髓核摘除术对腰椎生物力学特性影响的有限元研究
Finite element analysis into the effect of discectomy on lumbar biomechanical characteristics
目的 采用三维有限元模型分析方法，探讨腰椎间盘突出症髓核摘除术对腰椎生物力学特性的影响。 方法 采用新型CAD方法精确建立腰椎L4～5活动节段有限元模型，构建正常模型、退变模型、髓核摘除模型和疤痕长入模型分别模拟正常椎间盘、退变椎间盘、髓核摘除后即刻和术后中长期时的椎间盘；并比较其生物力学特征。 结果 (1)髓核摘除模型的刚度较退变模型减小，但较正常模型提高； (2)疤痕长入模型腰椎节段刚度大幅回升并超过退变模型；(3)髓核摘除后即刻小关节突接触力减小，而疤痕长入模型则表现为小关节突接触力增加。 结论 腰椎间盘髓核摘除术后即刻对腰椎稳定性和后部结构应力影响较小，而髓核摘除中长期后则可有腰椎运动节段变硬和关节突的应力增加。
Objective To investigate the effects on the lumbar biomechanical characteristics caused by the discectomy in the treatment of the lumbar intervertebral disc protrusion using three-dimensional finite element model analysis methods. Methods The new effective CAD methods were adopted to accurately create the L4/5 segment's finite element model and simulate the normal disc, the degenerated disc, the denucleated disc immediately after operation as well as the postoperative disc in a long run; their biomechanical characteristics were also compared. Results ⑴The stiffness of the denucleated model, compared with the normal one, was reduced; ⑵the stiffness of lumbar segment drastically rose and even surpassed that of the degenerated one due to the fact that the scar tissue has been full into intra-disc cavity.⑶The facet contact force was decreased in discectomy model and the scar growth model was increased. Conclusion There is small impact on lumbar stability and posterior structure after discectomy immediately. The lumbar motion segment may stiffen and the stress of articular process may increase after discectomy in a long run.
Discectomy / Lumbar / Biomechanical Characteristics / Finite Element
[1] 兰 俊，陈其昕，翟晓军，等.腰椎间盘退变时椎间隙形态与腰椎曲度变化及其临床意义
[J].中国临床解剖学杂志，2005，23（2）：157-162.
[2] 刘耀升,陈其昕,廖胜辉，等.椎间盘高度降低及退变对腰椎生物力学影响的有限元分析
[J].中国临床解剖学杂志，2006,24（5）：566-570.
[3] Shirazi-Adl SA, Ahmed AM, Shrivastava SC. A finite element study of a lumbar motion segment subjected to pure sagittal plane moments
[J]. J Biomech, 1986,19（4）: 331-350.
[4] 刘耀升,陈其昕,李方财,等.终板凹陷角变化对腰椎运动节段生物力学影响的有限元分析
[J].中国临床解剖学杂志,2007,25 (2): 207-211.
[5] 袁 野，靳安民，何丽英，等.利用CT扫描及CAD技术建立腰椎活动节段的有限元模型
[J].中国临床解剖学杂志, 2002, 20(4): 298-300.
[6] Goel VK, Kim YE, Lim TH, et al. An analytical investigation of the mechanics of spinal instrumentation
[J]. Spine,1988,13(9):1003-1111.
[7] Kumaresan S, Yoganandan N, Pintar FA, et al. Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation
[J]. J Orthop Res，2001,19(5):977-984
[8] Qiu TX, Teo EC, Lee KK, et al. Validation of T10-T11 finite element model and determination of instantaneous axes of rotations in three anatomical planes
[J]. Spine,2003, 28(24):2694-2699.
[9] Kirkaldy-Willis W H, Farfan H F. Instability of the lumbar spine
[J]. Clin Orthop, 1982, 165:110-125．
[10]孟壮志，朱青安，范真，等.腰骶部椎间盘髓核摘除对脊柱稳定性影响的生物力学研究
[J].中国临床解剖学杂志，1999,17(1):75-76.
[11]Lu YM, Hutton WC, Gharpuray VM. The effect of fluid loss on the viscoelastic behavior of the lumbar intervertebral disc in compression
[J]. J Biomech Eng，1998，120(1):48-54.
[12]Meakin JR, Redpath TW, Hukins DWL. The effect of partial removal of the nucleus pulposus from the intervertebral disc on the response of the human annulus fibrosus to compression
[J]. Clin Biomech， 2001,16(2):12-18.
[13]张辉，靳安民，姚伟涛，等.正常腰椎间盘的测量及其临床意义
[J].中国临床解剖学杂志，2005,23(5): 467-469.
[14]杜东鹏，张克华，葛宝丰，等.腰椎间盘膨隆的有限元分析
[J].中国临床解剖学杂志，1999,17（3）：268-269.
[15]Adams MA, Hutton WC. The effect of posture on the role of the apophysial joints in resisting intervertebral pressive forces
[J]. J Bone Joint Surg Br, 1980, 62(3): 358-362.
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