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后路腰椎椎体间截骨(PSO)中卫星棒构型(直线型 vs. 侧方型)和螺钉类型(单轴 vs. 多轴)的多棒结构的生物力学比较:是否存在最佳构型?

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?

机构信息

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.

出版信息

Eur Spine J. 2022 Nov;31(11):3050-3059. doi: 10.1007/s00586-022-07331-7. Epub 2022 Aug 6.


DOI:10.1007/s00586-022-07331-7
PMID:35932334
Abstract

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.

摘要

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。

相似文献

[1]
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

[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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引用本文的文献

[1]
Impact of lumbar pedicle subtraction osteotomy (PSO) level on global alignment and proportion (GAP) score in revision adult iatrogenic flatback spinal deformities.

Spine Deform. 2025-7-8

[2]
Influence of implant density on mechanical complications in adult spinal deformity surgery.

Eur Spine J. 2024-12

[3]
Biomechanical evaluation of multi-rod constructs to stabilize an S1 pedicle subtraction osteotomy (PSO): a finite element analysis.

Spine Deform. 2024-3

本文引用的文献

[1]
Load-sharing biomechanics of lumbar fixation and fusion with pedicle subtraction osteotomy.

Sci Rep. 2021-2-11

[2]
Biomechanical in vitro comparison between anterior column realignment and pedicle subtraction osteotomy for severe sagittal imbalance correction.

Eur Spine J. 2019-8-14

[3]
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

[4]
Outcomes of Non-Operative Management for Pseudarthrosis after Pedicle Subtraction Osteotomies at Minimum 5 Years Follow-Up.

J Korean Neurosurg Soc. 2019-9

[5]
Optimal satellite rod constructs to mitigate rod failure following pedicle subtraction osteotomy (PSO): a finite element study.

Spine J. 2018-11-8

[6]
Biomechanical advantages of supplemental accessory and satellite rods with and without interbody cages implantation for the stabilization of pedicle subtraction osteotomy.

Eur Spine J. 2018-5-8

[7]
Comparison of short-segment monoaxial and polyaxial pedicle screw fixation combined with intermediate screws in traumatic thoracolumbar fractures: a finite element study and clinical radiographic review.

Clinics (Sao Paulo). 2017-10

[8]
Anterior support reduces the stresses on the posterior instrumentation after pedicle subtraction osteotomy: a finite-element study.

Eur Spine J. 2017-10

[9]
Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up.

J Neurosurg Spine. 2017-10

[10]
Instrumentation failure following pedicle subtraction osteotomy: the role of rod material, diameter, and multi-rod constructs.

Eur Spine J. 2017-3

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