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요추부 척추관 협착증 치료를 위한 요추부 극돌기 삽입술의 추간판 내 압력 분포 변화에 관한 생체역학적 분석
권순영(Soon-Yong Kwon),전성철(Sung-Chul Jun),문수정(Soo-Jung Moon),탁계래(Gye-Rae Tack),이성재(Sung-Jae Lee),신규철(Kyu-Cheol Shin) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.6
목적: 요추부 척추관 협착증 치료를 위한 여러 형태의 요추부 극돌기 spacer 중 가장 초기 형태인 골시멘트 spacer 삽입에 따른 추간판의 생체역학적 압력 변화를 분석하고자 하였다. 대상 및 방법: 시편으로는 생후 2주일 미만의 송아지 요추 다분절 (Ll-L5) 6개를 이용하였다. 각각 3개의 시편을 정상군과 요추 3-4번 극돌기 사이에 골시멘트 12 mm 원형 spacer를 삽입한 시술군으로 구분하였다. 압축 하중 (700 N) 및 신전 하중 (700 N+7.5 Nm) 하에서 압력센서를 이용하여 정상군과 시술군의 요추 2-3번, 3-4번, 4-5번 사이의 전방 섬유륜, 수핵, 후방 섬유륜, 후측방 섬유륜에서의 압력을 측정하였다. 결과: 정상 시편의 경우 압축 하중에 비해 신전 하중 시 후방 부위 섬유륜내의 압력이 증가하는 양상을 나타내었다. 그리고 spacer를 삽입한 후 압축 하중 및 신전 하중에서 인접한 추간판(L2-L3, L4-L5)의 압력 변화는 정상군과의 비교 시 통계학적으로 유의한 차이를 보이지 않았다(p>0.05). 하지만 신전 하중 하에서, 정상군의 요추 3-4번 사이의 수핵, 정 후방 섬유륜, 후 측방 섬유륜에서의 압력이 l.48±0.27 MPa, l.42±0.21 MPa, 1.71±0.56 MPa로 나타난 것에 비해, 시술 후 압력이 1.11±0.18 MPa, 0.96±0.31 MPa, 1.08±0.14 MPa로, 수핵의 경우 25%, 정 후방 섬유륜에서는 31.7%, 후 측방 섬유륜에서는 36.8%의 감소율을 보였고, 통계학적인 유의한 차이를 나타내었다(p<0.05). 결론: 신전 하중 하에서의 압력의 감소 효과는, 요추부의 신전을 유발하는 자세에 따라 증상이 나타나는 요추부 척추관 협착증의 원인으로 알려진 추간판의 팽륜의 감소를 유발할 것으로 사료된다. 또한 기존 내고정 장치를 이용한 시술 부위의 너무 강한 융합은 인접한 추간판에서의 퇴행화를 가속화 시킨다고 보고 되었다. 또한 시술 후 인접한 추간판내 압력의 경우 정상군의 결과와 유의한 차이가 없었으며, 이는 spacer의 삽입술이 인접한 추간판의 생체 역학적 역할에 변화를 유발하지 않을 것으로 사료된다. Purpose: To assess the biomechanical effects and effectiveness of an interspinous spinal spacer (ISS) on the intradiscal pressure using in vitro biomechanical tests. Materials and Methods: Six calf spine specimens (less than 2 weeks of age, L1-L5) were divided to two groups the intact and the surgery groups (n=3 each). For the surgery group, an ISS made from PMMA (Greek pi=12-mm) were inserted into the space between the spinous processes of L3-L4. The intradiscal pressures at the various regions of the annulus (anterior, posterior, and posterolateral locations) and the nucleus pulposus were measured using the four pressure transducers under pure compression (700 N) and extension loads (700 N+7.5 Nm). Results: An increase in pressure was observed from neutral to extension at the posterior and posterolateral annulus. After inserting the ISS, the changes in pressure at the adjacent disc levels (L2-L3, L4-L5) were negligible regardless of the loading conditions (p>0.05). However, at the implanted level (L3-L4) statistically significant changes in the pressure were found under extension loading at the nucleus pulposus, posterior and posterolateral regions of the annulus with a pressure drop from 1.48 MPa, 1.42 MPa, 1.71 MPa to 1.11 MPa, 0.961 MPa, 1.08 MPa, at the respective locations (p<0.05). The relative percentage decrease were 25%, 31.7%, and 36.8%. Conclusion: On the implanted level, these results showed that the insertion of the ISS with PMMA can effectively reduce the intradiscal pressures by at least 25% quite uniformly over the intraver-tebral disc during extension. More effective reduction was observed at the posterolateral location. The pressure changes at the adjacent levels were negligible in contrast to the abnormal pressure changes that are frequently reported after conventional rigid fusion. This suggests that the likelihood of adjacent level degeneration after surgery can be minimized using the ISS insertion.
