文献类型：期刊文献

中文题名：3种复位固定法对T_(12)椎体压缩骨折后脊柱力学稳定性变化的有限元分析

英文题名：Changes in the mechanical stability of the spine after T_(12) vertebral compression fracture:A three-reduction methods finite element analysis

作者：秦大平[1,2];张晓刚[2];高国栋[2];权祯[2];赵雅文[2];徐斌[1];徐世伟[2];王志鹏[2];张华[1];赵希云[2];陶维天[1]

第一作者：秦大平

机构：[1]甘肃中医药大学,兰州730000;[2]甘肃中医药大学附属医院,兰州730020

第一机构：甘肃中医药大学

年份：2025

卷号：40

期号：7

起止页码：3739

中文期刊名：中华中医药杂志

外文期刊名：China Journal of Traditional Chinese Medicine and Pharmacy

收录：;北大核心:【北大核心2023】；

基金：国家自然科学基金项目(No.82260941,No.81760873);甘肃省高校青年博士支持项目(No.2023QB-089);甘肃省高等学校创新基金项目(No.2020A-073);兰州市人才创新创业项目(No.2021-RC-101);甘肃中医药大学科学研究与创新基金项目(No.2022KCZD-1)。

语种：中文

中文关键词：3种复位固定法;T_(12)椎体压缩骨折;力学稳定性;有限元分析

外文关键词：Three reduction methods;T_(12)vertebral compression fracture;Mechanical stability;Finite element analysis

摘要：目的:通过有限元分析3种复位固定法对T_(12)椎体压缩骨折椎体高度恢复不全状态下与人体正常脊柱进行对比分析,结合临床实际针对T_(12)椎体在骨折治疗前后椎体高度丢失相同状态下不同工况条件对脊柱力学稳定性变化差异进行有限元分析,明确不同治疗方法之间的生物力学机制和临床适应证选择的差异性。方法:选择2名健康志愿者,选择16例住院T_(12)椎体压缩骨折患者CT及MRI扫描资料,通过PACS影像系统对符合条件的经过经皮球囊扩张椎体成形术(PKP)、经皮后凸椎体成形术(PVP)及中医过伸复位手法配合PKP治愈的临床真实病例,提取其CT及MRI扫描资料,建立T_(12)三维有限元模型并验证模型有效性,对3种复位固定法对T_(12)椎体压缩骨折后不同运动工况下椎体各结构应力变化。结果:经椎体强化术后PKP、PVP治疗在脊柱前屈、后伸,左、右侧弯,左、右旋转,轴向7种不同运动状态下与正常人体脊柱胸腰段模型应力变化比较,其椎体结构(包括椎体、椎间盘、纤维环、髓核)的Von Mises应力有明显增大趋势,对于T_(12)椎体压缩骨折经骨水泥强化术(PKP、PVK、手法配合PKP)后,其在左右旋转运动状态下椎体、关节突关节应力明显增大。纤维环、椎间盘的应力略低于正常人体;对终板的应力影响主要体现在骨折椎体经骨水泥强化术后对邻近椎体终板应力有明显的增加,与正常人体模型比较,从筋-骨系统进行分析,骨与肌肉、韧带所代表的动静力变化都明显降低。结论:采用PKP、中医过伸复位手法配合PKP与PVP 3种复位法治疗OVCF的临床疗效差异性和对人体脊柱胸腰段椎体、附属结构及相邻椎体长期稳定性方面的差异,明确中医过伸复位手法配合PKP方法能使纤维环、椎间盘、髓核及相邻椎体终板、关节突软骨的应力变化幅度减小,趋于一种稳定状态,降低了远期伤椎高度丢失、并发再骨折以及相邻椎体再骨折的发生比率,提高其远期疗效和增加OVCF胸腰段治疗后筋骨系统的稳定性。对选择不同治疗方法之间的生物力学差异和临床适应证匹配程度提供理论和生物力学依据。
Objective:Finite element analysis was conducted by the comparison of Ti2 vertebral compression fracture under incomplete recovery with human normal spine,combined with the finite element analysis of the difference in spine mechanical stability under the same state of vertebral height loss after fracture treatment,to clarify the biomechanical differences between their different treatments and the selectivity of clinical indications.Methods:Two healthy volunteers were selected,and X-ray examination excluded thoracic and lumbar spine related lesions,no obvious deformity,hyperplasia,degeneration,and the history of other spinal diseases and spinal surgery was excluded.In addition,2 CT and MRI scanning data of hospitalized osteoporosis were selected,and 16 qualified clinical real cases cured by PKP,TCM overextension and PKP,PVP were selected through PACS imaging system,their CT and MRI data were extracted,the T_(12) three-dimensional finite element model was established and the effectiveness of the model was verified.T_(12) Structural stress changes of vertebral structure under different exercise conditions after vertebral compressive fracture with three reset treatments.Results:After vertebral reinforcement PKP and PVP treatment was compared with the stress changes of the normal human spine chest and waist model in the spinal anterior flexion,posterior extension,left and right bending,left and right rotation,and axial movement states,the Von Mises stress of the vertebral structure includes vertebral,disc,fiber ring,and nucleus.After T_(12) vertebral compression fracture was reinforced by bone cement(PKP,PVK,technique with PKP),the stress of vertebral and articular process increased significantly in the left and right rotation movement state.The stress change of the fiber ring and disc is slightly lower than normal people;the stress effect on the end plate is mainly reflected in the fracture stress increase of the adjacent end plate.Compared with the normal human model,the bone and dynamic changes represented by bones,muscles and ligaments are significantly reduced.Conclusion:The clinical efficacy of PKP and PVP and the long-term stability of the thoracic and lumbar vertebrae,accessory structure and adjacent vertebrae.The PKP method can reduce the stress changes of fiber ring,disc,nucleus and adjacent vertebral terminal plate and articular process cartilage,tend to a stable state,reduce the long-term vertebral height loss,concurrent refracture and adjacent vertebral fracture,improve its long-term efficacy and increase the stability of muscles and bone system by OvCF thoracolumbar treatment.It provides a theoretical and biomechanical basis for the biomechanical differences between choosing different treatments and the degree of matching of clinical indications.