李海云,吴浩.腰椎间盘突出症力学特征的仿真计算方法[J].医用生物力学,2012,27(1):96-101.
[8]BROLIN K,HALLDIN P.Development of a finite element model of the upper cervical spine and a parameter study of ligament characteristics[J].Spine,2004,29(4):376-385.
[9]SHIM C S,PARK S W,LEE S H,et al.Biomechanical evaluation of an interspinous stabilizing device,locker[J].Spine,2008,33(22):E820-827.
[10]HOOGLAND T,SCHUBERT M,MIKLITZ B,et al.Transforaminal posterolateral endoscopic discectomy with or without the combination of low-dose chymopapain:aprospective randomized study in 280consecutive cases[J].Spine,2006,31(24):E890-897.
[11]HOOGLAND T,VAN DEN BREKEL DIJKSTRA K,SCHUBERT M,et al.Endoscopic transforaminal discectomy for recurrent lumbar disc herniation:aprospective,cohort evaluation of 262consecutive cases[J].Spine,2008,33(9):973-978.
[12]YEUNG A T,TSOU P M.Posterolateral endoscopic excision for lumbar disc herniation:surgical technique,outcome,and complications in 307consecutive cases[J].Spine,2002,27(7):722-731.
[13]阮朝阳,何永春,曾强华,等.腰椎椎间孔成形幅度对关节突压力变化的有限元分析[J].脊柱外科杂志,2017,15(6):357-360.
[14]李振宙,侯树勋,吴闻文,等.经皮侧后路腰椎间孔成形术对腰椎解剖及生物力学影响的实验研究[J].中国骨与关节杂志,2010,9(6):503-508.
[15]李嵩鹏,周游,李定,等.椎间孔境(TESSYS)入路相关L5-S1阶段椎间孔解剖学观察[J].中国临床解剖学杂志,2015,30(2):129-133.