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单侧和双侧椎弓根螺钉固定植骨融合前后的生物力学稳定性:有限元研究

Biomechanical Stability Before and After Graft Fusion with Unilateral and Bilateral Pedicle Screw Fixation: Finite Element Study.

作者信息

Li Jie, Wang Wenkai, Zuo Rui, Zhou Yue

机构信息

Department of Orthopaedics, Xinqiao Hospital, Army Military University, Chongqing, People's Republic of China.

Department of Orthopaedics, Xinqiao Hospital, Army Military University, Chongqing, People's Republic of China.

出版信息

World Neurosurg. 2019 Mar;123:e228-e234. doi: 10.1016/j.wneu.2018.11.141. Epub 2018 Nov 24.


DOI:10.1016/j.wneu.2018.11.141
PMID:30481621
Abstract

BACKGROUND: Minimally invasive transformational lumbar interbody fusion (MI-TLIF) with unilateral pedicle screw (UPS) fixation was controversial. The aim of this study was to compare the stability between UPS and bilateral pedicle screw (BPS) fixation before and after graft fusion. METHODS: An L3-L5 finite element model was modified to simulate L4/5 MI-TLIF. Five different statuses of posterior instrumentation were simulated: UPS fixation or BPS fixation before and after graft fusion and removal of posterior instrumentation after graft fusion. Range of motion and Von Mises stress were evaluated for intact and instrumentation models in all loading planes. RESULTS: Range of motion of the L4/5 segment with UPS fixation was 2.1, 1.3, and 1.7 times greater than those with BPS fixation before fusion in flexion-extension, lateral bending, and axial rotation, respectively, while it was 1.3, 1.1, and 1.4 times greater after fusion. The peak Von Mises stresses on posterior instrumentations with UPS fixation ranged from 1.0 to 1.7 times greater than those in BPS fixation before fusion, while it ranged from 1.0 to 1.4 times greater after fusion. The peak Von Mises stresses on intervertebral graft with UPS fixation ranged from 1.9 to 3.5 times greater than those with BPS fixation before fusion, while it ranged from 0.9 to 1.2 times greater after fusion. CONCLUSIONS: Fusion of graft improved the fixation effect of posterior instrumentation system. Unilateral pedicle screw fixation could provide similar biomechanical stability to bilateral pedicle screw fixation in 1-level MI-TLIF after fusion.

摘要

背景:采用单侧椎弓根螺钉(UPS)固定的微创转换型腰椎椎间融合术(MI-TLIF)存在争议。本研究旨在比较植骨融合前后UPS和双侧椎弓根螺钉(BPS)固定的稳定性。 方法:对L3-L5有限元模型进行修改以模拟L4/5 MI-TLIF。模拟了五种不同的后路内固定状态:植骨融合前后的UPS固定或BPS固定以及植骨融合后去除后路内固定。评估了所有加载平面上完整模型和内固定模型的活动范围和冯·米塞斯应力。 结果:在屈伸、侧弯和轴向旋转时,融合前L4/5节段采用UPS固定的活动范围分别比采用BPS固定的大2.1倍、1.3倍和1.7倍,而融合后则大1.3倍、1.1倍和1.4倍。融合前,采用UPS固定的后路内固定上的冯·米塞斯应力峰值比采用BPS固定的大1.0至1.7倍,而融合后则大1.0至1.4倍。融合前,采用UPS固定的椎间植骨上的冯·米塞斯应力峰值比采用BPS固定的大1.9至3.5倍,而融合后则大0.9至1.2倍。 结论:植骨融合改善了后路内固定系统的固定效果。在1节段MI-TLIF融合后,单侧椎弓根螺钉固定可提供与双侧椎弓根螺钉固定相似的生物力学稳定性。

相似文献

[1]
Biomechanical Stability Before and After Graft Fusion with Unilateral and Bilateral Pedicle Screw Fixation: Finite Element Study.

World Neurosurg. 2019-3

[2]
Bilateral pedicle screw fixation provides superior biomechanical stability in transforaminal lumbar interbody fusion: a finite element study.

Spine J. 2015-8-1

[3]
Finite Element Analysis of a New Pedicle Screw-Plate System for Minimally Invasive Transforaminal Lumbar Interbody Fusion.

PLoS One. 2015-12-9

[4]
Less invasive posterior fixation method following transforaminal lumbar interbody fusion: a biomechanical analysis.

Spine J. 2006

[5]
Biomechanical Stability Afforded by Unilateral Versus Bilateral Pedicle Screw Fixation with and without Interbody Support Using Lateral Lumbar Interbody Fusion.

World Neurosurg. 2018-2-17

[6]
A comparison of the influence of three different lumbar interbody fusion approaches on stress in the pedicle screw fixation system: Finite element static and vibration analyses.

Int J Numer Method Biomed Eng. 2018-10-30

[7]
Novel pedicle screw and plate system provides superior stability in unilateral fixation for minimally invasive transforaminal lumbar interbody fusion: an in vitro biomechanical study.

PLoS One. 2015-3-25

[8]
Biomechanical changes of oblique lumbar interbody fusion with different fixation techniques in degenerative spondylolisthesis lumbar spine: a finite element analysis.

BMC Musculoskelet Disord. 2024-8-24

[9]
Biomechanical evaluation of lateral lumbar interbody fusion with secondary augmentation.

J Neurosurg Spine. 2016-12

[10]
Biomechanical comparison of multilevel lateral interbody fusion with and without supplementary instrumentation: a three-dimensional finite element study.

BMC Musculoskelet Disord. 2017-2-2

引用本文的文献

[1]
Spontaneous facet fusion following lateral lumbar interbody fusion supplemented with percutaneous pedicle screw fixation in degenerative lumbar disease.

Eur Spine J. 2025-8-12

[2]
The biomechanical effects of treating double-segment lumbar degenerative diseases with unilateral fixation through interlaminar fenestration interbody fusion surgery: a three-dimensional finite element study.

BMC Musculoskelet Disord. 2025-1-11

[3]
Fusion's Location and Quality within the Fixated Segment Following Transforaminal Interbody Fusion (TLIF).

Healthcare (Basel). 2023-10-24

[4]
Biomechanical investigation of the hybrid lumbar fixation technique with traditional and cortical bone trajectories in transforaminal lumbar interbody fusion: finite element analysis.

J Orthop Surg Res. 2023-7-31

[5]
Successful outcomes of unilateral bilateral pedicle screw fixation for lumbar interbody fusion: A meta-analysis with evidence grading.

World J Clin Cases. 2022-12-26

[6]
Safety and efficacy of unilateral and bilateral pedicle screw fixation for lumbar degenerative diseases by transforaminal lumbar interbody fusion: An updated systematic review and meta-analysis.

Front Neurol. 2022-10-10

[7]
Biomechanical Evaluation of Transforaminal Lumbar Interbody Fusion with Coflex-F and Pedicle Screw Fixation: Finite Element Analysis of Static and Vibration Conditions.

Orthop Surg. 2022-9

[8]
[Biomechanical study of different approach for lumbar interbody fusion surgeries under vibration load].

Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2021-10-25

[9]
Influence of posterior pedicle screw fixation at L4-L5 level on biomechanics of the lumbar spine with and without fusion: a finite element method.

Biomed Eng Online. 2021-10-7

[10]
Biomechanical evaluation of four different posterior instrumentation techniques for single-level transforaminal lumbar interbody fusion: a finite element analysis.

Am J Transl Res. 2020-10-15

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