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不同后路固定技术治疗老年骨质疏松性胸腰椎爆裂骨折的生物力学评价:有限元分析

Biomechanical evaluation of different posterior fixation techniques for treating thoracolumbar burst fractures of osteoporosis old patients: a finite element analysis.

作者信息

Zhang Guodong, Du Yukun, Jiang Guangzong, Kong Weiqing, Li Jianyi, Zhu Zhongjiao, Xi Yongming

机构信息

Department of Spinal Surgery, Tengzhou Central People's Hospital, Tengzhou, China.

Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.

出版信息

Front Bioeng Biotechnol. 2023 Nov 1;11:1268557. doi: 10.3389/fbioe.2023.1268557. eCollection 2023.

Abstract

To investigate the biomechanical characteristics of different posterior fixation techniques in treatment of osteoporotic thoracolumbar burst fractures by finite element analysis. The Dicom format images of T10-L5 segments were obtained from CT scanning of a volunteer, and transferred to the Geomagic Studio software, which was used to build digital models. L1 osteoporotic burst fracture and different posterior fixation techniques were simulated by SolidWorks software. The data of ROM, the maximum displacement of fixed segment, ROM of fractured L1 vertebrae, the stress on the screws and rods as well as on fractured L1 vertebrae under different movement conditions were collected and analysed by finite element analysis. Among the four groups, the largest ROM of fixed segment, the maximum displacement of fixed segment and ROM of fractured vertebrae occurred in CBT, and the corresponding data was 1.3°, 2.57 mm and 1.37°, respectively. While the smallest ROM of fixed segment, the maximum displacement of fixed segment and ROM of fractured vertebrae was found in LSPS, and the corresponding data was 0.92°, 2.46 mm and 0.89°, respectively. The largest stress of screws was 390.97 Mpa, appeared in CBT, and the largest stress of rods was 84.68 MPa, appeared in LSPS. The stress concentrated at the junction area between the root screws and rods. The maximum stress on fractured vertebrae was 93.25 MPa, appeared in CBT and the minimum stress was 56.68 MPa, appeared in CAPS. And the stress of fractured vertebrae concentrated in the middle and posterior column of the fixed segment, especially in the posterior edge of the superior endplate. In this study, long-segment posterior fixation (LSPF) provided with the greatest stability of fixed segment after fixation, while cortical bone screw fixation (CBT) provided with the smallest stability. Cement-augmented pedicle screw-rod fixation (CAPS) and combined using cortical bone screw and pedicle screw fixation (CBT-PS) provided with the moderate stability. CBT-PS exhibited superiority in resistance of rotational torsion for using multiple connecting rods. CAPS and CBT-PS maybe biomechanically superior options for the surgical treatment of burst TL fractures in osteoporotic patients.

摘要

通过有限元分析研究不同后路固定技术治疗骨质疏松性胸腰椎爆裂骨折的生物力学特性。从一名志愿者的CT扫描中获取T10 - L5节段的Dicom格式图像,并将其传输到Geomagic Studio软件中,用于构建数字模型。使用SolidWorks软件模拟L1骨质疏松性爆裂骨折及不同的后路固定技术。通过有限元分析收集并分析不同运动条件下固定节段的ROM、固定节段的最大位移、骨折L1椎体的ROM、螺钉和棒以及骨折L1椎体上的应力数据。在四组中,固定节段的最大ROM、固定节段的最大位移和骨折椎体的ROM在CBT组中最大,相应数据分别为1.3°、2.57mm和1.37°。而固定节段的最小ROM、固定节段的最大位移和骨折椎体的ROM在LSPS组中最小,相应数据分别为0.92°、2.46mm和0.89°。螺钉的最大应力为390.97Mpa,出现在CBT组,棒的最大应力为84.68MPa,出现在LSPS组。应力集中在椎弓根螺钉与棒的交界处。骨折椎体上的最大应力为93.25MPa,出现在CBT组,最小应力为56.68MPa,出现在CAPS组。且骨折椎体的应力集中在固定节段的中柱和后柱,尤其是在上终板的后缘。在本研究中,长节段后路固定(LSPF)在固定后提供了固定节段最大的稳定性,而皮质骨螺钉固定(CBT)提供了最小的稳定性。骨水泥增强椎弓根螺钉 - 棒固定(CAPS)和皮质骨螺钉与椎弓根螺钉联合固定(CBT - PS)提供了中等稳定性。CBT - PS在使用多个连接杆时表现出抗扭转优势。CAPS和CBT - PS可能是骨质疏松患者爆裂性胸腰椎骨折手术治疗的生物力学上更优的选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ecd2/10646582/69f3cdbd2452/fbioe-11-1268557-g001.jpg

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