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一种新型微创椎弓根骨水泥螺钉应用于猪椎体Kümmel病治疗的生物力学评估

Biomechanical evaluation of a novel minimally invasive pedicle bone cement screw applied to the treatment of Kümmel's disease in porcine vertebrae.

作者信息

Ma Xiang, Feng Qing, Zhang Xingze, Sun Xiaolei, Lin Longwei, Guo Lin, An Lijun, Cao Shenglin, Miao Jun

机构信息

Tianjin Hospital, Tianjin University, Tianjin, China.

Tianjin Medical University, Tianjin, China.

出版信息

Front Bioeng Biotechnol. 2023 Jul 5;11:1218478. doi: 10.3389/fbioe.2023.1218478. eCollection 2023.

Abstract

Treatment of Kümmel's Disease (KD) with pure percutaneous kyphoplasty carries a greater likelihood of bone cement displacement due to hardened bone and defect of the peripheral cortex. In this study, we designed a novel minimally invasive pedicle bone cement screw and evaluate the effectiveness and safety of this modified surgical instruments in porcine vertebrae. 18 mature porcine spine specimens were obtained and soaked in 10% formaldehyde solution for 24 h. 0.5000 mmol/L EDTA-Na solution was used to develop osteoporosis models of porcine vertebrae. They were all made with the bone deficiency at the anterior edge of L1. These specimens were randomly divided into 3 groups for different ways of treatment: Group A: pure percutaneous kyphoplasty (PKP) group; Group B: unilateral novel minimally invasive pedicle bone cement screw fixation combined with PKP group; Group C: bilateral novel minimally invasive pedicle bone cement screw fixation combined with PKP group. The MTS multi-degree of freedom simulation test system was used for biomechanical tests, including axial loading of 500 N pressure, range of motion (ROM) in flexion, extension, left/right lateral bending, and left/right axial rotation at 5 Nm, and the displacement of bone cement mass at maximum angles of 5° and 10°. The three groups were well filled with bone cement, no leakage or displacement of bone cement was observed, and the height of the vertebrae was higher than pre-operation ( < 0.05). In the left/right axial rotation, the specimens were still significantly different ( < 0.05) from the intact specimens in terms of ROM after PKP. In other directions, ROM of all group had no significant difference ( < 0.05) and was close to the intact vertebrae. Compared with PKP group, the relative displacement of bone cement in groups B and C was smaller ( < 0.05). In the animal vertebral models, the treatment of KD with the placement of novel pedicle minimally invasive bone cement screw combined with PKP can effectively restore the vertebral height, improve the stability of the affected vertebra and prevent the displacement of bone cement. Biomechanically, there is no significant difference between bilateral and unilateral fixation.

摘要

由于骨质硬化和外周皮质缺损,采用单纯经皮椎体后凸成形术治疗 Kümmel 病(KD)时骨水泥移位的可能性更大。在本研究中,我们设计了一种新型微创椎弓根骨水泥螺钉,并评估了这种改良手术器械在猪椎体中的有效性和安全性。获取 18 个成熟猪脊柱标本,浸泡于 10%甲醛溶液中 24 小时。用 0.5000 mmol/L 的 EDTA-Na 溶液建立猪椎体骨质疏松模型。均造成 L1 前缘骨质缺损。将这些标本随机分为 3 组进行不同治疗方式:A 组:单纯经皮椎体后凸成形术(PKP)组;B 组:单侧新型微创椎弓根骨水泥螺钉固定联合 PKP 组;C 组:双侧新型微创椎弓根骨水泥螺钉固定联合 PKP 组。使用 MTS 多自由度模拟测试系统进行生物力学测试,包括 500 N 压力的轴向加载、5 Nm 时的前屈、后伸、左右侧屈和左右轴向旋转的活动范围(ROM),以及在 5°和 10°最大角度时骨水泥团块的位移。三组骨水泥均填充良好,未观察到骨水泥渗漏或移位,椎体高度高于术前(P<0.05)。在左右轴向旋转方面,PKP 术后标本的 ROM 与完整标本仍有显著差异(P<0.05)。在其他方向上,所有组的 ROM 无显著差异(P<0.05),且接近完整椎体。与 PKP 组相比,B 组和 C 组骨水泥的相对位移较小(P<0.05)。在动物椎体模型中,采用新型椎弓根微创骨水泥螺钉联合 PKP 治疗 KD 可有效恢复椎体高度,提高患椎稳定性并防止骨水泥移位。在生物力学方面,双侧固定和单侧固定无显著差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5525/10354293/eb47b6ec52fa/fbioe-11-1218478-g001.jpg

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