摘要
背景:高位腰椎管狭窄症是一种复杂的脊柱退行性疾病,针对发生在高位腰椎(L1-L4)的狭窄,手术选择尤为复杂,现有微创手术各具优缺点,目前鲜有对于治疗高位腰椎管狭窄症不同手术方式生物力学对比及有限元分析的相关研究报道。目的:分析脊柱内镜下单侧入路双侧减压术、经椎间孔入路内镜下腰椎椎管减压术及交叉过顶减压术治疗高位腰椎管狭窄症的生物力学特点,评估3种手术方式在治疗高位腰椎管狭窄症中的可靠性与有效性,为临床决策提供生物力学证据支持。方法:选择1名健康男性志愿者的腰椎CT图像,借助Mimics、Geomagic、Solidworks和Ansys等软件构建正常L1-L5腰椎节段的有限元模型M0。选择具有代表高位腰椎特点的L2-L3节段,在此基础上分别建立脊柱内镜下单侧入路双侧减压手术模型M1,经椎间孔入路内镜下腰椎椎管减压手术模型M2及交叉过顶减压手术模型M3。使用软件模拟并评估各组模型在前屈、后伸、左侧弯、右侧弯、左旋转及右旋转6种工况下腰椎全节段的活动度变化以及椎间盘的Von Mises应力极值。结果与结论:①与模型M0相比,模型M1、M2、M3在6种工况下的活动度均增加,其中M1增加最为显著;②手术模型M1和M2在前屈、后伸及右旋转中的活动度增加尤为突出,其他工况的增加比例均不超过7%;③模型M1与M3相比,在后伸及左侧弯时整体关节活动度略有增加,其他方面无明显变化,且L1-L5腰椎节段未达失稳状态;④模型M1的椎间盘应力极值在前屈和后伸载荷条件下增加最为显著,而在左侧弯、右侧弯、左旋转及右旋转载荷下,增加的幅度都不超过5%;⑤结果提示脊柱内镜下单侧入路双侧减压技术在治疗高位腰椎管狭窄症时,由于小关节的偏矢状位解剖特点,完成减压操作会切除更多的小关节,这影响了腰椎整体节段的稳定性;椎间孔入路内镜下腰椎椎管减压技术适用于椎间孔区狭窄患者,对于中央型腹侧狭窄严重的患者,不能充分完成减压;而Cross-Overtop技术能够有效扩大中央椎管和侧隐窝的容积,优化减压效果,在治疗高位腰椎管狭窄症时具有独特的优势。
BACKGROUND:Upper lumbar spinal stenosis is a multifactorial degenerative disorder of the spine.For narrowing of the spinal canal in the upper lumbar region(L1-L4),surgical decision-making is particularly complex.Existing minimally invasive surgeries each have their own advantages and limitations.Currently,there are few reports on biomechanical comparison and finite element analysis of different surgical methods for the treatment of high lumbar spinal stenosis.OBJECTIVE:To analyze the biomechanical impact of endoscopic unilateral laminotomy for bilateral decompression,transforaminal endoscopic lumbar decompression,and cross-overtop decompression in the treatment of upper lumbar spinal stenosis using endoscopy,and to verify the reliability and effectiveness of these three surgical techniques in treating upper lumbar spinal stenosis,providing a biomechanical basis for clinical decision-making.METHODS:The CT images of the lumbar spine of a healthy volunteer were selected,and the finite element model M0 of the normal lumbar L1-L5 segments was established using Mimics,Geomagic,Solid works,and Ansys software.The L2-L3 segment,representing upper lumbar characteristics,was chosen.Based on this model,the surgical models for endoscopic unilateral laminotomy for bilateral decompression(M1),transforaminal endoscopic lumbar decompression(M2),and cross-overtop decompression(M3)were established.Using software,the changes in the range of motion of the entire lumbar segment and the maximum Von Mises stress of the intervertebral discs were simulated and evaluated for each group of models under six loading conditions:flexion,extension,left lateral bending,right lateral bending,left rotation,and right rotation.RESULTS AND CONCLUSION:(1)Compared with model M0,the range of motion in M1,M2,and M3 increased under all six conditions,with M1 showing a greater increase.(2)M1 and M2 demonstrated significant increases in range of motion under forward bending,extension,and right rotation,while the increase under other conditions remained below 7%.(3)Compared with model M3,model M1 exhibited slightly increased overall joint range of motion during extension and left bending,while no significant changes were observed in other aspects,and the L1-L5 lumbar segments did not reach an unstable state.(4)In model M1,the maximum Von Mises stress of the intervertebral discs increased most significantly under flexion and extension loading conditions.However,under left lateral bending,right lateral bending,left rotation,and right rotation loading conditions,the increase did not exceed 5%.(5)These findings suggest that due to the sagittal anatomical characteristics of the facet joints,the unilateral laminotomy for bilateral decompression technique,while decompressing,involves resection of more facet joints,which impacts overall segmental stability.The transforaminal endoscopic lumbar decompression technique is suitable for patients with foraminal stenosis but cannot achieve complete decompression for those with severe ventral central stenosis.The Cross-Overtop technique effectively enlarges the volume of the central canal and lateral recess,optimizing decompression,and shows unique advantages in treating upper lumbar spinal stenosis.
作者
马靖博
杨广南
刘江
蒋强
张晗硕
韩嘉恒
丁宇
Ma Jingbo;Yang Guangnan;Liu Jiang;Jiang Qiang;Zhang Hanshuo;Han Jiaheng;Ding Yu(Second Affiliated Hospital of Anhui Medical University,Hefei 230032,Anhui Province,China;Department of Orthopedics,Sixth Medical Center,PLA General Hospital,Beijing 100048,China)
出处
《中国组织工程研究》
北大核心
2026年第3期577-585,共9页
Chinese Journal of Tissue Engineering Research
基金
国家自然科学基金项目(82274637),项目负责人:丁宇。
关键词
高位腰椎管狭窄症
脊柱内镜
椎管减压术
生物力学
有限元分析
upper lumbar spinal stenosis
spinal endoscopy
decompression surgery
biomechanics
finite element analysis
