Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Department of Spinal Surgery, Tengzhou Central People's Hospital, Tengzhou, Shandong, China.
Spine (Phila Pa 1976). 2024 Aug 1;49(15):E229-E238. doi: 10.1097/BRS.0000000000005034. Epub 2024 May 9.
STUDY DESIGN: Finite element analysis. OBJECTIVE: To investigate the biomechanical effect of four posterior fixation techniques on stability and adjacent segment degeneration in treating thoracolumbar burst fractures with osteoporosis. SUMMARY OF BACKGROUND DATA: In terms of stability and adjacent segment degeneration, there remains no consensus or guidelines on the optimal technique for the treatment of thoracolumbar burst fractures in patients with osteoporosis. MATERIALS AND METHODS: Images of CT scans were imported into MIMICS and further processed by Geomagic to build three-dimensional models of the T10-L5 region. A v-shaped osteotomy was performed on the L1 vertebral body to simulate a burst fracture in the setting of osteoporosis. Subsequently, four fixation techniques were designed using SolidWorks software. Range of motion (ROM) of the global spine, ROM distribution, ROM of adjacent segment, Von Mises stress on adjacent intervertebral disks, and facet joints were analyzed. RESULTS: Among the four groups, the cortical bone screw fixation (CBT) showed the highest global ROM at 1.86°, while long-segmented pedicle screw fixation (LSPS) had the lowest global ROM at 1.25°. The LSPS had the smallest percentage of ROM of fractured vertebral body to fixed segment at 75.04%, suggesting the highest stability after fixation. The maximum ROM of the adjacent segment was observed in the CBT at 1.32°, while the LSPS exhibited the smallest at 0.89°. However, the LSPS group experienced larger maximum stress on the adjacent intervertebral disks (9.60 MPa) and facet joints (3.36 MPa), indicating an increasing risk of adjacent segment disease. CONCLUSION: LSPS provided the greatest stability, while CBT provided the smallest amount of stability. However, the elevated stress on adjacent intervertebral disks and facet joints after LSPS fixation increased the possibility of adjacent segment degeneration. Cement-augmented pedicle screw fixation (CAPS) and combined cortical bone screw and pedicle screw fixation (CBT-PS) demonstrated significant biomechanical advantages in providing moderate fixation strength while reducing stress on the intervertebral disks and facet joints.
研究设计：有限元分析。
目的：探讨四种后路固定技术治疗骨质疏松性胸腰椎爆裂骨折的稳定性和相邻节段退变的生物力学效果。
背景资料概要：在稳定性和相邻节段退变方面，对于骨质疏松性胸腰椎爆裂骨折患者的最佳治疗技术，尚无共识或指南。
材料和方法：将 CT 扫描图像导入 Mimics 并进一步通过 Geomagic 处理，以构建 T10-L5 区域的三维模型。在骨质疏松症背景下，对 L1 椎体进行 V 形截骨以模拟爆裂骨折。随后，使用 SolidWorks 软件设计了四种固定技术。分析了整体脊柱的活动度（ROM）、ROM 分布、相邻节段的 ROM、相邻椎间盘的 Von Mises 应力和小关节。
结果：在四组中，皮质骨螺钉固定（CBT）的整体 ROM 最高，为 1.86°，而长节段椎弓根螺钉固定（LSPS）的整体 ROM 最低，为 1.25°。LSPS 固定后骨折椎体与固定节段的 ROM 百分比最小，为 75.04%，提示固定后稳定性最高。CBT 中观察到相邻节段的最大 ROM 为 1.32°，而 LSPS 中的最小 ROM 为 0.89°。然而，LSPS 组相邻椎间盘（9.60 MPa）和小关节（3.36 MPa）的最大应力较大，表明相邻节段疾病的风险增加。
结论：LSPS 提供了最大的稳定性，而 CBT 提供了最小的稳定性。然而，LSPS 固定后相邻椎间盘和小关节的高应力增加了相邻节段退变的可能性。骨水泥增强椎弓根螺钉固定（CAPS）和皮质骨螺钉与椎弓根螺钉联合固定（CBT-PS）在提供适度固定强度的同时，减少了椎间盘和小关节的应力，具有显著的生物力学优势。
Comput Methods Biomech Biomed Engin. 2019-10
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