Zot François, Ben-Brahim Estelle, Severyns Mathieu, Ledoux Yann, Mesnard Michel, Caillé Laëtitia, Swennen Cécile, Teyssédou Simon, Moufid Abdollah-Yassine, Germaneau Arnaud, Vendeuvre Tanguy
Institut Pprime, UPR 3346 CNRS-Université de Poitiers, Poitiers, France.
CHU de Poitiers, Department of Orthopaedic Surgery and Traumatology, Poitiers, France.
Front Bioeng Biotechnol. 2023 Nov 21;11:1287197. doi: 10.3389/fbioe.2023.1287197. eCollection 2023.
Lumbar disc arthroplasty is a surgical procedure designed to treat degenerative disc disease by replacing the affected disc with a mobile prosthesis. Several types of implants fall under the term total disc replacement, such as ball-and-socket, mobile core or elastic prostheses. Some studies have shown that facet arthritis can develop after arthroplasty, without much precision on the mechanical impact of the different implant technologies on the facet joints. This study aims to create validated patient-specific finite element models of the intact and post-arthroplasty lumbar spine in order to compare the mechanical response of ball-and-socket and elastic prostheses. Intact models were developed from CT-scans of human lumbar spine specimens (L4-S1), and arthroplasty models were obtained by replacing the L4-L5 disc with total disc replacement implants. Pure moments were applied to reproduce physiological loadings of flexion/extension, lateral bending and axial rotation. Models with ball-and-socket prosthesis showed increased values in both range of motion and pressure at the index level and lower values at the adjacent level. The mechanical behaviour of the elastic prosthesis and intact models were comparable. The dissipated friction energy in the facet joints followed a similar trend. Although both implants responded to the total disc replacement designation, the mechanical effects in terms of range of motion and facet joint loads varied significantly not only between prostheses but also between specimens. This confirms the interest that patient-specific surgical planning using finite element analysis could have in helping surgeons to choose the appropriate implant for each patient.
腰椎间盘置换术是一种外科手术,旨在通过用可移动假体替换受影响的椎间盘来治疗椎间盘退变疾病。几种类型的植入物都属于全椎间盘置换的范畴,例如球窝式、活动核心式或弹性假体。一些研究表明,关节置换术后可能会出现小关节关节炎,但对于不同植入技术对小关节的机械影响,研究的精确性不高。本研究旨在创建经过验证的完整和人工关节置换术后腰椎的患者特异性有限元模型,以比较球窝式和弹性假体的力学响应。完整模型是根据人类腰椎标本(L4-S1)的CT扫描构建的,人工关节置换模型是通过用全椎间盘置换植入物替换L4-L5椎间盘获得的。施加纯力矩以再现屈伸、侧弯和轴向旋转的生理负荷。球窝式假体模型在指数节段的运动范围和压力值增加,而在相邻节段的值较低。弹性假体和完整模型的力学行为具有可比性。小关节中的耗散摩擦能遵循类似趋势。尽管两种植入物都符合全椎间盘置换的定义,但在运动范围和小关节负荷方面的力学效应不仅在假体之间而且在标本之间都有显著差异。这证实了使用有限元分析进行患者特异性手术规划有助于外科医生为每个患者选择合适植入物的意义。