Denozière Guilhem, Ku David N
G. W. W. School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0405, USA.
J Biomech. 2006;39(4):766-75. doi: 10.1016/j.jbiomech.2004.07.039.
Surgical treatments for lower back pain can be distributed into two main groups: fusion (arthrodesis) and disc replacement (arthroplasty). The objective of this study was to compare, under severe loading conditions, the biomechanics of the lumbar spine treated either by fusion or total disc replacement (TDR). A three-dimensional model of a two-level ligamentous lumbar segment was created and simulated through static analyses with the finite-element method (FEM) software ABAQUS. The model was validated by comparing mobility, pressure on the facets, force in the ligaments, maximum stresses, disc bulge, and endplate deflection with measured data given in the literature. The FEM analysis predicted that the mobility of the model after arthrodesis on the upper level was reduced in all rotational degrees of freedom by an average of approximately 44%, relative to healthy normal discs. Conversely, the mobility of the model after TDR on the upper level was increased in all rotational degrees of freedom by an average of approximately 52%. The level implanted with the artificial disc showed excessive ligament tensions (greater than 500 N), high facet pressures (greater than 3 MPa), and a high risk of instability. The mobility and the stresses in the level adjacent to the arthroplasty were also increased. In conclusion, the model for an implanted movable artificial disc illustrated complications common to spinal arthroplasty and showed greater risk of instability and further degeneration than predicted for the fused model. This modeling technique provides an accurate means for assessing potential biomechanical risks and can be used to improve the design of future artificial intervertebral discs.
下背部疼痛的手术治疗可分为两大类:融合术(关节固定术)和椎间盘置换术(关节成形术)。本研究的目的是在重度负荷条件下,比较融合术或全椎间盘置换术(TDR)治疗的腰椎生物力学。通过使用有限元方法(FEM)软件ABAQUS进行静态分析,创建并模拟了一个两级韧带腰椎节段的三维模型。通过将模型的活动度、小关节压力、韧带力、最大应力、椎间盘膨出和终板位移与文献中给出的测量数据进行比较,对模型进行了验证。有限元分析预测,相对于健康的正常椎间盘,上节段进行融合术后模型在所有旋转自由度上的活动度平均降低约44%。相反,上节段进行TDR术后模型在所有旋转自由度上的活动度平均增加约52%。植入人工椎间盘的节段显示韧带张力过大(大于500 N)、小关节压力高(大于3 MPa)以及不稳定风险高。关节成形术相邻节段的活动度和应力也增加。总之,植入可移动人工椎间盘的模型说明了脊柱关节成形术常见的并发症,并且显示出比融合模型预测的更大的不稳定和进一步退变风险。这种建模技术为评估潜在的生物力学风险提供了一种准确的方法,可用于改进未来人工椎间盘的设计。
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