Song Xiao-Xing, Jin Lin-Yu, Li Xin-Feng, Qian Lie, Shen Hong-Xing, Liu Zu-De, Yu Bu-Wei
Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
World Neurosurg. 2018 Feb;110:e321-e329. doi: 10.1016/j.wneu.2017.10.177. Epub 2017 Nov 10.
Low bone mass in patients with adolescent idiopathic scoliosis has been well reported. Poor bone quality was regarded as a new and unique prognostic factor in aggravating curve progression. However, the potential biomechanical correlation between them remains unclear.
Three-dimensional finite element models of idiopathic scoliotic spine with different bone mineral status were created for axial loading simulation. An axial load of 3 different body weights was applied on different bone mineral mass models. The mechanical responses of the vertebral cortical and cancellous bone, facet joints, end plate, and intervertebral disc were analyzed.
Accompanied with the low bone mineral status, thoracic scoliosis produced asymmetric and higher stress in the cortical bone, lumbar facet joints, and end plate at the concave side of the thoracic structure curve. Stress increased in the disc at the apex of the scoliosis, whereas it mildly decreased in the L4-5 and L5-S1 disc. Body weight gain increased the stress in scoliotic spine structures in all bone mineral statues.
Biomechanical simulations indicated that low bone mineral mass might aggravate curve progression and induce more serious lumbar compensatory scoliosis in patients with adolescent idiopathic scoliosis. Weight gain was also a risk factor for curve progression.
青少年特发性脊柱侧凸患者的低骨量已有大量报道。骨质不佳被视为加重侧弯进展的一个新的独特预后因素。然而，它们之间潜在的生物力学关联仍不明确。
创建具有不同骨矿物质状态的特发性脊柱侧凸三维有限元模型，用于轴向载荷模拟。对不同骨矿物质质量模型施加3种不同体重的轴向载荷。分析椎体皮质骨和松质骨、小关节、终板和椎间盘的力学响应。
随着骨矿物质状态降低，胸段脊柱侧凸在胸段结构曲线凹侧的皮质骨、腰椎小关节和终板产生不对称且更高的应力。脊柱侧凸顶点处椎间盘的应力增加，而L4-5和L5-S1椎间盘的应力略有降低。体重增加会使所有骨矿物质状态下脊柱侧凸结构的应力增加。
生物力学模拟表明，低骨量可能会加重青少年特发性脊柱侧凸患者的侧弯进展，并诱发更严重的腰椎代偿性脊柱侧凸。体重增加也是侧弯进展的一个危险因素。
