Wang Zhong, Liu Peng, Liu Ming-Yong, Yin Xiang, Gan Yi-Bo, Luo Ke-Yu, Zhang Liang, Zhao Jian-Hua, Zhou Qiang, Liu Yao-Yao
Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, PR China.
Division of Spine Surgery, Department of Orthopedics, Daping Hospital(Army Medical Center of PLA), Army Medical University, Chongqing, 400042, PR China.
Heliyon. 2023 Feb 15;9(2):e13730. doi: 10.1016/j.heliyon.2023.e13730. eCollection 2023 Feb.
The failure mode of cement-augmented pedicle screw (CAPS) was different from common pedicle screw. No biomechanical study of this failure mode named as "reversed windshield-wiper effect" was reported. To investigate the mechanisms underlying this failure mode, a series of finite element models of CAPS and PS were modified on L4 osseous model. Nine models were created according to the cement volume at 0.5 mL interval (range: 1-5 mL). Pullout load and cranio-caudal loads were applied on the screws. Stress and instantaneous rotation center (IRC) of the vertebra were observed. Under cranio-caudal load, the stress concentrated on the screw tip and pedicle region. The maximal stress (MS) at the screw tip region was +2.143 MPa higher than pedicle region. With cement volume increasing, the maximal stress (MS) at the screw tip region decreased dramatically, while MS at pedicle region was not obviously affected. As dose increased to 1.5 mL, the MS at pedicle region became higher than screw tip region and the maximal stress difference was observed at 3.5 mL. IRC of the vertebra located at the facet joint region in PS model. While IRC in CAPS models shifted anteriorly closer to the vertebral body with the increasing of cement volume. Under axial pull-out load, the maximal stress (MS) of cancellous bone in CAPS models was 29.53-50.04% lower than that 2.228 MPa in PS model. MS in the screw-bone interface did not change significantly with cement volume increasing. Therefore, the possible mechanism is that anterior shift of IRC and the negative difference value of MS between screw tip and pedicle region due to cement augmentation, leading to the screw rotate around the cement-screw complex as the fulcrum point.
骨水泥增强椎弓根螺钉(CAPS)的失效模式与普通椎弓根螺钉不同。尚未见有关于这种被称为“反向雨刮器效应”的失效模式的生物力学研究报道。为了探究这种失效模式的潜在机制,在L4骨模型上对一系列CAPS和PS的有限元模型进行了修改。根据骨水泥体积以0.5 mL间隔(范围:1 - 5 mL)创建了九个模型。对螺钉施加拔出载荷和头尾向载荷。观察椎体的应力和瞬时旋转中心(IRC)。在头尾向载荷作用下,应力集中在螺钉尖端和椎弓根区域。螺钉尖端区域的最大应力(MS)比椎弓根区域高2.143 MPa。随着骨水泥体积增加,螺钉尖端区域的最大应力(MS)显著降低,而椎弓根区域的MS没有明显受到影响。当剂量增加到1.5 mL时,椎弓根区域的MS高于螺钉尖端区域,且在3.5 mL时观察到最大应力差值。PS模型中椎体的IRC位于小关节区域。而在CAPS模型中,随着骨水泥体积增加,IRC向前移位,更靠近椎体。在轴向拔出载荷作用下,CAPS模型中松质骨的最大应力(MS)比PS模型中的2.228 MPa低29.53 - 50.04%。螺钉 - 骨界面的MS随骨水泥体积增加没有显著变化。因此,可能的机制是IRC向前移位以及由于骨水泥增强导致螺钉尖端和椎弓根区域之间MS的负差值,使得螺钉以骨水泥 - 螺钉复合体为支点旋转。
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