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反向雨刮器效应导致骨水泥增强椎弓根螺钉失效:基于有限元实验的生物力学机制分析

Reversed windshield-wiper effect leads to failure of cement-augmented pedicle screw: Biomechanical mechanism analysis by finite element experiment.

作者信息

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

机构信息

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.

出版信息

Heliyon. 2023 Feb 15;9(2):e13730. doi: 10.1016/j.heliyon.2023.e13730. eCollection 2023 Feb.


DOI:10.1016/j.heliyon.2023.e13730
PMID:36852063
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9957816/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/e8b88a3fbbec/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/1f774a2e3da2/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/7f6354c114c0/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/e51c252665d5/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/2548d4d9978a/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/b021cbfbc2d6/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/e8b88a3fbbec/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/1f774a2e3da2/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/7f6354c114c0/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/e51c252665d5/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/2548d4d9978a/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/b021cbfbc2d6/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85bb/9957816/e8b88a3fbbec/gr6.jpg

相似文献

[1]
Reversed windshield-wiper effect leads to failure of cement-augmented pedicle screw: Biomechanical mechanism analysis by finite element experiment.

Heliyon. 2023-2-15

[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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[10]
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引用本文的文献

[1]
Biomechanical evaluation of various fixation strategies in oblique lumbar interbody fusion: a finite element analysis.

BMC Musculoskelet Disord. 2025-8-7

[2]
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本文引用的文献

[1]
A meta-analysis of complications associated with the use of cement-augmented pedicle screws in osteoporosis of spine.

Orthop Traumatol Surg Res. 2021-11

[2]
Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis.

J Orthop Surg Res. 2020-9-29

[3]
Clinical Effects and Complications of Pedicle Screw Augmentation with Bone Cement: Comparison of Fenestrated Screw Augmentation and Vertebroplasty Augmentation.

Clin Orthop Surg. 2020-5-14

[4]
Clinical efficacy of Bone Cement-injectable Cannulated Pedicle Screw Short Segment Fixation for Lumbar Spondylolisthesis with Osteoporosise.

Sci Rep. 2020-3-3

[5]
Cement augmentation of odontoid peg fractures: the effect of cement volume and distribution on construct stiffness.

Eur Spine J. 2020-5

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The Effect of Older Age on the Perioperative Outcomes of Spinal Fusion Surgery in Patients With Lumbar Degenerative Disc Disease With Spondylolisthesis: A Propensity Score-Matched Analysis.

Neurosurgery. 2020-9-15

[7]
Technical Note: Pedicle Cement Augmentation with Proximal Screw Toggle and Loosening.

Orthop Surg. 2019-6-9

[8]
The Effect and Safety of Polymethylmethacrylate-Augmented Sacral Pedicle Screws Applied in Osteoporotic Spine with Lumbosacral Degenerative Disease: A 2-Year Follow-up of 25 Patients.

World Neurosurg. 2019-1

[9]
Biomechanical study of injectable hollow pedicle screws for PMMA augmentation in severely osteoporotic lumbar vertebrae: effect of PMMA distribution and volume on screw stability.

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The quantity of bone cement influences the anchorage of augmented pedicle screws in the osteoporotic spine: A biomechanical human cadaveric study.

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