功能复位椎体强化治疗骨质疏松性椎体压缩骨折的有限元分析

Treatment of Osteoporotic Vertebral Compression Fracture with Vertebral Augmentation Directed by Theory of Functional Reduction of Chinese Medicine: A Three-dimensional Finite Element Analysis

目的:针对骨质疏松性椎体压缩骨折椎体强化治疗过程中椎体高度不能恢复到解剖复位但疗效满意的现象,结合中医骨伤功能复位理论,利用有限元分析寻找生物力学依据。方法:采用四例T12椎体骨质疏松性椎体压缩骨折(Osteoporotic vertebral compres-sion fracture,OVCF)患者影像资料,构建T12椎体高度为0-3级(Genant半定量法)T11-L1节段三维有限元模型各一例。运用有限元分析方法,模拟施加垂直、屈曲、左侧屈、右侧屈四个不同状态的载荷后,观察椎体强化术后T12椎体的应力。结果:T12椎体强化术不同椎体高度之间应力差异没有统计学意义(P>0.05)。结论:中医功能复位的标准适用于指导椎体强化术的临床治疗,即骨质疏松性椎体压缩骨折椎体强化治疗并不要求绝对追求伤椎椎体高度的恢复。

This study was aimed to find biomechanical evidences between the phenomenon which cannot achieve anatomical reduction but can get satisfactory results in the treatment of osteoporotic vertebral compression fracture of vertebral augmentation and Chinese medicine fracture function reduction theory by finite element analysis. Four patients of T12 vertebral osteoporotic vertebral compres-sion fracture were included in this study. The finite element model was reconstructed as T12 vertebral height of 0-3 grades（Genant semi-quantitative method） of T11-L1 three-dimensional for each case. To observe the stress of T12 vertebral body after vertebral augmentation, the finite element analysis method was used to simulate the load of four different states including vertical, flexion, left lateral flexion and right lateral flexion.The results showed that there was no significant difference in stress between different vertebral heights of T12 vertebral body（P 0.05）. It was concluded that fracture function reduction criteria of Chinese medicine can guide the clinical treatment of vertebral reinforcement, because osteoporotic vertebral compression fracture of vertebral augmentation treatment does not require absolute recovery of vertebral height.