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요추부 협착증 치료를 위한 극돌기 삽입술의 생체역학적 효과 분석
이희성,첸웬밍,송동률,권순영,이권용,이성재,Lee Hui-Sung,Chen Wen Ming,Song Dong-Ryul,Kwon Soon-Young,Lee Kwon-Yong,Lee Sung-Jae 대한의용생체공학회 2006 의공학회지 Vol.27 No.5
Many types of interspinous distraction devices (IDDs) have been recently developed as an alternative surgical treatment to laminectomy and fusion with pedicle screws for the treatment of the lumbar spinal stenosis (LSS). They are intended to keep the lumbar spine in a slightly flexed posture to relieve pain caused by narrowing of the spinal canal and vertebral foramen. However, their biomechanical efficacies are not well known. In this study, we evaluated the kinematic behaviors and changes in intradiscal pressure (IDP) of the porcine lumbar spine implanted with IDD. For kinematics analysis, five porcine lumbar spines (L2-L6) were used and the IDD was inserted at L4-L5. Three markers (${\phi}{\le}0.8mm$) were attached on each vertebra to define a rigid body motion for stereophotogrammetric assessment of the spinal motion in 3-D. A moment of 7.5Nm in flexion-extension, lateral bending, and axial rotation were imparted with a compressive force of 700N. Then, IDD was implanted at L3-L4. IDPs were measured using pressure transducer under compression (700N) and additional extension moment (700N+7.5Nm). In kinematic behaviors, insertion of IDD resulted in statistically significant decrease 42.8% at the implanted level in extension. There were considerable changes in ROM at the adjacent levels, but statistically insignificant. In other motions, there were no significant changes in ROM as well regardless of levels. IDPs at the surgical level (L3-L4) under compression and extension moment decreased by 12.9% and 18.8% respectively after surgery (p<0.05). At the superiorly adjacent levels, IDPs increased by 19.4% and 12.9% under compression and extension, respectively (p<0.05). Corresponding changes at the inferiorly adjacent levels were 29.4% and 6.9%, but they were statistically insignificant (p>0.05). The magnitude of pressure changes due to IDD, both at the operated and adjacent levels, were far less than the previously reported values with conventional fusion techniques. Our experimental results demonstrated the IDDs can be very effective in limiting the extension motion that may cause narrowing of the spinal canal and vertebral foramens while maintaining kinematic behaviors and disc pressures at the adjacent levels.
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Development of L4-L5 Lumbar Spine Finite Element Model to Estimate Spine Loads
조민혜(Minhye Jo),채수원(Soo-Won Chae) Korean Society for Precision Engineering 2021 한국정밀공학회지 Vol.38 No.6
Low back injury (LBI) often occurs during manual materials handling (MMH). Intradiscal pressure (IDP) is used to assess the risk of the LBI and is measured in vivo or by computer simulation. As for computer simulation, motion analysis and finite element (FE) analysis are usually employed. In this study, a FE model has been developed for L4-L5 segment with high risk of injury to predict LBI during manual lifting tasks. The FE model was composed of lumbar vertebrae, discs, and ligaments and a calibration process was performed to set the nonlinear material properties of the intervertebral disc. To validate the developed FE model, IDP and range of motion (ROM) under in vitro loading conditions were compared to the experiments and other FE studies in literature. Within in vitro range, IDP and ROM from the FE model were in agreement with results from previous studies. The FE model developed in this study can be scaled according to the subject used in the analysis integrating FE analysis to motion analysis, and is expected to be used in future work to estimate IDP and stress/strain in joint structures during occupational activities.
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