發(fā)布時(shí)間：2018-04-02 22:12

  本文選題：退變性腰椎側(cè)凸　切入點(diǎn)：關(guān)節(jié)突關(guān)節(jié)　出處：《第二軍醫(yī)大學(xué)》2015年碩士論文

【摘要】：目的：通過影像學(xué)資料研究退變性腰椎側(cè)凸中關(guān)節(jié)突角度、關(guān)節(jié)突不對(duì)稱、脊柱-骨盆序列與椎體旋轉(zhuǎn)之間的關(guān)系。然后,基于正常并且得到驗(yàn)證的腰椎三維有限元模型建立個(gè)體化的退變性腰椎側(cè)凸有限元模型,對(duì)其進(jìn)行力學(xué)分析并探討腰椎關(guān)節(jié)突關(guān)節(jié)在退變性腰椎側(cè)凸發(fā)病過程中相關(guān)的生物力學(xué)機(jī)制研究。通過研究退變性腰椎側(cè)凸有限元模型中腰椎關(guān)節(jié)突關(guān)節(jié)的生物力學(xué)特性,為探討退變性腰椎側(cè)凸形成的相關(guān)生物力學(xué)機(jī)制及其演變過程提供思路,從而指導(dǎo)臨床工作。方法：選取60名具有站立位的全脊柱正側(cè)位片以及CT圖像的退變性腰椎側(cè)凸患者為研究對(duì)象。在正側(cè)位片上測(cè)量患者的Cobb角,骨盆入射角(pelvic incidence, PI)和腰椎前凸角(lumbar lordosis, LL)。通過CT橫斷面測(cè)量L3/4,L4/5和L5/S1雙側(cè)關(guān)節(jié)突角度。關(guān)節(jié)突不對(duì)稱定義為左、右側(cè)關(guān)節(jié)突角度相差大于10°。然后,為了建立個(gè)體化的退變性腰椎側(cè)凸三維有限元模型并研究其關(guān)節(jié)突關(guān)節(jié)的生物力學(xué)作用,我們首先將腰椎連續(xù)薄層CT平掃獲取得DICOM格式的數(shù)據(jù)導(dǎo)入建模軟件,建立腰椎正常三維有限元模型。我們基于臨床病人影像學(xué)資料將經(jīng)過驗(yàn)證的正常腰椎模型演變成三種不同彎曲程度的退變性腰椎側(cè)凸有限元模型(Cobb角10°-20°、20-30°、大于30°)。利用專業(yè)有限元軟件分析L1-L5雙側(cè)各個(gè)關(guān)節(jié)突關(guān)節(jié)相應(yīng)的受力情況。于L1椎體上施加400N的軸向載荷或是400N載荷結(jié)合5 N.m、10N.m以及15N.m的力矩。計(jì)算各個(gè)椎體雙側(cè)小關(guān)節(jié)受力特點(diǎn)。比較分析三個(gè)模型相應(yīng)關(guān)節(jié)突關(guān)節(jié)的應(yīng)力分布以及接觸應(yīng)力。觀察在退變性腰椎側(cè)凸演變過程中關(guān)節(jié)突關(guān)節(jié)的作用機(jī)制。結(jié)果：在Ⅰ型組和Ⅱ型組中,關(guān)節(jié)突不對(duì)稱發(fā)生率在L3/4(P=0.011), L4/5(P=0.043)以及L5/S1(P=0.004)存在明顯差異性。Ⅱ型退變性腰椎側(cè)凸LL值明顯小于Ⅰ型退變性腰椎側(cè)凸LL值(P=0.049)。而關(guān)節(jié)突角度、PI、LL在兩組中沒有統(tǒng)計(jì)學(xué)差異性。在兩組中,PI與LL均與相關(guān)性。通過有限元模型研究發(fā)現(xiàn)在退變性腰椎側(cè)凸中,關(guān)節(jié)突關(guān)節(jié)受力的改變除了與腰椎的運(yùn)動(dòng)情況相關(guān)外,還與彎曲的嚴(yán)重程度密切相關(guān)。退變性腰椎側(cè)凸發(fā)生以后,關(guān)節(jié)突關(guān)節(jié)存在壓縮、變性以及內(nèi)聚等改變,導(dǎo)致椎體更易發(fā)現(xiàn)旋轉(zhuǎn)脫位以及側(cè)方移位。當(dāng)側(cè)彎的腰椎進(jìn)行側(cè)彎運(yùn)動(dòng)時(shí),輕度彎曲的側(cè)凸腰椎中,凸側(cè)關(guān)節(jié)突應(yīng)力值均大于凹側(cè)關(guān)節(jié)突；而在中、重度彎曲的側(cè)凸腰椎中,凹側(cè)關(guān)節(jié)突關(guān)節(jié)受力明顯大于凸側(cè)。當(dāng)進(jìn)行旋轉(zhuǎn)運(yùn)動(dòng)時(shí),凸側(cè)關(guān)節(jié)突關(guān)節(jié)受到的張力明顯增大,而凹側(cè)關(guān)節(jié)突關(guān)節(jié)受到的壓縮力明顯減小。結(jié)論：在退變性腰椎側(cè)凸中,關(guān)節(jié)突不對(duì)稱是引起椎體旋轉(zhuǎn)的重要因素。并且,退變性腰椎側(cè)凸隨著LL的減小或消失出現(xiàn)相應(yīng)的神經(jīng)癥狀。退變性腰椎側(cè)凸使得關(guān)節(jié)突關(guān)節(jié)承載負(fù)荷不均勻。輕度彎曲時(shí),凸側(cè)關(guān)節(jié)突關(guān)節(jié)所受負(fù)荷較大；中度和重度彎曲時(shí),凹側(cè)關(guān)節(jié)突關(guān)節(jié)所受負(fù)荷較大。在退變性腰椎側(cè)凸中,腰椎應(yīng)力線偏向凸側(cè),凹側(cè)椎體通過壓縮變形調(diào)節(jié)腰椎的平衡,凸側(cè)關(guān)節(jié)突關(guān)節(jié)間隙增大導(dǎo)致腰椎不穩(wěn),關(guān)節(jié)突關(guān)節(jié)失去了維持椎體旋轉(zhuǎn)和側(cè)移的限制作用,椎體在腰椎承受負(fù)荷以后更容易向凸側(cè)旋轉(zhuǎn)半脫位且側(cè)向移位。關(guān)節(jié)突關(guān)節(jié)不平衡的受力引起腰椎出現(xiàn)力學(xué)失衡,最終導(dǎo)致退變性腰椎側(cè)凸發(fā)生、發(fā)展。
[Abstract]:Objective: To study the degree of joint angle of lumbar degenerative scoliosis by radiographs, facet asymmetry, spine pelvis sequence and vertebral rotation relation between. Then, the normal and degenerative lumbar lateral convex finite element model of individual three-dimensional finite element model of lumbar verification based on mechanical analysis on the biomechanical mechanism and research relevant in the pathogenesis of degenerative lumbar scoliosis of lumbar facet joints. The biomechanical properties of the finite element model of degenerative lumbar scoliosis of lumbar facet joint, to provide ideas for the study and evolution of biomechanical mechanism of lumbar degenerative scoliosis, so as to guide the clinical work. Methods: We selected 60 patients with standing full spine position radiographs and CT images of lumbar degenerative scoliosis patients as the research object. In the radiograph measurement The amount of patients with Cobb angle and pelvic incidence (pelvic incidence, PI) and lumbar lordosis (lumbar lordosis, LL). The CT L4/5 and