Su Yunshan, Wang Xiongfei, Ren Dong, Liu Yueju, Liu Shaoming, Wang Pengcheng
Department of Orthopaedic Trauma Service Center, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China.
Medicine (Baltimore). 2018 Aug;97(34):e12046. doi: 10.1097/MD.0000000000012046.
The objective of this study was to use finite element models to investigate the biomechanics of stable thoracolumbar burst fracture repair using unilateral short-segment fixation and 4 alternate pedicle screw systems.Four posterior pedicle screw systems were compared for unilateral short-segment fixation using finite element models: intermediate bilateral short pedicle screw fixation, intermediate bilateral long pedicle screw fixation, intermediate unilateral short pedicle screw fixation, and intermediate unilateral long pedicle screw fixation. We compared range of motion (ROM), von Mises stresses on the implants, and stress on the intervertebral discs superior and inferior to the injured vertebra during simulated spinal movements.There were no significant differences in ROM, von Mises stress, or intervertebral disc stress among the 4 intermediate pedicle screw fixation techniques for all spinal movements evaluated. In addition, there were no consolidated trends depicting beneficial differences between the short and long screw models, or between the unilateral and bilateral screw models.ROM, von Mises stress, and intervertebral disc stress are the same across the 4, posterior short-segment fixation techniques evaluated using finite element models. The simplest technique-posterior short segment fixation combined with intermediate unilateral short pedicle screw fixation-is a feasible treatment strategy for stable thoracolumbar fracture.
本研究的目的是使用有限元模型，研究采用单侧短节段固定和4种替代椎弓根螺钉系统修复稳定型胸腰椎爆裂骨折的生物力学。使用有限元模型比较了4种后路椎弓根螺钉系统用于单侧短节段固定的情况：中间双侧短椎弓根螺钉固定、中间双侧长椎弓根螺钉固定、中间单侧短椎弓根螺钉固定和中间单侧长椎弓根螺钉固定。我们比较了模拟脊柱运动过程中植入物的活动范围（ROM）、von Mises应力以及损伤椎体上下椎间盘的应力。在所有评估的脊柱运动中，4种中间椎弓根螺钉固定技术在ROM、von Mises应力或椎间盘应力方面均无显著差异。此外，在短螺钉模型与长螺钉模型之间，或单侧螺钉模型与双侧螺钉模型之间，均未呈现出表明存在有益差异的一致趋势。在使用有限元模型评估的4种后路短节段固定技术中，ROM、von Mises应力和椎间盘应力是相同的。最简单的技术——后路短节段固定联合中间单侧短椎弓根螺钉固定——是治疗稳定型胸腰椎骨折的一种可行策略。
