| 腰椎内镜下髓核摘除术对不同退变程度邻近节段椎间盘生物力学影响的有限元分析 |
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Received:September 14, 2020
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| 作者 | Author | 单位 | Unit | E-Mail |
| 徐文强 |
XU Wen-qiang |
南京中医药大学附属中西医结合医院, 江苏 南京 210028 |
Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, China |
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| 张啸宇 |
ZHANG Xiao-yu |
南京中医药大学附属中西医结合医院, 江苏 南京 210028 |
Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, China |
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| 王楠 |
WANG Nan |
南京中医药大学附属中西医结合医院, 江苏 南京 210028 |
Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, China |
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| 蒋理 |
JIANG Li |
南京中医药大学附属中西医结合医院, 江苏 南京 210028 |
Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, China |
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| 席志鹏 |
XI Zhi-peng |
南京中医药大学附属中西医结合医院, 江苏 南京 210028 |
Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, China |
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| 邓蓉蓉 |
DENG Rong-rong |
南京中医药大学附属中西医结合医院, 江苏 南京 210028 |
Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, China |
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| 王庚启 |
WANG Gen-qi |
南京中医药大学附属中西医结合医院, 江苏 南京 210028 |
Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, China |
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| 谢林 |
and XIE Lin |
南京中医药大学附属中西医结合医院, 江苏 南京 210028 |
Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, China |
xielin117@126.com |
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| 期刊信息：《中国骨伤》2021年34卷，第1期，第40-44页 |
| DOI：10.12200/j.issn.1003-0034.2021.01.008 |
| 基金项目:江苏省社会发展重点项目（编号：BE2019765）；江苏省中医药领军人才项目（编号：SLJ0210） |
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目的：探讨腰椎侧后路经皮内镜下髓核摘除术（percutaneous transforaminal endoscopic discectomy，PTED）对不同退变程度邻近节段椎间盘的生物力学的影响以及由该术式导致的邻椎病（adjacent segment diseases，ASD）发病风险。
方法：选择成年健康男性志愿者1名，CT扫描获得其腰骶椎影像数据，重建骨性结构外轮廓，并以此为基础在3D-CAD软件中使用平滑曲线拟合骨性结构外轮廓，正向绘制完整无退变的L3-S1节段三维有限元模型和L3-L4及L5-S1节段退变模型。在L4-L5节段右侧通过切除部分关节突、髓核组织模拟纤维环破口完成PTED手术仿真模拟后，在屈曲、后伸、左右侧屈、左右扭转6个工况下完成数字模拟分析，并通过采集纤维环冯米塞斯应力和椎间盘内压力的变化评估邻近节段椎间盘生物力学环境的变化，以评估术后ASD的风险。
结果：在无邻近节段椎间盘退变的有限元模型中，PTED术后模型纤维环冯米塞斯应力和椎间盘内压在绝大多数受力工况下均仅出现轻度上升，在少部分工况下出现轻度下降，术前术后并无显著变化趋势。在原有退变邻近节段椎间盘模型中，PTED术前术后模型的间盘退变相关生物力学指标均出现显著恶化，导致潜在的邻椎病发病风险上升。
结论：PTED手术不会导致无退变邻近节段椎间盘的术后生物力学环境明显恶化，而邻近节段椎间盘原有的退变是术后ASD发病的重要危险因素。 |
| [关键词]:椎间盘切除术,经皮 外科手术,内窥镜 有限元分析 |
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| Biomechanical affect of percutaneous transforaminal endoscopic discectomy on adjacent segments with different degrees of degeneration:a finite element analysis |
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Abstract:Objective: To investigate the biomechanical affect of percutaneous transforaminal endoscopic discectomy(PTED) on adjacent segments with different degrees of degeneration and related risk of adjacent segment diseases(ASD) caused by this operation.
Methods: A healthy male adult volunteer was selected,and the lumbosacral vertebra image data was obtained by CT scan,and the external contour of the bone structure was reconstructed. On this basis,the external contour of the bone structure was fitted by using the smooth curve in 3D-CAD software,and the complete three-dimensional finite element model of the non-degenerate L3-S1 segment and the degenerative models of the L3-L4 and L5-S1 segment were drawn forward. In L4,L5 segment simulating PTED surgery through the removal of right part of articular process and nucleus pulposus and anulus fibrosus. After PTED was simulated in the L4-L5 segment and the risk of ASD has been evaluated by six changes of biomechanical indicators in flexion,extension,left and right lateral bending,left and right axial rotation conditions.
Results: In the finite element model without adjacent segmental disc degeneration,the annulus fibrosus von Mises stress and intradiscal pressure of the PTED model showed only a slight increase under most stress conditions,and a slight decrease in a few conditions,and there was no significant change trend before and after surgery. In the original degenerated adjacent segment disc model,the biomechanical indicators related to disc degeneration in the pre- and post-PTED model showed significant deterioration,leading to an increased risk of potential adjacent spondylopathy.
Conclusion: PTED surgery will not lead to the significant deterioration of postoperative biomechanical environment of non-degeneration adjacent intervertebral discs,and the original degeneration of adjacent intervertebral discs is a important risk factor for ASD. |
| KEYWORDS:Diskectomy,percutaneous Surgical procedures,endoscopic Finite element analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 徐文强,张啸宇,王楠,蒋理,席志鹏,邓蓉蓉,王庚启,谢林.腰椎内镜下髓核摘除术对不同退变程度邻近节段椎间盘生物力学影响的有限元分析[J].中国骨伤,2021,34(1):40~44 |
| 英文格式: | XU Wen-qiang,ZHANG Xiao-yu,WANG Nan,JIANG Li,XI Zhi-peng,DENG Rong-rong,WANG Gen-qi,and XIE Lin.Biomechanical affect of percutaneous transforaminal endoscopic discectomy on adjacent segments with different degrees of degeneration:a finite element analysis[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(1):40~44 |
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