Yang Honghao, Pan Aixing, Hai Yong, Cheng Fengqi, Ding Hongtao, Liu Yuzeng
Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Beijing, China.
Front Bioeng Biotechnol. 2023 Mar 14;11:1148342. doi: 10.3389/fbioe.2023.1148342. eCollection 2023.
Posterior long spinal fusion was the common procedure for adult spinal deformity (ASD). Although the application of sacropelvic fixation (SPF), the incidence of pseudoarthrosis and implant failure is still high in long spinal fusion extending to lumbosacral junction (LSJ). To address these mechanical complications, advanced SPF technique by multiple pelvic screws or multirod construct has been recommended. This was the first study to compare the biomechanical performance of combining multiple pelvic screws and multirod construct to other advanced SPF constructs for the augmentation of LSJ in long spinal fusion surgery through finite element (FE) analysis. An intact lumbopelvic FE model based on computed tomography images of a healthy adult male volunteer was constructed and validated. The intact model was modified to develop five instrumented models, all of which had bilateral pedicle screw (PS) fixation from L1 to S1 with posterior lumbar interbody fusion and different SPF constructs, including No-SPF, bilateral single S2-alar-iliac (S2AI) screw and single rod (SS-SR), bilateral multiple S2AI screws and single rod (MS-SR), bilateral single S2AI screw and multiple rods (SS-MR), and bilateral multiple S2AI screws and multiple rods (MS-MR). The range of motion (ROM) and stress on instrumentation, cages, sacrum, and S1 superior endplate (SEP) in flexion (FL), extension (EX), lateral bending (LB), and axial rotation (AR) were compared among models. Compared with intact model and No-SPF, the ROM of global lumbopelvis, LSJ, and sacroiliac joint (SIJ) was decreased in SS-SR, MS-SR, SS-MR, and MS-MR in all directions. Compared with SS-SR, the ROM of global lumbopelvis and LSJ of MS-SR, SS-MR, and MS-MR further decreased, while the ROM of SIJ was only decreased in MS-SR and MS-MR. The stress on instrumentation, cages, S1-SEP, and sacrum decreased in SS-SR, compared with no-SPF. Compared with SS-SR, the stress in EX and AR further decreased in SS-MR and MS-SR. The most significantly decreased ROM and stress were observed in MS-MR. Both multiple pelvic screws and multirod construct could increase the mechanical stability of LSJ and reduce stress on instrumentation, cages, S1-SEP, and sacrum. The MS-MR construct was the most adequate to reduce the risk of lumbosacral pseudarthrosis, implant failure, and sacrum fracture. This study may provide surgeons with important evidence for the application of MS-MR construct in the clinical settings.
后路长节段脊柱融合术是治疗成人脊柱畸形(ASD)的常用手术方法。尽管应用了骶骨盆固定(SPF)技术,但在延伸至腰骶关节(LSJ)的长节段脊柱融合术中,假关节形成和植入物失败的发生率仍然很高。为了解决这些机械并发症,推荐采用多枚骨盆螺钉或多棒结构的先进SPF技术。这是第一项通过有限元(FE)分析比较多枚骨盆螺钉与多棒结构联合应用与其他先进SPF结构在长节段脊柱融合手术中增强LSJ生物力学性能的研究。基于一名健康成年男性志愿者的计算机断层扫描图像构建并验证了一个完整的腰骶部有限元模型。对完整模型进行修改以建立五个植入器械的模型,所有模型均采用从L1至S1的双侧椎弓根螺钉(PS)固定并进行后路腰椎椎间融合,以及不同的SPF结构,包括无SPF、双侧单枚S2-翼-髂骨(S2AI)螺钉和单棒(SS-SR)、双侧多枚S2AI螺钉和单棒(MS-SR)、双侧单枚S2AI螺钉和多棒(SS-MR)以及双侧多枚S2AI螺钉和多棒(MS-MR)。比较各模型在屈曲(FL)、伸展(EX)、侧方弯曲(LB)和轴向旋转(AR)时器械、椎间融合器、骶骨和S1上终板(SEP)的活动范围(ROM)及应力。与完整模型和无SPF模型相比,SS-SR、MS-SR、SS-MR和MS-MR模型在各个方向上的整体腰骶部、LSJ和骶髂关节(SIJ)的ROM均降低。与SS-SR相比,MS-SR、SS-MR和MS-MR模型的整体腰骶部和LSJ的ROM进一步降低,而SIJ的ROM仅在MS-SR和MS-MR模型中降低。与无SPF模型相比,SS-SR模型中器械、椎间融合器、S1-SEP和骶骨上的应力降低。与SS-SR相比,SS-MR和MS-SR模型在伸展和轴向旋转时的应力进一步降低。在MS-MR模型中观察到ROM和应力下降最为显著。多枚骨盆螺钉和多棒结构均可提高LSJ的机械稳定性,并降低器械、椎间融合器、S1-SEP和骶骨上的应力。MS-MR结构最适合降低腰骶部假关节形成、植入物失败和骶骨骨折的风险。本研究可为外科医生在临床应用MS-MR结构提供重要依据。