Wong Chia-En, Hu Hsuan-Teh, Huang Yu-Heng, Huang Kuo-Yuan
Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
Department of Civil Engineering, National Cheng Kung University, Tainan 701, Taiwan.
Bioengineering (Basel). 2022 Sep 21;9(10):491. doi: 10.3390/bioengineering9100491.
The management strategies of thoracolumbar (TL) burst fractures include posterior, anterior, and combined approaches. However, the rigid constructs pose a risk of proximal junctional failure. In this study, we aim to systemically evaluate the biomechanical performance of different TL reconstruction constructs using finite element analysis. Furthermore, we investigate the motion and the stress on the proximal junctional level adjacent to the constructs. We used a T10-L3 finite element model and simulated L1 burst fracture. Reconstruction with posterior instrumentation (PI) alone (U2L2 and U1L1+(intermediate screw) and three-column spinal reconstruction (TCSR) constructs (U1L1+PMMA and U1L1+Cage) were compared. Long-segment PI resulted in greater global motion reduction compared to constructs with short-segment PI. TCSR constructs provided better stabilization in L1 compared to PI alone. Decreased intradiscal and intravertebral pressure in the proximal level were observed in U1L1+IS, U1L1+PMMA, and U1L1+Cage compared to U2L2. The stress and strain energy of the pedicle screws decreased when anterior reconstruction was performed in addition to PI. We showed that TCSR with anterior reconstruction and SSPI provided sufficient immobilization while offering additional advantages in the preservation of physiological motion, the decreased burden on the proximal junctional level, and lower risk of implant failure.
胸腰椎爆裂骨折的治疗策略包括后路、前路及联合入路。然而，坚固的内固定结构存在近端交界区失败的风险。在本研究中，我们旨在通过有限元分析系统评估不同胸腰椎重建结构的生物力学性能。此外，我们研究了重建结构相邻近端交界区的运动和应力情况。我们使用了一个T10-L3有限元模型并模拟了L1爆裂骨折。比较了单纯后路内固定（PI）（U2L2和U1L1+(中间螺钉)）及三柱脊柱重建（TCSR）结构（U1L1+聚甲基丙烯酸甲酯（PMMA）和U1L1+椎间融合器）。与短节段PI结构相比，长节段PI导致整体运动减少更多。与单纯PI相比，TCSR结构在L1节段提供了更好的稳定性。与U2L2相比，在U1L1+中间螺钉（IS）、U1L1+PMMA和U1L1+椎间融合器中观察到近端节段椎间盘内和椎体内压力降低。当在PI基础上进行前路重建时，椎弓根螺钉的应力和应变能降低。我们表明，前路重建联合短节段PI的TCSR提供了足够的固定，同时在保留生理运动、减轻近端交界区负担及降低植入物失败风险方面具有额外优势。
