Galbusera Fabio, Cina Andrea, Panico Matteo, Bassani Tito
Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, via Galeazzi 4, 20161, Milan, Italy.
Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
Sci Rep. 2021 Jan 19;11(1):1799. doi: 10.1038/s41598-021-81319-z.
Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine which is frequently corrected with the implantation of instrumentation with generally good or excellent clinical results; mechanical post-operative complications such as implant loosening and breakage are however relatively frequent. The rate of complications is associated with a lack of consensus about the surgical decision-making process; choices about the instrumentation length, the anchoring implants and the degree of correction are indeed mostly based on personal views and previous experience of the surgeon. In this work, we performed an in silico clinical trial on a large number of subjects in order to clarify which factors have the highest importance in determining the risk of complications by quantitatively analysing the mechanical stresses and loads in the instrumentation after the correction maneuvers. The results of the simulations highlighted the fundamental role of the curve severity, also in its three-dimensional aspect, and of the instrumentation strategy, whereas the length of the fixation had a lower importance.
青少年特发性脊柱侧凸是一种脊柱的三维畸形，通常通过植入器械进行矫正，临床效果一般良好或极佳；然而，机械性术后并发症如植入物松动和断裂却相对常见。并发症的发生率与手术决策过程缺乏共识有关；关于器械长度、锚固植入物和矫正程度的选择实际上大多基于外科医生的个人观点和以往经验。在这项研究中，我们对大量受试者进行了计算机模拟临床试验，以便通过定量分析矫正操作后器械中的机械应力和负荷，阐明哪些因素在确定并发症风险方面最为重要。模拟结果突出了侧弯严重程度（包括其三维方面）和器械策略的基本作用，而固定长度的重要性较低。
