medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-14-38-56medsovet-7020Research ArticleНЕВРОЛОГИЯNEUROLOGYВозможности персонализированного конечно-элементного сегментарного анализа шейного отдела позвоночника для прогнозирования течения дорсопатииPossibilities of personalized finite element segmental analysis of the cervical spine for predicting the course of dorsopathyhttps://orcid.org/0000-0002-8435-7562ЯковлевЕ. В.YakovlevE. V.

Яковлев Евгений Васильевич, кандидат медицинских наук, заведующий неврологическим отделением, Медицинский центр «Адмиралтейские верфи»; исполняющий обязанности заведующего кафедрой психофизиологии, Институт прикладного психоанализа и психологии Университета при Межпарламентской Ассамблее ЕврАзЭС; доцент кафедры фундаментальных медицинских дисциплин, Московский государственный областной университет

190121, Санкт-Петербург, ул. Садовая, д. 126,

199226, Санкт-Петербург, Галерный проезд, д. 3,

105005, Москва, ул. Радио, д.  10А, стр. 1

Evgeny V. Yakovlev, Cand. Sci. (Med.), Head of the Neurological Department, Medical Center “Admiralteyskie Verfi”; Acting Head of the Department of Psychophysiology, Institute of Applied Psychoanalysis and Psychology of the University under the Interparliamentary Assembly of the EurAsEC; Associate Professor of the Department of Fundamental Medical Disciplines, Moscow State Regional University

126, Sadovaya St., St Petersburg, 190121,

3, Galerniy Proezd, St Petersburg, 199226,

10A, Bldg. 1, Radio St., Moscow, 105005

vmeda-ev@mail.ruhttps://orcid.org/0000-0002-4050-214XОвсепьянА. Л.OvsepyanA. L.

Овсепьян Артур Левонович, биомедицинский инженер

197022, Санкт-Петербург, ул. Инструментальная, д. 2

Artur L. Ovsepyan, Biomedical Engineer

2, Instrumentalnaya St., St Petersburg, 197022

aqturovsepyan@gmail.comhttps://orcid.org/0000-0003-0363-102XЖиволуповС. А.ZhivolupovS. A.

Живолупов Сергей Анатольевич, доктор медицинских наук, профессор, профессор кафедры нервных болезней

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Sergey A. Zhivolupov, Dr. Sci. (Med.), Professor, Professor of the Department of Nervous Diseases

6, Akademik Lebedev St., St Petersburg, 194044

peroslava@yandex.ruhttps://orcid.org/0000-0002-2661-3759СмирновА. А.SmirnovA. A.

Смирнов Александр Александрович, кандидат медицинских наук, доцент, заведующий кафедрой фундаментальных медицинских дисциплин

105005, Москва, ул. Радио, д. 10А, стр. 1

Alexander A. Smirnov, Cand. Sci. (Med.), Associate Professor, Head of the Department of Fundamental Medical Disciplines

10A, Bldg. 1, Radio St., Moscow, 105005

savmeda@yandex.ruhttps://orcid.org/0000-0001-9671-462XГневышевЕ. Н.GnevyshevE. N.

Гневышев Евгений Николаевич, кандидат медицинских наук, начальник неврологического отделения, 3-й военный госпиталь войск национальной гвардии РФ; доцент кафедры психофизиологии, Институт прикладного психоанализа и психологии Университета при Межпарламентской Ассамблее ЕврАзЭС

192171, Санкт-Петербург, ул. Цимбалина, д. 13,

199226, Санкт-Петербург, Галерный проезд, д. 3

Evgeniy N. Gnevyshev, Cand. Sci. (Med.), Head of the Neurological Department, 3rd Military Hospital of the Russian National Guard Troops; Associate Professor of the Department of Psychophysiology, Institute of Applied Psychoanalysis and Psychology of the University under the Interparliamentary Assembly of the EurAsEC

13,  Tsimbalin St., 192171, St Petersburg,

3, Galerniy Proezd, St Petersburg, 199226

evg-gnevyshev@yandex.ruМедицинский центр «Адмиралтейские верфи»; Институт прикладного психоанализа и психологии Университета при Межпарламентской Ассамблее ЕврАзЭС; Московский государственный областной университетРоссияMedical Center “Admiralteyskie Verfi”; Institute of Applied Psychoanalysis and Psychology of the University under the Interparliamentary Assembly of the EurAsEC; Moscow State Regional UniversityRussian FederationСанкт-Петербургский государственный электротехнический университет «ЛЭТИ» имени В.И. Ульянова (Ленина)РоссияSt Petersburg State Electrotechnical University “LETI” named after V.I. Ulyanov (Lenin)Russian FederationВоенно-медицинская академии имени С.М. КироваРоссияMilitary Medical Academy named after S.M. KirovRussian FederationМосковский государственный областной университетРоссияMoscow State Regional UniversityRussian FederationИнститут прикладного психоанализа и психологии Университета при Межпарламентской Ассамблее ЕврАзЭС; 3-й военный госпиталь войск национальной гвардии РФРоссияInstitute of Applied Psychoanalysis and Psychology of the University under the Interparliamentary Assembly of the EurAsEC; 3rd Military Hospital of the Russian National Guard TroopsRussian Federation2022100820220143856Copyright © Яковлев Е.В., Овсепьян А.Л., Живолупов С.А., Смирнов А.А., Гневышев Е.Н., 20222022Яковлев Е.В., Овсепьян А.Л., Живолупов С.А., Смирнов А.А., Гневышев Е.Н.Yakovlev E.V., Ovsepyan A.L., Zhivolupov S.A., Smirnov A.A., Gnevyshev E.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7020Введение

