Department of Spine Surgery, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou, Jiangsu, 221006, China.
Graduate School of Xuzhou, Medical University, No. 209 Tongshan Road, Xuzhou, Jiangsu, 221004, China.
J Orthop Surg Res. 2024 Jul 12;19(1):402. doi: 10.1186/s13018-024-04870-1.
This study aimed to evaluate the effect of foraminoplasty using large-channel endoscopy during TESSYS on the biomechanics of the lumbar spine.
A complete lumbar spine model, M1, was built using 3D finite elements, and models M2 and M3 were constructed to simulate the intraoperative removal of the superior articular process of L5 using a trephine saw with diameters of 5 mm and 8.5 mm, respectively, and applying normal physiological loads on the different models to simulate six working conditions-anterior flexion, posterior extension, left-right lateral bending, and left-right rotation-to investigate the displacement and facet joint stress change of the surgical segment, and the disc stress change of the surgical and adjacent segments.
Compared with the M1 model, the M2 and M3 models showed decreased stress at the L4-5 left FJ and a significant increase in stress at the right FJ in forward flexion. In the M2 and M3 models, the L4-5 FJ stresses were significantly greater in left lateral bending or left rotation than in right lateral bending or right rotation. The right FJ stress in M3 was greater during left rotation than that in M2, and that in M2 was greater than that in M1. The L4-5disc stress in the M3 model was greater during posterior extension than that in the M1 and M2 models. The L4-5disc stress in the M3 model was greater in the right rotation than in the M2 model, and that in the M2 model was greater than that in the M1 model.
Foraminoplasty using large-channel endoscopy could increase the stress on the FJ and disc of the surgical segment, which suggested unnecessary and excessive resection should be avoided in PTED to minimize biomechanical disruption.
本研究旨在评估 TESSYS 术中使用大通道内镜行椎间孔成形术对腰椎生物力学的影响。
采用三维有限元方法构建完整腰椎模型 M1，并分别构建模型 M2 和 M3，以模拟使用直径为 5mm 和 8.5mm 的环锯切除 L5 上关节突，并在不同模型上施加正常生理负荷，模拟六种工作状态：前屈、后伸、左右侧屈和左右旋转，以研究手术节段的位移和小关节面应力变化，以及手术节段和相邻节段椎间盘的应力变化。
与 M1 模型相比，M2 和 M3 模型在前屈时 L4-5 左侧 FJ 处的应力降低，右侧 FJ 处的应力显著增加。在 M2 和 M3 模型中，左侧或左侧旋转时 L4-5 FJ 处的应力明显大于右侧或右侧旋转时的应力。M3 模型中左侧旋转时右侧 FJ 的应力大于 M2 模型，M2 模型中的应力大于 M1 模型。M3 模型中后伸时 L4-5 椎间盘的应力大于 M1 和 M2 模型。M3 模型中右侧旋转时 L4-5 椎间盘的应力大于 M2 模型，M2 模型中的应力大于 M1 模型。
使用大通道内镜行椎间孔成形术可增加手术节段 FJ 和椎间盘的应力，提示在经皮椎间孔内镜减压术中应避免不必要的过度切除，以最小化生物力学破坏。
