可膨胀椎间融合器治疗腰椎间盘轻度退变的有限元分析

doi:10.13481/j.1671-587x.20160328

摘要/Abstract

摘要：

目的: 建立可膨胀椎间融合器(EVIFC)和第4、5腰椎的有限元模型,分析EVIFC植入对腰椎生物力学的影响,为EVIFC的临床应用提供依据。方法: 根据健康成年男性腰椎CT扫描数据建立正常第4、5腰椎有限元模型,在此模型上模拟腰4-5椎间盘轻度退变,在三维模型上植入EVIFC。在屈伸、侧弯和旋转的载荷下,分析腰椎模型置入EVIFC前后的稳定性、椎间盘压力、终板压力及小关节载荷变化。结果: EVIFC的置入减少了退变节段终板、髓核和小关节的应力。屈伸时,腰4-5椎体退变模型的终板及髓核平均压力分别是6.1620和0.2016MPa,小关节载荷是32.8N;植入EVIFC后其数值分别是3.526、0.107MPa和8.5N。侧弯及旋转载荷结果一致。对于邻近的腰椎节段,与退变模型比较,植入EVIFC后,腰4-5终板和髓核应力值均有所减小,但其相邻节段纤维环的应力值均有所增加。结论: EVIFC对退变腰椎能起到良好的稳定效果,可满足人体生物力学需求,是一种适宜的新型腰椎融合器。

关键词: 腰椎, 椎间融合器, 生物力学, 有限元分析

Abstract:

Objective: To establish the expended vertebra interbody fusion cage (EVIFC) and finite element analysis of L4-5 and to analyze the influence of EVIFC insertion in the biomechanical parameters of lumbar spine,and to provide the biomechanical evidence for its clinical application. Methods: According to the umbar CT scan data of healthy adult male people, the normal L4-5 lumbar spine finite element model was established.In this model,the L4-5 intervertebral disc slight degeneration was simulated,and the 3D model was implanted with EVIFC.Under flexion,lateral bending,and rotation loading conditions,the stability of lumbar spine model before and after EVIFC implantion,the pressure of the intervertebral disc,endplate pressure and small joint loading changes were analyzed. Results: After the insertion of EVIFC,the stress in end-plate,nucleus and small joint of the L4-5 level was decreased. In flexion,the mean pressure values in the end-plate and nucleus of the degeneration model were 6.162 0 and 0.201 6 MPa,and the small joint load was 32.8 N.After implantation of EVIFC ,they were 3.526,0.107 MPa,and 8.5 N,respectively.The consistent results occurred in another two loading conditions,As for the adjacent levels,compared with degeneration model,the stress in end-plate and nucleus were decreased at the L4-5 level.The mean stress in the annulus of L4-5 was increased slightly. Conclusion: EVIFC has effect on the stability of slightly degenerative lumber spine which can meet the needs of human biomechanics,and it is a suitable and new lumbar fusion device.

Key words: lumbar spine, vertebra interbody fusion cage, biomechanics, finite element analysis

中图分类号:

R318.08

王宇, 穆尚强, 梅继文, 孙爽. 可膨胀椎间融合器治疗腰椎间盘轻度退变的有限元分析[J]. 吉林大学学报(医学版), 2016, 42(03): 565-569.

WANG Yu, MU Shangqiang, MEI Jiwen, SUN Shuang. Finite element analysis on lumbar intervertbral disc slight degeneration treated by expanded vertebra interbody fusion cage[J]. Journal of Jilin University Medicine Edition, 2016, 42(03): 565-569.

参考文献

[1] Koca OL,Eskitascioglu G,Usumez A. Three-dimensional finite-element analysis of functional stresses in different bone locations produced by implants placed in the maxillary posterior region of the sinus floor[J].J Prosthet Dent,2005 ,93(1):38-44.

[2] Chang YI,Shin SJ,Baek SH.Three-dimensional finite element analysis in distal enmasse movement of the maxillary dentition with the multiloop edgewise archwire[J].Eur J Orthod,2004,26(3):339-345.

[3] 马金梁,张记恩,刘克斌,等.一种新型腰椎间融合器的研制及生物力学评价[J].重庆医学,2014,43(4):465-468.

[4] Wang M,Tang SJ,McGrady LM,et al.Biomechanical comparison of supplemental posterior fixations for two-level anterior lumbar interbody fusion[J].Proc Inst Mech Eng H,2012,227(3):245-250.

