Engineering Center for Orthopedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA.
Spine & Scoliosis Specialists, Tampa, FL, USA.
Eur Spine J. 2022 Nov;31(11):3050-3059. doi: 10.1007/s00586-022-07331-7. Epub 2022 Aug 6.
PURPOSE: Multi-rod constructs are used commonly to stabilize pedicle subtraction osteotomies (PSO). This study aimed to evaluate biomechanical properties of different satellite rod configurations and effects of screw-type spanning a PSO. METHODS: A validated 3D spinopelvic finite element model with a L3 PSO (30°) was used to evaluate 5 models: (1) Control (T10-pelvis + 2 rods); (2) lateral satellite rods connected via offsets to monoaxial screws (LatSat-Mono) or (3) polyaxial screws (LatSat-Poly); (4) in-line satellite rods connected to monoaxial screws (InSat-Mono) or (4) polyaxial screws (InSat-Poly). Global and PSO range of motions (ROM) were recorded. Rods' von Mises stresses and PSO forces were recorded and the percent differences from Control were calculated. RESULTS: All satellite rods (save InSat-Mono) increased PSO ROM and decreased primary rods' von Mises stresses at the PSO. Lateral rods increased PSO forces (LatSat-Mono:347.1 N; LatSat-Poly:348.6 N; Control:336 N) and had relatively lower stresses, while in-line rods decreased PSO forces (InSat-Mono:280.1 N; InSat-Poly:330.7 N) and had relatively higher stresses. Relative to polyaxial screws, monoaxial screws further decreased PSO ROM, increased satellite rods' stresses, and decreased PSO forces for in-line rods, but did not change PSO forces for lateral rods. CONCLUSION: Multi-rod constructs using in-line and lateral satellite rods across a PSO reduced primary rods' stresses. Subtle differences in biomechanics suggest lateral satellite rods, irrespective of screw type, increase PSO forces and lower rod stresses compared to in-line satellite rods, which had a high degree of posterior instrumentation stress shielding and lower PSO forces. Clinical studies are warranted to determine if these findings influence clinical outcomes.
目的:多棒结构常用于稳定椎弓根切除截骨术(PSO)。本研究旨在评估不同卫星棒构型的生物力学特性以及螺钉跨越 PSO 的影响。
方法:使用经过验证的具有 L3 PSO(30°)的 3D 脊柱骨盆有限元模型来评估 5 种模型:(1)对照(T10-骨盆+2 根棒);(2)通过偏移连接到单轴螺钉的侧卫星棒(LatSat-Mono)或(3)多轴螺钉(LatSat-Poly);(4)连接到单轴螺钉的直线卫星棒(InSat-Mono)或(4)多轴螺钉(InSat-Poly)。记录整体和 PSO 活动范围(ROM)。记录棒的 von Mises 应力和 PSO 力,并计算与对照相比的百分比差异。
结果:所有卫星棒(除了 InSat-Mono)均增加了 PSO ROM,并降低了 PSO 处主要棒的 von Mises 应力。侧棒增加了 PSO 力(LatSat-Mono:347.1 N;LatSat-Poly:348.6 N;对照:336 N),且具有相对较低的应力,而直线棒则降低了 PSO 力(InSat-Mono:280.1 N;InSat-Poly:330.7 N),且具有相对较高的应力。与多轴螺钉相比,单轴螺钉进一步降低了 PSO ROM,增加了卫星棒的应力,并降低了直线棒的 PSO 力,但并未改变侧棒的 PSO 力。
结论:使用侧卫星棒和直线卫星棒跨越 PSO 的多棒结构降低了主要棒的应力。生物力学方面的细微差异表明,侧卫星棒(无论螺钉类型如何)均比直线卫星棒增加了 PSO 力并降低了棒的应力,而直线卫星棒具有高度的后向器械应力屏蔽作用和较低的 PSO 力。需要进行临床研究以确定这些发现是否会影响临床结果。
Spine (Phila Pa 1976). 2022-4-15