Zhao Wen-Tao, Qin Da-Ping, Zhang Xiao-Gang, Wang Zhi-Peng, Tong Zun
Gansu University of Chinese Medicine, No. 35, Dingxi East Rd., Chengguan District, Lanzhou, 730000, Gansu Province, People's Republic of China.
Yunnan University of Traditional Chinese Medicine, No. 1076, Yuhua Rd., Chenggong District, Kunming, 650500, Yunnan Province, People's Republic of China.
J Orthop Surg Res. 2018 Feb 8;13(1):32. doi: 10.1186/s13018-018-0733-1.
BACKGROUND: Clinical results have shown that different vertebral heights have been restored post-augmentation of osteoporotic vertebral compression fractures (OVCFs) and the treatment results are consistent. However, no significant results regarding biomechanical effects post-augmentation have been found with different types of vertebral deformity or vertebral heights by biomechanical analysis. Therefore, the present study aimed to investigate the biomechanical effects between different vertebral heights of OVCFs before and after augmentation using three-dimensional finite element analysis. METHODS: Four patients with OVCFs of T12 underwent computed tomography (CT) of the T11-L1 levels. The CT images were reconstructed as simulated three-dimensional finite-element models of the T11-L1 levels (before and after the T12 vertebra was augmented with cement). Four different kinds of vertebral height models included Genant semi-quantitative grades 0, 1, 2, and 3, which simulated unilateral augmentation. These models were assumed to represent vertical compression and flexion, left flexion, and right flexion loads, and the von Mises stresses of the T12 vertebral body were assessed under different vertebral heights before and after bone cement augmentation. RESULTS: Data showed that the von Mises stresses significantly increased under four loads of OVCFs of the T12 vertebral body before the operation from grade 0 to grade 3 vertebral heights. The maximum stress of grade 3 vertebral height pre-augmentation was produced at approximately 200%, and at more than 200% for grade 0. The von Mises stresses were significantly different between different vertebral heights preoperatively. The von Mises stresses of the T12 vertebral body significantly decreased in four different loads and at different vertebral body heights (grades 0-3) after augmentation. There was no significant difference between the von Mises stresses of grade 0, 1, and 3 vertebral heights postoperatively. The von Mises stress significantly decreased between pre-augmentation and post-augmentation in T12 OVCF models of grade 0-3 vertebral heights. CONCLUSION: Vertebral augmentation can sufficiently reduce von Mises stresses at different heights of OVCFs of the vertebral body, although this technique does not completely restore vertebral height to the anatomical criteria.
背景：临床结果表明，骨质疏松性椎体压缩骨折（OVCFs）强化术后不同椎体高度得到了恢复，且治疗效果一致。然而，通过生物力学分析，尚未发现不同类型的椎体畸形或椎体高度在强化后的生物力学效应有显著差异。因此，本研究旨在使用三维有限元分析来研究OVCFs不同椎体高度在强化前后的生物力学效应。 方法：4例T12椎体骨质疏松性压缩骨折患者接受了T11-L1节段的计算机断层扫描（CT）。将CT图像重建为T11-L1节段（T12椎体用骨水泥强化前后）的模拟三维有限元模型。四种不同的椎体高度模型包括Genant半定量分级0、1、2和3级，模拟单侧强化。假设这些模型代表垂直压缩、屈曲、左侧屈曲和右侧屈曲载荷，并评估骨水泥强化前后不同椎体高度下T12椎体的von Mises应力。 结果：数据显示，术前T12椎体OVCFs在四种载荷下，从椎体高度分级0到分级3，von Mises应力显著增加。分级3椎体高度强化前的最大应力约为200%时产生，分级0时超过200%。术前不同椎体高度之间的von Mises应力有显著差异。强化后，T12椎体在四种不同载荷和不同椎体高度（分级0-3）下的von Mises应力显著降低。术后分级0、1和3椎体高度的von Mises应力之间无显著差异。分级0-3椎体高度的T12 OVCF模型在强化前和强化后的von Mises应力显著降低。 结论：椎体强化可以充分降低椎体OVCFs不同高度处的von Mises应力，尽管该技术不能将椎体高度完全恢复到解剖学标准。
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