Department of Spinal Surgery, The Third Affiliated Hospital of Shihezi University Medical College, Shihezi, 832000 Xinjiang Uygur Autonomous Region, China.
Department of Spinal Surgery, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, 213000 Jiangsu Province, China.
Biomed Res Int. 2022 Apr 25;2022:2863379. doi: 10.1155/2022/2863379. eCollection 2022.
This research was developed to accurately evaluate the unstable fractures of thoracolumbar before and after surgery and discuss the treatment timing and methods. Three-dimensional (3D) finite element method was adopted to construct the T-L segment model of human body. The efficiency of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP), two commonly used internal fixation procedures, was retrospectively compared. A total of 150 patients with chest fracture who received PKP or PVP surgery in our hospital, and 104 patients with the same symptoms who received conservative treatment were collected and randomly rolled into PVP group (75 cases), PKP group (75 cases), and control group (104 cases). Visual analog scale (VAS) score and Oswestry disability index (ODI) of patients were collected before and after surgery and 2, 12, and 24 months after surgery. Then, the anterior and central height of the patient's cone and the kyphosis angle were calculated by X-ray. Lumbar minimally invasive fusion system and lumbar pedicle screw rod system were established by computer-aided design (CAD), and the biomechanical characteristics were analyzed. The results showed that there was no substantial difference in VAS score and ODI score between PKP and PVP ( > 0.05), but they were higher than those of the control group ( < 0.05). The anterior edge and middle height of vertebra in the two groups were higher than those in control group ( < 0.05), and the increase in PKP group was more substantial ( < 0.05). The kyphosis of the two groups was smaller than that of the control group ( < 0.05), and the decrease of the kyphosis of the PKP group was more substantial ( < 0.05). In summary, the thoracolumbar segment model established by 3D finite element method was an effective model, and it was verified on patients that both PKP and PVP could achieve relatively satisfactory efficacy. The implantation of the new internal fixation system had no obvious effect on the lumbar movement. This work provided a novel idea and method for the treatment of senile thoracolumbar unstable fracture, as well as experimental data of biomechanics for the operation of senile unstable fracture.
本研究旨在准确评估胸腰椎术后不稳定骨折，并探讨其治疗时机和方法。采用三维（3D）有限元法构建人体 T-L 节段模型。回顾性比较两种常用内固定术式经皮椎体后凸成形术（PKP）和经皮椎体成形术（PVP）的效果。收集我院收治的胸腰椎骨折患者 150 例，行 PKP 或 PVP 手术，并随机将 104 例有相同症状但行保守治疗的患者分为 PVP 组（75 例）、PKP 组（75 例）和对照组（104 例）。收集患者术前、术后及术后 2、12、24 个月的视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI），并通过 X 线计算患者椎体前缘和中央高度及后凸角。通过计算机辅助设计（CAD）建立腰椎微创融合系统和腰椎椎弓根螺钉棒系统，分析其生物力学特性。结果显示，PKP 组和 PVP 组 VAS 评分和 ODI 评分无明显差异（>0.05），但均高于对照组（<0.05）；两组椎体前缘和中部高度均高于对照组（<0.05），PKP 组增高更明显（<0.05）；两组后凸角均小于对照组（<0.05），PKP 组减小更明显（<0.05）。总之，3D 有限元法建立的胸腰椎节段模型是一种有效的模型，通过对患者进行验证，PKP 和 PVP 均可取得较为满意的疗效。新型内固定系统的植入对腰椎活动无明显影响。本工作为老年胸腰椎不稳定骨折的治疗提供了新的思路和方法，为老年不稳定骨折的手术治疗提供了生物力学实验数据。
