Graduate School of Tianjin Medical University, Tianjin, China.
Institute of Orthopedics, Fengfeng General Hospital of North China Medical& Health Group, Handan, Hebei, China.
Comput Methods Biomech Biomed Engin. 2024 Nov;27(14):2081-2089. doi: 10.1080/10255842.2023.2271602. Epub 2023 Oct 20.
The objective of this study was to analyze the effects of annulus fibrosus incision and foraminoplasty on lumbar biomechanics during posterior lateral approach translaminar percutaneous endoscopic lumbar discectomy (PELD) using a lumbar 4/5 segment model and three-dimensional finite element analysis (FEA). We created a model of the L4 to L5 segment and performed simulated foraminoplasty, annulus fibrosus incision, and a combined operation. The models were tested under six working conditions, and we recorded the deformation and equivalent strain/stress of each group. Results showed that foraminoplasty can affect the stability and rotation axis of the segment during rotation without significantly impacting discal stress. Conversely, annulus fibrosus incision significantly increases discal stress except for when the patient is doing a forward flexion movement. We recommend that surgical maneuvers minimize the removal and destruction of the annulus fibrosus and that rotation movements are avoided during the short-term recovery period following PELD surgery.
本研究旨在通过腰椎 4/5 节段模型和三维有限元分析（FEA），分析后路经皮侧方入路椎间孔镜腰椎间盘切除术（PELD）中纤维环切开和椎间孔成形术对腰椎生物力学的影响。我们建立了 L4 到 L5 节段的模型，并进行了模拟椎间孔成形术、纤维环切开术和联合手术。在六种工作条件下对模型进行了测试，并记录了每组的变形和等效应变/应力。结果表明，椎间孔成形术在旋转时会影响节段的稳定性和旋转轴，但不会显著影响椎间盘的应力。相反，纤维环切开术除了在患者进行前屈运动时会显著增加椎间盘的应力。我们建议手术操作尽量减少纤维环的切除和破坏，并避免在 PELD 手术后的短期恢复期进行旋转运动。
