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优化的卫星棒构建以减轻经椎弓根截骨术(PSO)后棒失败:有限元研究。

Optimal satellite rod constructs to mitigate rod failure following pedicle subtraction osteotomy (PSO): a finite element study.

机构信息

Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedics surgery, Colleges of Engineering and Medicine, University of Toledo, 5046 NI, MS 303, Toledo, OH 43606, USA.

Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedics surgery, Colleges of Engineering and Medicine, University of Toledo, 5046 NI, MS 303, Toledo, OH 43606, USA.

出版信息

Spine J. 2019 May;19(5):931-941. doi: 10.1016/j.spinee.2018.11.003. Epub 2018 Nov 8.


DOI:10.1016/j.spinee.2018.11.003
PMID:30414992
Abstract

BACKGROUND CONTEXT: Pedicle subtraction osteotomy (PSO) is a challenging restoration technique for sagittal imbalance and is associated with significant complications. One of the major complications is rod fracture and there exists a need for a biomechanical assessment of this complication for various instrumentation configurations. PURPOSE: To evaluate and compare the global range of motion (ROM), rod stress distribution, and the forces on the pedicle subtraction site in various instrumentation configurations using finite element analysis. STUDY DESIGN/SETTING: A computational biomechanical analysis. METHODS: A previously validated osseoligamentous three-dimensional spinopelvic finite element model (T10-pelvis) was used to develop a 30° PSO at the L3 level. In addition to the standard bilateral cobalt chromium primary rod instrumentation of the PSO model, various multirod configurations including constructs with medially, laterally, and posteriorly affixed satellite rods and the short-rod technique were assessed in spinal physiological motions. T10-S1 global ROM, maximum von Mises stress on the rods and at the PSO level, factor of safety (yield stress of the rod material/maximum actual stress in the rod) and the load acting across the PSO site were compared between various instrumentation configurations. The higher the factor of safety the lesser the chances of rod failure. RESULTS: Among all multirod constructs, posteriorly affixed satellite rod construct showed the greatest motion reduction compared to the standard bilateral rod configuration followed by medially and laterally affixed satellite rod constructs. Compared to the standard bilateral rod configuration, recessed short-rod technique resulted in 4% to 49% reduction in T10-S1 ROM recorded in extension and lateral bending motions, respectively, while the axial rotation motion increased by approximately 31%. Considering the maximum stress values on the rods, the recessed short-rod technique showed the greatest factor of safety (FOS = 4.1) followed by posteriorly (FOS = 3.9), medially (FOS = 3), laterally affixed satellite rod constructs (FOS = 2.8), and finally the standard bilateral rod construct (FOS = 2.7). By adding satellite rods, the maximum von Mises stress at the PSO level of the rods also reduced significantly and at this level resulted in the greatest FOS in the posteriorly affixed satellite rod construct. Compared to the standard bilateral rod construct, the load magnitude acting on the osteotomy site decreased by 11%, 16%, and 37% in the laterally, medially, and posteriorly affixed satellite rod constructs, respectively, and did not change with the short-rod technique. CONCLUSIONS: Adding satellite rods increases the rigidity of the construct, which results in an increase in the stability and the reduction of the global ROM. Additionally, having satellite rods reduces the stress on the primary rods at the PSO level and shifts the stresses from this PSO region to areas adjacent to the side-by-side connectors. The data suggest a significant benefit in supplementing medial over lateral satellite rods at the PSO by reducing stress on the primary rods. Except the recessed short-rod technique, all other multirod constructs decrease the magnitude of the load acting across the osteotomy region, which could cause a delayed or non-union at the PSO site. CLINICAL SIGNIFICANCE: The study evaluates the mechanical performance of various satellite rod instrumentation configurations following PSO to predict the risk factors for rod fracture and thereby mitigate the rate of clinically relevant failures.

摘要

背景上下文:经椎弓根截骨术(PSO)是一种用于矫正矢状面失平衡的具有挑战性的重建技术,与显著的并发症相关。主要并发症之一是杆断裂,因此需要对各种器械配置进行生物力学评估。

目的:使用有限元分析评估和比较各种器械配置下整体活动范围(ROM)、杆的应力分布和经椎弓根截骨部位的力。

研究设计/设置:计算生物力学分析。

方法:使用先前验证的骨韧带三维脊柱骨盆有限元模型(T10-骨盆)在 L3 水平上建立 30°PSO。除了 PSO 模型的标准双侧钴铬初级杆器械外,还评估了各种多杆配置,包括在脊柱生理运动中具有内侧、外侧和后侧固定卫星杆的结构以及短杆技术。比较了各种器械配置下 T10-S1 整体 ROM、杆和 PSO 水平的最大 von Mises 应力、安全系数(杆材料屈服应力/杆中的实际最大应力)和作用在 PSO 部位的力。安全系数越高,杆断裂的可能性越小。

结果:在所有多杆结构中,与标准双侧杆构型相比,后侧固定卫星杆结构的运动减少最大,其次是内侧和外侧固定卫星杆结构。与标准双侧杆构型相比,凹陷短杆技术在伸展和侧屈运动中分别导致 T10-S1ROM 减少 4%至 49%,而轴向旋转运动增加约 31%。考虑到杆上的最大应力值,凹陷短杆技术表现出最大的安全系数(FOS=4.1),其次是后侧(FOS=3.9)、内侧(FOS=3)、外侧固定卫星杆结构(FOS=2.8),最后是标准双侧杆结构(FOS=2.7)。通过添加卫星杆,杆的 PSO 水平的最大 von Mises 应力也显著降低,并且在该水平上,后侧固定卫星杆结构产生最大的 FOS。与标准双侧杆结构相比,在外侧、内侧和后侧固定卫星杆结构中,作用在截骨部位的力大小分别减少了 11%、16%和 37%,而短杆技术则没有变化。

结论:添加卫星杆增加了结构的刚度,从而增加了稳定性并减少了整体 ROM。此外,卫星杆的存在减少了 PSO 水平主杆上的应力,并将应力从该 PSO 区域转移到相邻的侧对侧连接器区域。数据表明,通过减少 PSO 处主杆上的应力,在 PSO 处补充内侧卫星杆比补充外侧卫星杆具有显著的益处。除了凹陷短杆技术外,所有其他多杆结构都减少了作用在截骨区域的力的大小,这可能导致 PSO 部位的延迟或非融合。

临床意义:该研究评估了 PSO 后各种卫星杆器械配置的力学性能,以预测杆断裂的风险因素,从而降低临床上相关失败的发生率。

相似文献

[1]
Optimal satellite rod constructs to mitigate rod failure following pedicle subtraction osteotomy (PSO): a finite element study.

Spine J. 2018-11-8

[2]
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Eur Spine J. 2022-11

[3]
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[4]
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[5]
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Spine (Phila Pa 1976). 2022-4-15

[6]
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[7]
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[8]
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[9]
Biomechanical stability of transverse connectors in the setting of a thoracic pedicle subtraction osteotomy.

Spine J. 2015-7-1

[10]
Instability and instrumentation failures after a PSO: a finite element analysis.

Eur Spine J. 2014-11

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