腰椎固定融合与经椎间孔椎体间融合术的负荷分担生物力学。

Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy.

机构信息

Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico Di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.

Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Ulm, Germany.

出版信息

Sci Rep. 2021 Feb 11;11(1):3595. doi: 10.1038/s41598-021-83251-8.

Abstract

Pedicle subtraction osteotomy (PSO) is an invasive surgical technique allowing the restoration of a well-balanced sagittal profile, however, the risks of pseudarthrosis and instrumentation breakage are still high. Literature studied primary stability and posterior instrumentation loads, neglecting the load shared by the anterior column, which is fundamental to promote fusion early after surgery. The study aimed at quantifying the load-sharing occurring after PSO procedure across the ventral spinal structures and the posterior instrumentation, as affected by simple bilateral fixation alone, with interbody cages adjacent to PSO level and supplementary accessory rods. Lumbar spine segments were loaded in vitro under flexion-extension, lateral bending, and torsion using an established spine tester. Digital image correlation (DIC) and strain-gauge (SG) analyses measured, respectively, the full-field strain distribution on the ventral surface of the spine and the local strain on posterior primary rods. Ventral strains considerably decreased following PSO and instrumentation, confirming the effectiveness of posterior load-sharing. Supplemental accessory rods considerably reduced the posterior rod strains only with interbody cages, but the ventral strains were unaffected: this indicates that the load transfer across the osteotomy could be promoted, thus explaining the higher fusion rate with decreased rod fracture risk reported in clinical literature.

摘要

椎弓根切除截骨术 (PSO) 是一种侵入性手术技术,可恢复平衡的矢状位轮廓,但假关节和器械断裂的风险仍然很高。文献研究了原发性稳定性和后路器械的负荷,但忽略了前柱分担的负荷,这对于术后早期促进融合至关重要。本研究旨在定量分析 PSO 手术后穿过腹侧脊柱结构和后路器械的负荷分担情况,分别受单纯双侧固定、PSO 水平相邻椎间笼和补充辅助杆的影响。使用已建立的脊柱试验机,在屈伸、侧屈和扭转下对腰椎节段进行体外加载。数字图像相关 (DIC) 和应变计 (SG) 分析分别测量了脊柱腹侧表面的全场应变分布和后路主要杆的局部应变。PSO 和器械固定后,腹侧应变明显降低,证实了后路负荷分担的有效性。仅使用椎间笼,补充辅助杆可显著降低后路杆的应变,但腹侧应变不受影响:这表明可以促进截骨处的负载转移,从而解释了临床文献中报道的更高融合率和降低的杆断裂风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aeda/7878841/7e5cb4076d3f/41598_2021_83251_Fig1_HTML.jpg

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