Matsukawa Keitaro, Yato Yoshiyuki, Imabayashi Hideaki, Hosogane Naobumi, Asazuma Takashi, Chiba Kazuhiro
Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama; and.
Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan.
J Neurosurg Spine. 2016 Jun;24(6):910-5. doi: 10.3171/2015.11.SPINE15926. Epub 2016 Feb 19.
OBJECTIVE In the management of isthmic spondylolisthesis, the pedicle screw system is widely accepted surgical strategy; however, there are few reports on the biomechanical behavior of pedicle screws in spondylolytic vertebrae. The purpose of the present study was to compare fixation strength between pedicle screws inserted through the traditional trajectory (TT) and those inserted through a cortical bone trajectory (CBT) in spondylolytic vertebrae by computational simulation. METHODS Finite element models of spondylolytic and normal vertebrae were created from CT scans of 17 patients with adult isthmic spondylolisthesis (mean age 54.6 years, 10 men and 7 women). Each vertebral model was implanted with pedicle screws using TT and CBT techniques and compared between two groups. First, fixation strength of a single screw was evaluated by measuring axial pullout strength. Next, vertebral fixation strength of a paired-screw construct was examined by applying forces simulating flexion, extension, lateral bending, and axial rotation to vertebrae. RESULTS Fixation strengths of TT screws showed a nonsignificant difference between the spondylolytic and the normal vertebrae (p = 0.31-0.81). Fixation strength of CBT screws in the spondylolytic vertebrae demonstrated a statistically significant decrease in pullout strength (21.4%, p < 0.01), flexion (44.1%, p < 0.01), extension (40.9%, p < 0.01), lateral bending (38.3%, p < 0.01), and axial rotation (28.1%, p < 0.05) compared with those in the normal vertebrae. In the spondylolytic vertebrae, no statistically significant difference was observed for pullout strength between TT and CBT (p = 0.90); however, the CBT construct showed lower vertebral fixation strength in flexion (39.0%, p < 0.01), extension (35.6%, p < 0.01), lateral bending (50.7%, p < 0.01), and axial rotation (59.3%, p < 0.01) compared with the TT construct. CONCLUSIONS CBT screws are less optimal for stabilizing the spondylolytic vertebra due to their lower fixation strength compared with TT screws.
目的 在峡部裂型腰椎滑脱症的治疗中,椎弓根螺钉系统是广泛接受的手术策略;然而,关于椎弓根螺钉在峡部裂椎体中的生物力学行为的报道较少。本研究的目的是通过计算机模拟比较在峡部裂椎体中经传统轨迹(TT)置入的椎弓根螺钉与经皮质骨轨迹(CBT)置入的椎弓根螺钉之间的固定强度。方法 从17例成人峡部裂型腰椎滑脱症患者(平均年龄54.6岁,男10例,女7例)的CT扫描中创建峡部裂椎体和正常椎体的有限元模型。每个椎体模型采用TT和CBT技术植入椎弓根螺钉,并在两组之间进行比较。首先,通过测量轴向拔出力评估单枚螺钉的固定强度。其次, 通过对椎体施加模拟前屈、后伸、侧弯和轴向旋转的力来检查双螺钉结构的椎体固定强度。结果 TT螺钉在峡部裂椎体和正常椎体之间的固定强度无显著差异(p = 0.31 - 0.81)。与正常椎体相比,峡部裂椎体中CBT螺钉的拔出强度(21.4%,p < 0.01)、前屈(44.1%,p < 0.01)、后伸(40.9%,p < 0.01)、侧弯(38.3%,p < 0.01)和轴向旋转(28.1%,p < 0.05)的固定强度在统计学上显著降低。在峡部裂椎体中,TT和CBT之间的拔出强度无统计学显著差异(p = 0.90);然而,与TT结构相比,CBT结构在椎体前屈(39.0%,p < 0.01)、后伸(35.6%,p < 0.01)、侧弯(50.7%,p < 0.01)和轴向旋转(59.3%,p < 0.01)时显示出较低的椎体固定强度。结论 与TT螺钉相比,CBT螺钉固定强度较低,因此在稳定峡部裂椎体方面不太理想。
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