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不同胸腰椎爆裂骨折治疗策略的生物力学比较:有限元研究。

Biomechanical Comparison of Different Treatment Strategies for Thoracolumbar Burst Fracture: A Finite Element Study.

机构信息

School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China; Spinal Deformity Clinical and Research Center of Anhui Province, Fuyang, Anhui, China.

School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China.

出版信息

World Neurosurg. 2023 Dec;180:e429-e439. doi: 10.1016/j.wneu.2023.09.084. Epub 2023 Sep 25.


DOI:10.1016/j.wneu.2023.09.084
PMID:37757943
Abstract

OBJECTIVE: The aim of this study was to compare the biomechanical performance of 6 pedicle screw internal fixation strategies for the treatment of burst fractures of the thoracolumbar spine using finite element (FE) analysis. METHODS: A finite element model of the T11-L3 thoracolumbar segment was established to simulate L1 vertebral burst fractures, and 6 models were conducted under multidirectional loading conditions: P2-D2, P1-D1, P2-D1,P1-D, P1-BF-D1, and P1-UF-D1. The range of motion (ROM) in the T12-L2 region and the von Mises stresses of pedicle screws and rods under the 6 internal fixation models were mainly analyzed. RESULTS: The maximum ROM and von Mises stress were obtained under flexion motion in all models. The P1-BF-D1 model had the least ROM and screw stress. However, when the injured vertebra was not nailed bilaterally, the P1-UF-D1 model had the smallest ROM; the maximum von Mises stress on the screw and rod was remarkably higher than that recorded in the other models. Moreover, the P2-D1 model had a ROM similar to that of the P1-D2 model, but with lower screw stress. The 2 models outperformed the P1-D1 model in all 6 conditions. The P2-D2 model had a similar ROM with the P2-D1 model; nevertheless, the maximum von Mises stress was not substantially reduced. CONCLUSIONS: The P1-BF-D1 model exhibited better stability and less von Mises stress on the pedicle screws and rods, thereby reducing the risk of screw loosening and fracture. The P2-D1 internal fixation approach is recommended when the fractured vertebrae are not nailed bilaterally.

摘要

目的:本研究旨在通过有限元(FE)分析比较 6 种椎弓根螺钉内固定策略治疗胸腰椎爆裂骨折的生物力学性能。

方法:建立 T11-L3 胸腰椎节段的有限元模型,模拟 L1 椎体爆裂骨折,在多向加载条件下对 6 种模型进行研究:P2-D2、P1-D1、P2-D1、P1-D、P1-BF-D1 和 P1-UF-D1。主要分析 T12-L2 节段的活动范围(ROM)和 6 种内固定模型中椎弓根螺钉和棒的 von Mises 应力。

结果:所有模型在屈伸运动中均获得最大 ROM 和 von Mises 应力。P1-BF-D1 模型的 ROM 最小,螺钉和棒的 von Mises 应力最小。然而,当受伤椎体未双侧钉固时,P1-UF-D1 模型的 ROM 最小;螺钉和棒上的最大 von Mises 应力显著高于其他模型。此外,P2-D1 模型的 ROM 与 P1-D2 模型相似,但螺钉应力较低。在所有 6 种情况下,这 2 种模型的 ROM 均优于 P1-D1 模型。P2-D1 模型的 ROM 与 P2-D1 模型相似;然而,最大 von Mises 应力并未显著降低。

结论:P1-BF-D1 模型表现出更好的稳定性和椎弓根螺钉和棒上较低的 von Mises 应力,从而降低螺钉松动和断裂的风险。当骨折椎体未双侧钉固时,建议采用 P2-D1 内固定方法。

相似文献

[1]
Biomechanical Comparison of Different Treatment Strategies for Thoracolumbar Burst Fracture: A Finite Element Study.

World Neurosurg. 2023-12

[2]
Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis.

BMC Musculoskelet Disord. 2017-6-15

[3]
Extent and location of fixation affects the biomechanical stability of short- or long-segment pedicle screw technique with screwing of fractured vertebra for the treatment of thoracolumbar burst fractures: An observational study using finite element analysis.

Medicine (Baltimore). 2018-6

[4]
Treatment of unstable thoracolumbar fractures through short segment pedicle screw fixation techniques using pedicle fixation at the level of the fracture: a finite element analysis.

PLoS One. 2014-6-10

[5]
Biomechanical Effect of Different Posterior Fixation Techniques on Stability and Adjacent Segment Degeneration in Treating Thoracolumbar Burst Fracture With Osteoporosis: A Finite Element Analysis.

Spine (Phila Pa 1976). 2024-8-1

[6]
A finite element study on posterior short segment fixation combined with unilateral fixation using pedicle screws for stable thoracolumbar fracture.

Medicine (Baltimore). 2018-8

[7]
Comparison of short-segment monoaxial and polyaxial pedicle screw fixation combined with intermediate screws in traumatic thoracolumbar fractures: a finite element study and clinical radiographic review.

Clinics (Sao Paulo). 2017-10

[8]
Treatment of Thoracolumbar Fractures Through Different Short Segment Pedicle Screw Fixation Techniques: A Finite Element Analysis.

Orthop Surg. 2020-3-2

[9]
Finite element analysis comparing short-segment instrumentation with conventional pedicle screws and the Schanz pedicle screw in lumbar 1 fractures.

Neurosurg Rev. 2019-8-2

[10]
A Hybrid Uniplanar Pedicle Screw System with a New Intermediate Screw for Minimally Invasive Spinal Fixation: A Finite Element Analysis.

Biomed Res Int. 2020

引用本文的文献

[1]
Finite element analysis of short-segment fixation combined with expandable polyetheretherketone vertebral body replacement in osteoporotic vertebrae.

BMC Musculoskelet Disord. 2025-8-20

[2]
Characteristics and mechanical mechanisms of intervertebral disc degeneration in old thoracolumbar fractures with kyphosis: clinical observations and finite element analyses.

BMC Musculoskelet Disord. 2024-12-19

[3]
Application of Multi-Rod Constructs for the Revision of Thoracolumbar Fractures.

Orthop Surg. 2024-10

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