Введение. Применение методов математического моделирования в клинической практике позволяет идентифицировать патогенетические формы дорсопатий и тем самым обоснованно использовать концепцию таргетного лечения при ведении пациентов данной категории.

Цель – оценить возможности конечно-элементного сегментарного анализа шейного отдела позвоночника для персонализированного лечения и прогнозирования течения дорсопатий.

Материалы и методы

Материалы и методы. На основании сочетанных данных компьютерной и магнитно-резонансной томографии пациента (женщина 1951 года рождения) генерировалась модель сегмента C5 – C7, включающая позвонки C5, C6, C7, межпозвонковые диски, переднюю и заднюю продольные связки, две пары фасеточных суставов, спинной мозг, выйную связку. Средствами компьютерного моделирования и методом конечных элементов проводился анализ напряженно-деформированного состояния шейного отдела позвоночника пациента с дегенеративно-дистрофическими изменениями в сегментах C2 – C7. В программном обеспечении Abaqus/CAE 6.14 проводился конечно-элементный анализ напряженно-деформированного состояния C5 – C7 в состоянии флексии, ротации и компрессии. Полученные при компрессии данные для нормы сравнивались с ранее проведенными экспериментами in silico и in vitro.

Результаты

Результаты. Для каждого состояния получены эпюры напряжений и перемещений, кривые «нагрузка – перемещение», профили напряжений в межпозвонковых дисках. Осевая подвижность сегмента при компрессионной нагрузке ниже в  два раза в сравнении с нормой при тех же граничных условиях и моделях материалов. Исследована степень вовлеченности спинного мозга в конфликты с окружающими его анатомическими структурами. При повороте модели вправо наблюдались конфликты корешков спинного мозга с костными структурами позвонков в фораминальных зонах, а также на уровне дисков С5 – С6 и  С6 – С7 с левыми заднебоковыми поверхностями фиброзных колец. При повороте модели влево наблюдались конфликты спинного мозга во всех фораминальных зонах, а также на уровне диска С6 – С7 с левыми заднебоковыми поверхностями фиброзных колец. На основании данных о напряжениях в исследуемом сегменте прогнозировалось дальнейшее развитие дорсопатий и дегенеративных изменений в шейном отделе позвоночника.

Выводы

Выводы. Использование конечно-элементного сегментарного анализа шейного отдела позвоночника создает объективные предпосылки для формирования комбинированного персонализированного лечения и прогнозирования течения дорсопатий.

Introduction

Introduction. The use of mathematical modeling methods in clinical practice will make it possible to identify the pathogenetic forms of dorsopathies and thus reasonably use the concept of targeted treatment in the management of patients of this category.

Aim

Aim. To evaluate the possibilities of finite element segmental analysis of the cervical spine for personalized treatment and prediction of the course of dorsopathies.

Material and methods

Material and methods. Based on the combined data of computed and magnetic resonance imaging of the patient (female, born in 1951), a model of the C5 – C7 segment was generated, including: vertebrae C5, C6, C7, IVD, anterior and posterior longitudinal ligaments, two pairs of facet joints, spinal cord, nuchal ligament. Computer modeling and finite element method were used to  analyze the stress-strain state of the cervical spine of a patient with degenerative-dystrophic changes in the C2 – C7 segments. In the Abaqus/CAE 6.14 software, finite element analysis of the C5 – C7 stress-strain state was carried out in the state of flexion, rotation and compression. The data obtained during compression were compared with previous experiments in silico and in vitro for the norm.

Results

Results. For each state, stress and displacement diagrams, load-displacement curves, stress profiles in the MPD were obtained. The axial mobility of the segment under compressive load is two times lower compared to the norm under the same boundary conditions and material models. The degree of involvement of the spinal cord in conflicts with the surrounding anatomical structures was studied. When the model was rotated to the right, conflicts were observed between the spinal cord roots and the bone structures of the vertebrae in the foraminal zones, as well as at the level of the C5 – C6 and C6 – C7 discs with the left posterolateral surfaces of the fibrous rings. When the model was turned to the left, conflicts of the spinal cord were observed in all foraminal zones, as well as at the level of the C6 – C7 disc with the left posterolateral surface of the fibrous rings. Based on the data on stresses in the studied segment, further development of dorsopathies and degenerative changes in the cervical spine was predicted.

Conclusions

Conclusions. The use of finite element segmental analysis of the cervical spine creates objective prerequisites for the formation of a combined personalized treatment and prediction of the course of dorsopathies.

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The authors declare that there are no conflicts of interest present.