腰椎棘突间撑开装置生物力学及有限元分析的研究与进展

Research progress of biomechanics and finite element analysis of lumbar interspinous devices

背景:非融合技术在临床应用日益广泛,棘突间撑开装置便是其中重要的一员,与传统融合技术相比具有独特的生物力学优势,随着假体设计和植入技术不断改进,在未来具有更广阔的应用前景。目的:对腰椎棘突间撑开装置的生物力学及有限元分析研究进展进行综述。方法:第一作者以"腰椎,棘突间装置,生物力学,有限元分析"检索CNKI数据库、万方数据库,以"Lumbar spine,Interspinous devices,Biomechanics,Finite element analysis"检索PubM ed数据库、SpringerL ink数据库。纳入有关腰椎棘突间撑开装置生物力学分析或有限元分析的研究,排除重复研究。通过阅读摘要初步筛选,共选取44篇文献进行综述,其中中文8篇,英文36篇。结果与结论:(1)就生物力学研究而言,几种临床较为常见的棘突间撑开装置都可以通过限制屈伸活动增加置入节段矢状面的稳定性,对相应节段的侧弯和旋转无影响或影响较小;(2)不同植入物尺寸、置入位置对置入节段和邻近节段影响的研究报道较少;(3)三维有限元分析通过应力云图可直观分析棘突间撑开装置置入前后椎间盘、椎板峡部和小关节等结构承受应力分布的变化。生物力学研究及有限元分析均证实,棘突间撑开装置对椎间盘、小关节有明显分担负荷作用,同时对邻近节段的活动、应力没有产生明显影响;(4)提示棘突间撑开装置短期生物力学优越性明显,其长期生物力学优势仍需进一步深入研究。有限元分析可以模拟不同在体力学环境,分析棘突间撑开装置置入后不同研究对象力学分布变化,是一种较为有效的评估棘突间撑开装置力学作用机制的手段。

BACKGROUND： The lumbar interspinous device, as a kind of non-fusion technology has been extensively applied in the clinic and exerts superiority in biomechanics compared with the traditional fusion technology. With the development of prosthesis design and impanation technology, it reveals a better application prospect. OBJECTIVE： To review the biomechanics and finite element analysis of lumbar interspinous devices. METHODS： The first author retrieved the databases of CNKI, Wan Fang, PubM ed and Springer Link using the keywords of ＂lumbar spine, interspinous devices, biomechanics, finite element analysis＂ in Chinese and English, respectively. Researches related to the biomechanics and finite element analysis of lumbar interspinous devices were included and repeated researches were excluded. A total of 44 literatures were enrolled for review, including 8 Chinese and 36 English literatures. RESULTS AND CONCLUSION：（1） Biomechanically, several interpinous devices, which are commonly used in the clinic, can increase the stability of the implanted segment in sagittal alignment by limiting the range of flexion-extension, with no significant change in lateral bending and axial rotation.（2） Few studies analyze the influence of the implant size and placement on the implanted segment and on the adjacent segments.（3） Through the stress nephogram, three-dimension finite element analysis can intuitively analyze the changes of the stress distribution in the intervertebral disc, isthmus and facet joints before and after implantation. Both biomechanical studies and finite element analysis indicate that interspinous devices can share the load of the disc and facet joints, and at the same time, make no effect on the range of motion and stress of the adjacent segment.（4） In conclusion, the short-term biomechanical advantage of the interspinous devices is obvious, but further studies are needed. The finite element analysis can simulate different body physical environment, and can analyze mechanical distribution changes after implantation, which is an effective way to evaluate the mechanical mechanism of the interspinous devices.