不同治疗方法对骨质疏松性胸腰椎压缩骨折椎体力学稳定性影响的有限元分析

Finite element analysis of effect of different treatment methods on vertebral stability of osteoporotic vertebral compression fractures

目的采用有限元分析探讨不同治疗方法治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)对脊柱力学稳定性变化的影响。方法选择2020年1月—2021年6月收治的10例胸腰椎OVCF患者,其中5例行微创手术治疗(手术组),5例行保守治疗(保守治疗组);另选择5例健康志愿者作为正常对照(正常对照组)。3组研究对象年龄及性别差异均无统计学意义(P>0.05)。手术组及保守治疗组于治疗前后行骨折椎体及邻近节段CT扫描,正常对照组行T12~L2CT扫描检查。将CT扫描数据导入Mimics10.01软件,构建三维有限元模型;将正常对照组模型与既往相关文献测量结果进行比较验证有效性后,测量各组不同运动状态下脊柱结构应力及活动度(range of motion,ROM)。结果经验证研究构建的三维有限元模型有效。治疗后在不同运动状态下,3组结构应力比较差异均有统计学意义(P<0.05)。治疗前,手术组和保守治疗组各向ROM均低于正常对照组(P<0.05),保守治疗组和手术组差异无统计学意义(P>0.05);治疗后,正常对照组和手术组各向ROM均高于保守治疗组(P<0.05),手术组与正常对照组差异无统计学意义(P>0.05)。结论对于OVCF患者,采用微创手术治疗可以获得较好效果,与保守治疗相比,能提高脊柱稳定性,可以作为一种首选治疗方法,有助于改善患者预后。

Objective To investigate the effect of different treatment methods on the vertebral stability of osteoporotic vertebral compression fracture(OVCF)by finite element analysis.Methods Ten patients with thoracolumbar OVCF admitted between January 2020 and June 2021 were selected,5 of whom underwent operation(operation group),5 underwent conservative treatment(conservative treatment group).Another 5 healthy volunteers were selected as the control group.There was no significant difference in gender and age between groups(P>0.05).The operation group and the conservative treatment group received CT examination of the fractured vertebral body and adjacent segments before and after treatments,while the control group received CT examination of T12-L2.By importing CT data into Mimics 10.01 software,the finite element model was constructed.After comparing the finite element model of control group with the previous relevant literature measurement results to verify the validity,the spinal structural stress and range of motion(ROM)in each group under different conditions were measured.Results The three-dimensional finite element model was verified to be valid.There were significant differences in spinal structural stress after treatment between groups under different conditions(P<0.05).Before treatment,the ROMs of operation group and conservative treatment group under difference conditions were significantly lower than those of control group(P<0.05),and there was no difference between conservative treatment group and operation group(P>0.05).After treatment,the ROMs of the control group and the operation group were significantly higher than those of the conservative treatment group(P<0.05),and there was no significant difference between the operation group and the control group(P>0.05).Conclusion For patients with OVCF,the minimally invasive operation can achieve better results.Compared with conservative treatment,it can reduce the effect on spinal stability,and can be as a preferred treatment method,which is helpful to improve the prognosis of patients.