CAJ | 학술논문

目的应用非线性有限元分析研究单侧椎板开窗髓核摘除术对相邻节段不同程度退变椎间盘应力分布的影响.方法墓于断层CT图像建立L3～L5节段三维非线性有限元模型,并依据L3～L4椎间盘不同退变程度建立轻、中和重度退变有限元模型,以及单侧椎板开窗髓核摘除术后模型.在模拟前屈、后伸、左右侧弯和左右旋转六个主要生理活动条件下,分析相邻节段椎间盘L3～L4髓核和纤维环von Mises应力极值变化.结果行L4～L5左侧椎板开窗髓核摘除后,相邻L3～L4椎间盘为健康椎间盘时,髓核和纤维环基质内von Mises应力极值后伸最大,左侧弯时最小;轻度退变时,应力极值在左侧弯时增加最明显;中度退变时,髓核和纤维环基质von Mises应力极值减小,但仍高于健康椎间盘应力;重度退变时,髓核内von Mises应力极值均较轻中度椎间盘退变时下降,除轴向旋转运动外,甚至低于健康椎间盘时的应力值;纤维环基质内von Mises应力值较轻中度退变时下降,但仍高于健康椎间盘内纤维环应力,尤以左侧弯时明显.结论当相邻节段椎间盘退变时,行单侧椎板开窗髓核摘除后避免同侧侧弯可以减少异常应力的产生,降低椎间盘退变加速的风险.
목적 응용비선성유한원분석연구단측추판개창수핵적제술대상린절단불동정도퇴변추간반응력분포적영향.방법 묘우단층CT도상건립L3～L5절단삼유비선성유한원모형,병의거L3～L4추간반불동퇴변정도건립경、중화중도퇴변유한원모형,이급단측추판개창수핵적제술후모형.재모의전굴、후신、좌우측만화좌우선전륙개주요생리활동조건하,분석상린절단추간반L3～L4수핵화섬유배von Mises응력겁치변화.결과 행L4～L5좌측추판개창수핵적제후,상린L3～L4추간반위건강추간반시,수핵화섬유배기질내von Mises응력겁치후신최대,좌측만시최소;경도퇴변시,응력겁치재좌측만시증가최명현;중도퇴변시,수핵화섬유배기질von Mises응력겁치감소,단잉고우건강추간반응력;중도퇴변시,수핵내von Mises응력겁치균교경중도추간반퇴변시하강,제축향선전운동외,심지저우건강추간반시적응력치;섬유배기질내von Mises응력치교경중도퇴변시하강,단잉고우건강추간반내섬유배응력,우이좌측만시명현.결론 당상린절단추간반퇴변시,행단측추판개창수핵적제후피면동측측만가이감소이상응력적산생,강저추간반퇴변가속적풍험.
Objectives To study the stress distribution of the adjacent different grades of disc degeneration underwenting unilateral laminectomy and discectomy surgery using non-linear finite element analysis. Methods Based on the lumbar CT scans, the finite element model (FEM) of lumbar spinal segment(L3-L3) was established. According to L3-L4 intervertebral disc degeneration, different grades of disc degeneration( healthy,mild, moderate and severe) models were established and unilateral laminectomy and discectomy surgery were also established. Physiological action such as flextion , extension , lateral bending and lateral rotation was simulated and the yon Mises stress in the nucleus pulposus and annulus fibrosus matrix of L3-L4 disc was investagated. Results After unilateral laminectomy and discectomy surgery, the extremum value of yon Mises stress of nucleus pulposus and annulus fibrosus matrix was maximum during extension and minimus left bending in the healthy intervertebral disc. Compared with healthy disc, the increment of extremum value was found during left bending in the mildly degenerated disc. When the value decreased in the moderately degenerated disc, but still higher than that in the healthy disc. When the adjacent disc is severly degenerated, the extremum value of nucleus pulposus decreased, in addition to axial rotation, and even lower than that of healthy disc. The value of annulus matrix decreased and still higher than that of healthy disc , especially during left bending. Conclusions After unilateral laminectomy and discectomy surgery, avoiding lateral bending will reduce the abnormal stress in the degenerated disc and decreased the risk of accelerating disc degeneration.