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经皮椎体后凸成形术(PSO)中杆断裂的风险与交联位置的关系:有限元研究。

Risk of rod fracture according to cross-link position in pedicle subtraction osteotomy (PSO): A finite element study.

机构信息

Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Department of Biomedical Engineering, College of Biomedical Science& Engineering, Inje University, Gyeongnam, Republic of Korea.

出版信息

J Clin Neurosci. 2020 Mar;73:304-307. doi: 10.1016/j.jocn.2020.01.053. Epub 2020 Jan 18.


DOI:10.1016/j.jocn.2020.01.053
PMID:31964559
Abstract

PURPOSE: The purpose of this study is to investigate the effect of the cross-link position on the rod fracture phenomenon during pedicle subtraction osteotomy (PSO) surgery using finite element model (FEM). METHODS: A three-dimensional finite element model of a lumbar spine with sagittal imbalance was constructed using computed tomography data of a 65-year-old female patient. After simulating the standard PSO at the L4 level, we constructed four models, specifically a model without a cross-link and three models with a cross-link at three different sites. The peak von Mises stress (PVMS) of the rod around the PSO site was measured after applying physiological loads (flexion, extension, axial rotation, and lateral bending) in each model. RESULTS: The measured PVMS outcomes at the PSO site were 135.8, 135.9, 208.9, and 384.7 MPa for model 1, 2, 3, and 4 during flexion, and 180.0, 180.1, 210.1, and 445.7 MPa during extension. These results show that when the cross-link is located at the PSO site, the rod stress at the PSO site increases significantly during flexion and extension. As the cross-link moved away from the PSO site, the effect on the rod stress decreased. When the cross-link was placed two levels away from the PSO site, the rod stress was scarcely affected. CONCLUSION: When the cross-link during PSO surgery was positioned two levels away from the PSO site, the risk of rod fracture did not increase.

摘要

目的:本研究旨在通过有限元模型(FEM)研究椎弓根切除截骨术(PSO)中交联位置对棒断裂现象的影响。

方法:使用 65 岁女性患者的 CT 数据构建了矢状位失衡腰椎的三维有限元模型。在模拟标准 L4 水平的 PSO 后,我们构建了四个模型,分别为无交联模型和三个交联位置不同的模型。在每个模型中施加生理负荷(屈伸、轴向旋转和侧屈)后,测量 PSO 部位周围棒的最大 von Mises 应力(PVMS)。

结果:在屈伸运动中,模型 1、2、3 和 4 的 PSO 部位的测量 PVMS 结果分别为 135.8、135.9、208.9 和 384.7 MPa;在伸展运动中,模型 1、2、3 和 4 的测量 PVMS 结果分别为 180.0、180.1、210.1 和 445.7 MPa。结果表明,当交联位于 PSO 部位时,在屈伸过程中,PSO 部位的棒的应力显著增加。随着交联远离 PSO 部位,对棒的应力的影响减小。当交联放置在远离 PSO 部位两个节段时,棒的应力几乎不受影响。

结论:当 PSO 手术中的交联位于远离 PSO 部位两个节段时,不会增加棒断裂的风险。

相似文献

[1]
Risk of rod fracture according to cross-link position in pedicle subtraction osteotomy (PSO): A finite element study.

J Clin Neurosci. 2020-1-18

[2]
Cross-link is a risk factor for rod fracture at pedicle subtraction osteotomy site: A finite element study.

J Clin Neurosci. 2019-5-10

[3]
Optimal satellite rod constructs to mitigate rod failure following pedicle subtraction osteotomy (PSO): a finite element study.

Spine J. 2018-11-8

[4]
Instability and instrumentation failures after a PSO: a finite element analysis.

Eur Spine J. 2014-11

[5]
Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis.

BMC Musculoskelet Disord. 2017-6-15

[6]
Use of Supplemental Short Pre-Contoured Accessory Rods and Cobalt Chrome Alloy Posterior Rods Reduces Primary Rod Strain and Range of Motion Across the Pedicle Subtraction Osteotomy Level: An In Vitro Biomechanical Study.

Spine (Phila Pa 1976). 2016-4

[7]
Supplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study.

Eur Spine J. 2019-5-25

[8]
Does solid fusion eliminate rod fracture after pedicle subtraction osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis?

Spine J. 2018-5-21

[9]
Biomechanical comparison of multi-rod constructs by satellite rod configurations (in-line vs. lateral) and screw types (monoaxial vs. polyaxial) spanning a lumbar pedicle subtraction osteotomy (PSO): is there an optimal configuration?

Eur Spine J. 2022-11

[10]
Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity.

J Neurosurg Spine. 2014-12

引用本文的文献

[1]
Biomechanical effects of posterior lumbar interbody fusion with vertical placement of pedicle screws compared to traditional placement.

World J Clin Cases. 2024-7-16

[2]
Biomechanical Comparison of Different Numbers and Configurations of Cross-Links in Long-Segment Spinal Fixation-An Experimental Study in a Porcine Model.

Global Spine J. 2023-1

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