[5] 石岩,崔文岗,肖德明.腰椎椎间融合器临床研究进展[J].国际骨科学杂志,2013,34(1):45-48.

[6] Zhang QH,Teo EC,Ng HW,et al.Finite element analysis of momentrotation relationships for human cervical spine[J].J Biomech,2006,39(1):189-193.

[7] Ding JY,Qian S,Wan L,et al.Design and finite-element evaluation of a versatile assembled lumbar interbody fusion cage[J].Arch Orthop Trauma Surg,2010,130(4):565-571.

[8] Chuah HG,Abd Rahim I,Yusof MI.Topology optimisation of spinal interbody cage for reducing stress shielding effect[J].Comput Methods Biomech Biomed Engin,2010,13(3):319-326.

[9] Rihn JA,Makda J,Hong J,et al.The use of RhBMP-2 in single-level transforaminal lumbar interbody fusion:a clinical and radiographic analysis[J].Eur Spine J,2009,18(11):1629-1636.

[10] Balseiro S,Nottmeier EW.Vertebral osteolysis originating from subchondral cyst end plate defects in transforaminal lumbar interbody fusion using rhBMP-2.Report of two cases [J].Spine J,2010,10(7):e6-e10.

[11] Fabbri N,Rustemi E,Masetti C,et al.Severe osteolysis and soft tissue mass around total hip arthroplasty:description of four cases and review of the literature with respect to clinico-radiographic and pathologic differential diagnosis[J].Eur J Radiol,2011,77(1):43-50.

[12] Yim EK,Darling EM,Kulangara K,et al.Nanotography-induced changes in focal adhesions,cytoskeletal organization,and mechanical properties of human mesenchymal stem cells[J].Biomaterials,2010,31(6):1299-1306.

[13] Beuvelot J,Portet D,Lecollinet G,et al.In vitro kinetic study of growth and mineralization of osteoblast-like cells (Saos-2) on titanium surface coated with a RGD functionalized bispho -sphonate[J].J Biomed Mater Res B Appl Biomater,2009,90(2):873-881.

[14] Corniola MV,Jgersberg M,Stienen MN,et al.Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion[J].J Clin Neurosci,2015,22(3):597-598.

[15] Yamada K,Ito M,Akazawa T,et al.A preclinical large animal study on a novel intervertebral fusion cage covered with high porosity titanium sheets with a triple pore structure used for spinal fusion[J].European Spine J,2015:1-8.

[16] Hart RA,Daniels AH,Bahney T,et al.Relationship of donor variables and graft dimension on biomechanical performance of femoral ring allograft[J].J Orthop Res,2011,29(12):1840-1845.

[17] Razi AE,Spivak JM,Kummer FJ,et al.Biomechanical comparison of translaminar screw versus pedicle screw supplementation of anterior femoral ring allografts in one-level lumar spine fusion[J].Bull NYU Hosp Jt Dis,2011,69(4):298-302.

[18] Suzuki T,Abe E,Miyakoshi N,et al.Anterior decompression and shortening reconstruction with a titanium mesh cage through a posterior approach alone for the treatment of lumbar burst fractures[J].Asian Spine J,2012,6(2):123-130.

[19] 李菊根,杨进顺,谢楚海,等.可膨胀性椎间融合器治疗腰椎退行性疾病的术后并发症分析[J].中国矫形外科杂志,2012,20(12):1137-1139.

[20] 周春光,宋跃明,屠重棋,等.多元氨基酸共聚物/磷酸钙复合材料椎间融合器的设计制备及压缩强度测试[J].生物医学工程学杂志,2011,28(6):1136-1140.

[21] 丁金勇,钱莘,吴小程,等.新型组合式腰椎间融合器的研制和生物力学评价[J].中国临床解剖学杂志,2009,27(5):588-591.

[22] Le TV,Baaj AA,Dakwar E,et al.Subsidence of polyetheretherketone intervertebral cages in minimally invasive lateral retroperit oneal transpsoas lumbar interbody fusion[J].Spine,2012,37(14):1268-1273.

[23] 刘家明,龙新华,周扬,等.一期后路经椎间孔入路病灶清除椎体间非结构性植骨内固定治疗腰椎结核的疗效观察[J].解放军医学杂志,2015,40(11):938-942.