应用有限元分析椎体成形术两种注射骨水泥方法生物力学变化.docVIP

应用有限元分析椎体成形术两种注射骨水泥方法的生物力学 【摘要】 目的 用有限元分析椎体成形术退针注射的方法的生物力学效果。方法采用的原始影像来自一位男性患者，70岁，L1椎体骨质疏松性疼痛， 患者伤椎实施了椎体成形术，椎体成形术采用单侧入路，进针点选择左侧椎弓根近中心部位，内倾角度为24.5°，采用退针注射法注射。先将针穿刺到达椎体的前中1/3部位，注射骨水泥3ml，然后缓慢向后退针至椎体的1/2部位，并停留3分钟，然后注射剩余剂量的2ml，再退针到椎体的中后1/3部位进行注射1ml。然后和采用传统的将全部6ml骨水泥一次性注入椎体中前1/3的方法进行对比（模拟）获取椎体L1~L2节段断层图像，建立有限元模型，施加负荷，进行生物力学分析。结果退针注射法注射骨水泥，较传统的一次性注射法有更好的生物力学分布 结论退针注射法注射骨水泥由值得在临床上推广应用。 【关键词】椎体成形术；退针注射 穿刺 传统注射 [Abstract] objective to use a validated finite element mordel to evaluate the stress distribution of the vertebro bodies after vertebroplasty by needle withdraw way, methods the primary imagine is from a –seventy-old man,and his L1 is osteoporosisand painful. .the patient is given operation in the injuried vertebrae by onelateral,the needing point is in the left central of lateral mass of vertebrae, introversion angle is 24.5°,using withdraw way.first ]puncture the neelde to the front one third,and inject 3ml bone cement in,and withdraw the needle to the middle of the vertebrae,staying 3 minits,and then inject 2 ml bone cement, and then withdraw the needle to the hind 1/3 of the body,injecting 1 ml in it. Contrasting with the way inject the all 6 ml bone cement one time in the front 1/3,which is the tradition way （simulate）and get L1~L2 fault image, getting a validated finite element mordel,exerting urge , and evaluate the stress distribution of the vertebro bodies.result the way using withdraw way inject has better stress distribution. Conclusion the withdraw way injecting bone cement should be generalized clinically. Key words percutaneous vertebroplasty; needle withdraw puncture tradition way 0引言 椎体成形术是一种微创手术，是通过椎弓根向椎体内注入骨水泥，以达到固定骨折 及矫正椎体变形的疗效，同时有止痛作用，使患者早日恢复日常生活。是用来治疗骨质疏松症脊柱骨折和椎体溶骨性破坏的最有效方法。其优点为伤口较小、步骤简单、可在局麻下完成，而且费用低廉。1987年,法国放射学家Galibert等[1]首先采用了经皮穿刺椎体后注射骨水泥治疗1例C2椎体侵袭性海绵状血管瘤,取得了意想不到的镇痛效果。1990年Galibert[2]首次将其应用于骨质疏松症所致的压缩性骨折并取得了惊人的疗效。此后该技术得到广泛的应用。但生物力学研究表明在注入骨水泥后单个骨质疏松椎体的硬度和强度有很大的增长[3-4] ，由于过量的骨水泥易引起渗漏，而导致并发症的发生,并且由于骨水泥注射后应力的增加，相临椎体骨折的现象时有发生，所以应该