颈椎后路正中经棘突椎管劈开术椎管空间的解剖测量及撑开应力的有限元分析

doi:10.3760/cma.j.cn101202-20221011-00307

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摘要目的探讨颈椎后路正中经棘突椎管劈开术椎管空间解剖学特点及撑开应力的有限元分析。方法选取2020年11月扬州大学临床医学院体检中心行颈部CT检查者5人,其中男3人、女2人,年龄26~35（30.0±3.4）岁。将5例受检者颈椎CT图像资料导入Mimics 17.0及Geomagic Studio 10.0软件构建颈椎C₃~C₆几何模型。应用SolidWorks 2017软件完成皮质骨、松质骨的匹配后,模拟颈椎后正中经棘突椎管劈开术,将颈椎C₃~C₆棘突椎板劈开2 mm宽的截骨窗口。用Ansys 19.0软件对C₃~C₆椎管劈开几何模型进行网格划分、赋予材料属性,建立C₃~C₆椎骨后路正中经棘突椎管劈开三维有限元模型。在三维有限元模型中,分别对C₃~C₆颈椎劈开截面施加向外撑开的应力,撑开至棘突椎板基底部裂缝宽度为10 mm时,观察以下指标：（1）将C₃~C₆颈椎分为椎体、椎弓、侧块、椎板、棘突5个区域,分析C₃~C₆颈椎在棘突椎板基底部裂缝宽度为10 mm时各区域应力分布及变形情况;（2）比较C₃~C₆椎骨不同区域在棘突基底部撑开10 mm时所需撑开应力的差异;（3）测量比较C₃~C₆棘突长度,不同椎骨在棘突椎板基底部撑开10 mm时椎管的最大可视范围、最大可视角;（4）分析颈椎棘突长度与最大可视范围及最大可视角度的相关性。结果（1）颈椎C₃~C₆在棘突椎板撑开10 mm时应力分布情况趋于一致,椎骨应力分布由大到小依次为椎弓区域、椎板区域、椎体区域、侧块区域、棘突区域;棘突椎板撑开10 mm时在棘突、椎板区域变形较大,侧块、椎弓及椎体区域变形较小。（2）颈椎C₃~C₆棘突椎板撑开10 mm时应力分别为（34.5±3.6）、（28.6±2.3）、（24.8±2.1）、（25.7±2.3）MPa,C₃撑开应力大于C₄、C₅、C₆,差异有统计学意义（F=13.77,P<0.001）。（3）颈椎C₃~C₆棘突长度分别为（15.1±1.5）、（17.3±2.0）、（18.3±2.5）、（27.9±3.0） mm,C₆棘突长度大于C₃、C₄、C₅,差异有统计学意义（F=29.80,P<0.001）;颈椎C₃~C₆最大可视范围分别为（25.0±2.0）、（24.5±1.7）、（22.8±1.2）、（20.7±0.7） mm,C₃、C₄、C₅最大可视范围均大于C₆,差异有统计学意义（F=9.39,P<0.001）;颈椎C₃~C₆最大可视角分别为75.6°±1.6°、75.6°±2.4°、68.5°±6.5°、53.4°±1.7°,C₃、C₄最大可视角大于C₅、C₆,C₅最大可视角大于C₆,差异有统计学意义（F=40.99,P<0.001）。（4）颈椎棘突长度与最大可视范围、最大可视角度均呈负相关,差异均有统计学意义（r=-0.96,-0.97,P值均<0.05）。结论颈椎C₃~C₆在棘突椎板撑开10 mm时椎弓、椎板承受较大撑开应力,其中C₃所需撑开应力大于C₄、C₅、C₆。椎骨最大变形在棘突、椎板区域,C₃、C₄、C₅较C₆可获得更好的可视范围及可视角度,棘突长度与最大可视范围及最大可视角度存在相关性。