L5/S1 L3/4 cross section measurement, bilateral facet angle. The facet asymmetry is defined as the left and right side facet angle difference greater than 10 degrees. Then, in order to three-dimensional finite element biomechanical effect the model of degenerative lumbar scoliosis and to study the establishment of individualized facet, we will first continuous lumbar CT scan to obtain software modeling data into DICOM format, the establishment of a three-dimensional finite element model of normal lumbar. Based on clinical and imaging data of our patients after normal lumbar model validation into three different bending degree the finite element model of degenerative lumbar scoliosis (Cobb angle 10 degrees -20 degrees, 20-30 degrees, more than 30 degrees). The force analysis of L1-L5 bilateral zygapophysial joints each corresponding using the professional finite element software The axial load conditions. 400N is applied to the L1 vertebral body or 400N load combined with 5 N.m 10N.m and 15N.m, the torque force characteristics calculation of each vertebral body. Bilateral facet. Comparative analysis of stress distribution and contact the three corresponding model of facet joint stress. To observe the mechanism of evolution in degenerative facet joints lumbar scoliosis. Results: in the group of type I and type II group, facet asymmetry in the incidence of L3/4 (P=0.011), L4/5 (P=0.043) and L5/S1 (P=0.004) had significant difference. Type II degenerative lumbar scoliosis LL value is significantly less than the type of degenerative lumbar scoliosis LL value (P=0.049) and joint. Angle, PI, LL had no significant difference in the two groups. In two groups, PI and LL were found in association with degenerative lumbar scoliosis. Through the study of the finite element model of facet joint stress change except the movement and lumbar spine related, It is closely related with the severity of bending. After the occurrence of degenerative lumbar scoliosis, facet joint degeneration and compression, cohesion and other changes, leading to more easily find vertebral rotatory dislocation and lateral displacement of lumbar scoliosis. When the lateral bending, slightly curved lumbar scoliosis, convex side facet stress value more than the concave side facet; and in severe bending of lumbar scoliosis, concave facet joint stress is significantly greater than the convex side. When the rotary motion, the convex side of the facet joint tension increases obviously, and the concave side facet was significantly reduced by the compression force closed section. Conclusion: in degenerative lumbar scoliosis, facet joint asymmetry is an important factor causing vertebral rotation. And degenerative lumbar scoliosis with LL decreased or disappeared and corresponding neurological symptoms. The facet joints of lumbar degenerative scoliosis bearing negative The Netherlands is not uniform. Slightly curved, convex side facet joints by large load; moderate and severe bending, concave side facet joints by load. In degenerative lumbar scoliosis, lumbar stress line bias the convex side, the concave side of the vertebral body through regulating the balance of lumbar compression deformation increases, the convex side facet joint space cause lumbar instability, limit the role of facet joint lost maintain vertebral rotation and lateral movement of the vertebral body more easily after lumbar load to the convex side of the lateral displacement and rotation subluxation. The facet joint unbalanced force is caused by lumbar mechanical imbalance, eventually leading to occurrence of degenerative lumbar scoliosis.

【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3;R318.01

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