改良椎弓根螺钉固定与传统腰骶骨盆固定治疗骶髂关节脱位的有限元分析
Finite element analysis of modified pedicle screw fixation and traditional lumbopelvic fixation for the treatment of sacroiliac joint disruption.
作者信息
Zhang Jun, Wei Yan, Yin Weizhong, Wang Jian, Liu Bingli, Ao Rongguang, Yu Baoqing
机构信息
Department of Orthopaedics, Pudong New Area People's Hospital, Shanghai, 201299, China.
Department of Surgery, Pudong New Area People's Hospital, Shanghai, 201299, China.
出版信息
BMC Musculoskelet Disord. 2024 Dec 27;25(1):1075. doi: 10.1186/s12891-024-08185-4.
INTRODUCTION
The modified pedicle screw fixation (PSF) was designed to simulate an integrated framework structure to ameliorate the resistance to vertical and shearing forces of the disrupted sacroiliac complex, and the aim of this study was to compare the biomechanical characteristics of PSF and traditional lumbopelvic fixation (LPF) for the treatment of sacroiliac joint disruption.
METHODS
The digital computer simulation model of an intact spine-pelvis-femur complex with main ligaments was built from clinical images. A left sacroiliac joint disruption model was mimicked by removing the concerned ligaments. After model validation, the two fixation models (modified PSF and traditional LPF) were established, and assembled with the disruption model. Under five loading scenarios (compression, flexion, extension, right bending, and left twisting), the finite element simulation was implemented. The maximum von Mises stress (VMS) of internal fixations and pelvises, maximum deformations on the Z-, Y-, X-axes and overall deformation of the sacrum were evaluated and compared.
RESULTS
Under all loading conditions, the maximum VMS of internal fixations and pelvises in the modified PSF model were lower than those in the traditional LPF model. Under flexion, right bending, and left twisting, the maximum Z-axis deformation of the sacrum for the modified PSF model was smaller than that of the traditional LPF model. For compression, the maximum Y-axis deformation of the sacrum was smaller than that of the traditional LPF model. During various loading modes, the maximum X-axis, and overall deformations of the sacrum for the modified PSF model were smaller than those in the traditional LPF model.
CONCLUSIONS
Compared with the traditional LPF, the modified PSF shows superior biomechanical stability, with satisfied resistance to vertical and shearing forces, which might be potentially suitable for treating sacroiliac joint disruption.
引言
改良椎弓根螺钉固定术（PSF）旨在模拟一种一体化框架结构，以改善骶髂复合体破坏后的垂直和剪切力抵抗能力。本研究的目的是比较PSF与传统腰骶部固定术（LPF）治疗骶髂关节破坏的生物力学特性。
方法
利用临床图像构建包含主要韧带的完整脊柱-骨盆-股骨复合体的数字计算机模拟模型。通过移除相关韧带模拟左侧骶髂关节破坏模型。模型验证后，建立两种固定模型（改良PSF和传统LPF），并与破坏模型组装。在五种加载工况（压缩、屈曲、伸展、右侧弯曲和左侧扭转）下进行有限元模拟。评估并比较内固定物和骨盆的最大von Mises应力（VMS）、骶骨在Z、Y、X轴上的最大变形以及整体变形。
结果
在所有加载条件下，改良PSF模型中内固定物和骨盆的最大VMS均低于传统LPF模型。在屈曲、右侧弯曲和左侧扭转时，改良PSF模型中骶骨的最大Z轴变形小于传统LPF模型。在压缩时，骶骨的最大Y轴变形小于传统LPF模型。在各种加载模式下，改良PSF模型中骶骨的最大X轴和整体变形均小于传统LPF模型。
结论
与传统LPF相比，改良PSF显示出更好的生物力学稳定性，对垂直和剪切力的抵抗能力令人满意，可能适合治疗骶髂关节破坏。
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