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	黄吉军
	张恒柱
	王永祥
	张文东

关键词 ：颈椎, 解剖, 有限元分析, 生物力学, 椎管劈开术

Abstract：Objective This study aimed to investigate the spinal canal space characteristics and the finite element analysis of the distraction stress of the posterior cervical median spinous process splitting laminectomy. Method Five patients who underwent cervical CT examination at the Clinical Medical College of Yangzhou University Physical Examination Center in November 2020 were selected. There were three males and two females, aged from 26 to 35 (30.0±3.4) years. The cervical CT image data of five patients have been imported into Mimics 17.0 and Geomagic Studio 10.0 software to establish the geometric models of C₃-C₆ vertebrae. The Solidworks 2017 software was used to complete the matching of cortical and cancellous bones. The modes were performed 2 mm sagittal longitudinal splitting on the spinous process and lamina to simulate posterior cervical median spinous process splitting laminectomy. Then, the geometry models of C₃-C₆were meshed, assigned material properties, and the three-dimensional finite element model was established with Ansys 19.0 software. Outward distraction stresses were applied to each cervical split section of the finite modes. The gap width at the bottom of the spinous process base was set as 10 mm The following indicators were observed: (1) The C₃-C₆vertebrae were divided into five regions: vertebral body, pedicle, lateral mass, lamina, and spinous process regions. The stress distribution and strain of C₃-C₆ vertebrae were analyzed when the gap width at the base of the spinous process was 10 mm. (2) The stretching stress of C₃-C₆ was compared when the gap width at the base of the spinous process was 10 mm. (3) The length of spinous processes of C₃-C₆ were measured and compared. The maximum visual range and maximum visual angle of the spinal canal were compared as the gap of the base of the spinous process was 10 mm. (4) The correlation between the length of the spinous process, the maximum visible range, and the maximum visual angle was analyzed. Results (1) The stress distribution of C₃-C₆ vertebrae tended to be consistent when the spinous process and lamina were expanded by 10 mm. The stress distribution of the vertebral body was in the order of pedicle region > lamina region > vertebral body region > lateral mass region > spinous process region from large to small. When the spinous process and lamina were expanded by 10 mm, the deformation was larger in the spinous process and lamina region, whereas the deformation of lateral mass, vertebral arch, and vertebral body region was smaller. (2) The required distraction stresses of C₃-C₆ were (34.5±3.6), (28.6±2.3), (24.8±2.1), and (25.7±2.3)MPa, respectively. The stress required by C₃ was greater than C₄, C₅, and C₆. The difference was statistically significant (F=13.77, P<0.001). (3) The length of C₃-C₆ spinous processes were (15.1±1.5), (17.3±2.0), (18.3±2.5), and (27.9±3.0) mm, respectively. The C₆ spinous processes were longer than C₃, C₄, and C₅. The difference was statistically significant (F=29.80, P <0.001). The maximum visual range of each cervical vertebra was (25.0±2.0), (24.5±1.7), (22.8±1.2), and (20.7±0.7) mm. Moreover, C₃, C₄, and C₅could obtain a better visual range than C₆ with statistically significant differences (F=9.39, P<0.001). The maximum visual angles of each cervical vertebra were 75.6°±1.6°, 75.6°±2.4°, 68.5°±6.5°, and 53.4°±1.7°. Meanwhile, the maximum visual angle of C₃ and C₄were greater than C₅ and C₆, respectively. The maximum visual angle of C₅was greater than C₆. The difference was statistically significant (F=40.99, P<0.001). (4) The length of the cervical spinous process was negatively correlated with the maximum visible range and the maximum visible angle. The difference was statistically significant (r=-0.96, -0.97, all P values <0.05). Conclusion The pedicle and lamina of C₃-C₆ support the maximum stress when the process of spinous process lamina expands by 10 mm. The supporting stress required by C₃ is greater than C₄, C₅, and C₆. The largest deformation of the vertebrae is in the spinous process and lamina region. Moreover, C₃, C₄, and C₅can get a better visual range and visual angle than C₆. The length of the spinous process is correlated with the maximum visible range and the maximum visible angle.

Key words： Cervical vertebra Anatomy Finite element analysis Biomechanics Laminectomy

收稿日期: 2022-10-11

基金资助:国家自然科学基金（82072423）

通讯作者: 张恒柱, Email：zhanghengzhu@sina.com

引用本文:

黄吉军, 张恒柱, 王永祥, 张文东. 颈椎后路正中经棘突椎管劈开术椎管空间的解剖测量及撑开应力的有限元分析[J]. 中华解剖与临床杂志, 2023, 28(5): 332-337.
Huang Jijun, Zhang Hengzhu, Wang Yongxiang, Zhang Wendong. Anatomical measurement of spinal canal space and finite element analysis of distraction stress of the posterior cervical median spinous process splitting laminectomy. Chinese Journal of Anatomy and Clinics, 2023, 28(5): 332-337.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20221011-00307 或 http://www.cjac.com.cn/CN/Y2023/V28/I5/332

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