两种术式髓核摘除对腰椎生物力学影响的有限元分析
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Finite element analysis of biomechanical effects of nucleotomy with two procedures on lumbar spine
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    摘要:

    目的评价两种术式髓核摘除对腰椎节段稳定性和纤维环应力的影响。方法在L4-5节段三维有限元模型上分别模拟骨性椎板开窗髓核摘除和椎板间隙开窗髓核摘除,施加不同类型载荷,观察节段间旋转角度和纤维环最大应力的改变。结果骨性椎板开窗髓核摘除后,腰椎节段在前屈和后伸载荷下旋转角度分别增加31%和28%,纤维环最大应力分别增加16%和6%;椎板间隙开窗髓核摘除后,腰椎节段在前屈和后伸载荷下旋转角度分别增加33%和39%,纤维环最大应力分别增加17%和0.2%。两种术式髓核摘除后,纤维环的应力分布均没有发生改变。结论和椎板间隙开窗相比,骨性椎板开窗髓核摘除能更好地保持腰椎的后伸稳定性,但后伸时纤维环承受的应力明显增大。

    Abstract:

    Objective To evaluate the biomechanical effects of nucleotomy with two procedures on the stability of lumbar spine and the highest von Mises stress in annulus.Method A three-dimensional finite element model of L4-5 motion segment was established by using CT scans.Nucleotomy through osseous lamina fenestration and through interlaminar fenestration was simulated on the model,respectively,and axial compressive load of 400N with moment of 6.0Nm in six directions,including flexion,extension,left and right lateral bending,left and right axial torsion,were employed on the models.Rotational degrees of inter-segment and the highest von Mises stress in annulus were examined. Result After nucleotomy through osseous lamina fenestration,the rotational degrees of inter-segment in flexion and extention conditions increased by 31% and 28%,respectively;the highest von Mises stress in annulus increased by 16% and 6%,respectively.After nucleotomy through interlaminar fenestration,the rotational degrees of inter-segment in flexion and extention conditions increased by 33% and 39%,respectively;the highest von Mises stress in annulus increased by 17% and 0.2%,respectively.After nucleotomy with the two procedures,the stress distribution in annulus keeps unchanged,but the stress values increased in all cases.Conclusion Contrast to nucleotomy through interlaminar fenestration,nucleotomy through osseous lamina fenestration can keep the lumbar spine more stable in extension condition,but the increase of stress in annulus is higher in the same condition.

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吴青坡,张春霖,张美超,孙国绍,孙长山.两种术式髓核摘除对腰椎生物力学影响的有限元分析[J].医用生物力学,2007,22(3):298-301

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