Li Jie, Wang Wenkai, Zuo Rui, Zhou Yue
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.
World Neurosurg. 2019 Mar;123:e228-e234. doi: 10.1016/j.wneu.2018.11.141. Epub 2018 Nov 24.
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.
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。
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