CAJ | 학술논문

目的探索椎体后凸成形术(PKP)术后骨水泥椎间盘渗漏对相邻椎体的力学影响,探讨相邻椎体继发骨折的病因.方法利用MIMICS软件用有限元方法对1例T12压缩骨折PKP术后出现椎间盘骨水泥渗漏的患者手术前后CT图片进行预处理,后导入ABAQUS软件中建立T10-L2的三维有限元模型,设置0.3、1.0、4.0 Mpa 3种轴向载荷进行生物力学分析,观察不同载荷下模型整体及各部分的Von Mises应力,重点评价骨水泥椎间盘渗漏对骨折相邻椎体的力学影响.结果成功建立了PKP术后骨水泥椎间盘渗漏的手术前后三维有限元模型,当轴向压力以0.3、1.0、4.0 MPa增加后,椎间盘、软骨终板和椎体整体的应力也成比例增加.PKP术后脊柱胸腰段各部位的应力开始重新分布,增强椎体(T12)的上、下终板应力增强区域范围增加;相邻椎间盘(T11-12、T12-L1)及相邻终板(T11下终板、L1上终板)的应力增强区域增加;T12相邻椎体(T11、L1)所受最大应力显著增加,但是远端椎体(T10、L2)的最大应力明显减少.结论 PKP术后骨水泥椎间盘渗漏引起上下相邻椎体继发骨折的并发症可能和生物力学行为的改变密切相关.
목적 탐색추체후철성형술(PKP)술후골수니추간반삼루대상린추체적역학영향,탐토상린추체계발골절적병인.방법 이용MIMICS연건용유한원방법대1례T12압축골절PKP술후출현추간반골수니삼루적환자수술전후CT도편진행예처리,후도입ABAQUS연건중건립T10-L2적삼유유한원모형,설치0.3、1.0、4.0 Mpa 3충축향재하진행생물역학분석,관찰불동재하하모형정체급각부분적Von Mises응력,중점평개골수니추간반삼루대골절상린추체적역학영향.결과 성공건립료PKP술후골수니추간반삼루적수술전후삼유유한원모형,당축향압력이0.3、1.0、4.0 MPa증가후,추간반、연골종판화추체정체적응력야성비례증가.PKP술후척주흉요단각부위적응력개시중신분포,증강추체(T12)적상、하종판응력증강구역범위증가;상린추간반(T11-12、T12-L1)급상린종판(T11하종판、L1상종판)적응력증강구역증가;T12상린추체(T11、L1)소수최대응력현저증가,단시원단추체(T10、L2)적최대응력명현감소.결론 PKP술후골수니추간반삼루인기상하상린추체계발골절적병발증가능화생물역학행위적개변밀절상관.
Objective To explore the biomechanical effects on adjacent vertebra of thoracolumbar osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP) with cement leakage into the disc by using finite element analysis. Methods T10-L2 segment data were obtained from computed tomography (CT) scans of an elder female with single T12 OVCF undergoing a cement leakage into the T1 2-L1 disc after PKP. A three-dimensional finite element Model of thoracolumbar spine (T10-L2)was built in the Mimics and the ABAQUS software. The stress on annulus fiber, nucleus pulposus, endplate and facet joints under axial pressure (0. 3, 1.0, 4. 0 MPa) were analyzed. Results The 3D finite element after percutancous kyphoplasty (PKP) with cement leakage into the disc may be strongly related with the changes of biomechanical effects on adjacent vertebras of thoracolumbar OVCF. Models of thoracolumbar OVCF before and after PVP with a cement leakage into the T12-L1 disc were successfully established. The stresses increased with a rising axial pressure in the model of cement leakage into the disc after PVP, the stress augmentation scope on adjacent end plates ( T11 low plate & L1 top plate) and intervertebral disc (T11-12 & T12-L1 ) increased. The maximal Von Mises stress on adjacent vertebras (T11 & L1 ) increased while but the maximal Von Mises stress on end vertebras (T10 & L2) decreased. Conclusion Postoperative adjacent vertebral fracture.