The Finite Element Analysis Of The Lumbar Spine And The Evaluation Of Postoperative Rehabilitation Effect

Background and Object:Lumbar disc herniation(LDH)is one of the most important diseases that afflict human beings.With the progress of science and technology and technology innovation,percutaneous endoscopic excision of nucleus pulposus of lumbar spine(PELD)with its local anesthesia,small incision,quick recovery,as well as good prognosis in the clinical,yet there still exists controversy about the recovery,we need to solve postoperative complete reasonable rehabilitation concept,method,process and other issues.This topic proposed from the viewpoint of finite element analysis of biomechanics of normal people and patients with lumbar disc prolapse,and lumbar spine after minimally invasive surgery of lumbar modeling analysis,according to the biomechanics of space simulation,compare different biomechanics changes of the lumbar spine,thereby reflect the lumbar spinal biomechanical effects of the patients with minimally invasive surgery,postoperative patients get the basis of the weakened waist.In combination with this basis,we design a set of accord with Chinese characteristics,scientific and effective rehabilitation training method,grouping of patients and follow-up observations,which discuss the comprehensive rehabilitation training in percutaneous endoscopic excision of nucleus pulposus of lumbar spine(PELD)and the curative effect of postoperative treatment of lumbar intervertebral disc protrusion,guiding further treatment and rehabilitation.Methods:1.We established a three-dimensional model of the volunteers' lumbar vertebrae and assigned values to corresponding bones.2.Then we constructed the surface of the above model and established the cancellous bone model.3.Based on clinical measurement data,a lumbar disc herniation model was developed on the basis of normal intervertebral disc.4.Fixed the sacrum joint surface,applied axial pressure to the endplate of the corresponding vertebral body,and simulated the stress distribution of the adjacent vertebral endplates and intervertebral discs in the forward and backward flexion and left and right lateral flexion.5.Based on the principle of minimally invasive surgery of lumbar vertebrae,the model of lumbar intervertebral disc protrusion was simulated and the model was established.6.We applied mechanical load to the postoperative model and simulate stress distribution.7.The postoperative rehabilitation training scheme was designed according to the stress distribution of the finite element analysis.8.From Jul.2016 to Oct.2016,100 patients undergoing percutaneous endoscopic lumbar discectomy for herniated lumbar disc were assigned to the control group and experimental group(n=50 in each)randomly.Visual analog score(VAS),Oswestry Disability Index score(ODI),Timed up and go score(TUG)of low back pain and leg pain were collected preoperatively and once a week at consecutively postoperative 12 weeks.9.Finally,we followed up closely and collected data.Results:Visual analog score(VAS):The difference of low back pain of control group and experimental group between preoperative and postoperative 3 months[(5.8711.21)vs(1.28±0.51)]and[(5.73±0.78)vs(1.83±0.84)],were significant(P<0.05),and the data in each postoperative time points had statistical differences between experimental group and control group(P<0.05);The difference of leg pain of control group and experimental group between preoperative and postoperative 3 months[(8.13± 1.27)vs(1.36±0.71)]and[(7.96±0.63)vs(1.75±0.59)],were significant(P<0.05),and the data in each postoperative time points had statistical differences between experimental group and control group(P<0.05).Oswestry Disability Index score(ODI):The difference of control group and experimental group between preoperative and postoperative 3 months[(53.21 ± 12.2 8)vs(13.28±4.32)]and[(55.17± 13.60)vs(17.76±4.67)],were significant(P<0.05),and the data had statistical differences(P<0.05)between experimental group and control group from postoperative 10 days to postoperative 3 months.Timed up and go score(TUG):The difference of control group and experimental group between preoperative and postoperative 3 months[(15.46± 3.64)vs(7.25±2.30)]and[(16.13±3.89)vs(9.29±2.96)],were significant(P<0.05),and the data had statistical differences(P<0.05)between experimental group and control group from postoperative 3 days to postoperative 3 months.Conclusion:The comprehensive rehabilitation training improve the effect of percutaneous endoscopicsurgery on the treatment of lumbar disc herniation,the training can alleviate postoperative pain and promote patient's recovery.