The Analysis Of Three-Dimensional Finite Element Biomechanics Post MED Operative And The Treatment Of Clinical Study In LDH Recurrence Operation

BackgroundLumbar disc herniation is one of the common lumbar disease of orthopedics in our clinical, they have a variety of ways in the treatment, the purpose of all the nucleus pulposus of intervertebral disc resection prominent, removal of a diseased part, the relief of nerve compression,pain and other symptoms. At present gradually popular minimally invasive MED operation is the Micro-endoscope discectomy abbreviation, is the posterior translaminar approach microendoscopic discectomy. Achieved good fusion with the same early clinical results in its minimally invasive condition, and widely spread. In the posterior decompression process, bony structure partially stabilized spine removed, with the passage of time, the postoperative clinical follow-up feedback found adjacent segment degeneration, intervertebral disc herniation and recurrence.This requires our research and analysis the way of existing operation method and conducts, find the root point and the operation way of targeted improvement, reduce the postoperative recurrence or relapse. Biomechanics research on the past depend on the measurement of the vitro, but complicated human internal environment, make we can not further measurement and research. But at present, with the development of computer technology, using computer CT scanning,3D reconstruction of computer software, the finite element partition assignment analysis, mechanical loading, stress analysis and simulation, the three-dimensional finite element method to study the displacement makes biomechanical research into in vitro simulation stage, and gradually become the hottest research. At the same time, we combine the clinical follow-up data, the clinical data of postoperative recurrence, the first operation whether there is defect causes or recurrence and its experiment results are compared and analyzed, factors of relapse prevention, and prevention of recurrence.PART1The rearch of 3D finite element analysis in the post lumbar disc herniation treatment of MEDObjectiveBy using the three-dimensional finite element method, through Mimics 10.0 and ANSYS 14.0 software to carry on the MED treatment of postoperative lumbar disc herniation spinal stability and biomechanics.Methods1. Select male, normal, healthy adult volunteers who have no lumbar disease, height 175cm, weight 70kg, respectively on the lumbar vertebrae were thin layer CT the 0.9mm scan, CT data obtained in DICOM format.2, By imported the model in Mimics 10.0 software for modeling, divide the surface mesh, building three-dimensional model, assignment the material,so thar we get the normal lumbar L4-5 vitro model includes intervertebr disc.3, Through Boolean shear function, simulation of L4-5 disc removal operation, establish the MED extraction operation model, small fenestration operation model and excise the facet operation model named A, B, C, D four groups.4, Imported the four group model into ANSYS 14.0 software for stress load simulation, obtains the corresponding Total displacement vector sum, the Total von Mises stress, and the The von Mises total mechanical strain,the statistical cloud data,by using the SPSS20.0 to analyse the data.Results1, Total displacement vector sum:on partial laminectomy, decompression laminectomy range increases with increase of displacement, spinal stability decreased overall. A group of normal spinal stability on both sides of the basic symmetry;B and C groups under stresses in posterior spinous process of increased movement; D group when excised articular process, L5 vertebral lamina and spinous process displacement decreased significantly, the stress caused by L4 resection of lateral transverse processes of the facet structure shift obviously abnormal, left and right balance, stability of spinal posterior structure affected.2, Total von Mises stress:The middle of the four group of normal spinal pressure distribution in spinal vertebral pedicle level. In B, C, D three groups of resection of intervertebral disc only numerical changes, stress concentration did not change significantly.3, The von Mises total mechanical strain:Intervertebral disc tissue under pressure were the most sensitive. The A group showed a pressure sensitive located at the trailing edge of intervertebral disc, B, C, D three groups of pressure sensitive in resection of intervertebral disc after the trailing edge fiber ring, the front edge of the sensitive subsided, with increasing the range of decompression, the pressure sensitive value increase.Conclusion1, The more smaller in the posterior decompression area the more smaller impact on the stability of the spine,the MED for the treatment of lumbar disc herniation surgery of spinal biomechanics impact is small, can obtain the long-term good biomechanical stability.2, The largest regional spinal pressure intermediate distribution in spinal vertebral pedicle level, vertebral posterior structure resection, and little effect.3,Reduce the postoperative lumbar disc herniation laminectomy recurrence should reduce the scope and reduce intraoperative annulus incision range, total removal of nucleus pulposus, and as far as possible carries on the protection to the lamina and fiber ring, avoid the stress concentration on the "break", to reduce the recurrence of purposePART 2 Clinical study of MED in the treatment of recurrent postoperative lumbar disc herniationObjective:To study the clinical efficacy of MED treatment of recurrent postoperative lumbar disc herniation.Methods:In our hospital form 2003 June to 2013 June within 10 years therer were 61 cases patients diagnosis of recurrent postoperative lumbar disc herniation and according to the therapeutic operation mode, divided into two groups. The observation group 23 cases of MED patients as control group operation, a posterior arthrodesis for patients of 38 cases. The two operation two sets of statistics methods for the treatment of bleeding volume, operation time and postoperative JOA score, VAS score, statistical analysis was performed using spss20.0.Results:23 cases in observation group and 38 cases in the control group in the bleeding volume, operation time had significant difference, but the postoperative JOA score and VAS score no significant differences.Conclusion:The clinical effect of MED recurrence mid treatment of lumbar disc herniation postoperative satisfaction, and the technology will become more hot and more important focus on the development of spine surgery.