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增强螺钉技术预防经椎间孔腰椎椎间融合术(TLIF)融合器下沉:一项生物力学体外研究

Augmenting Screw Technique to Prevent TLIF Cage Subsidence: A Biomechanical In Vitro Study.

作者信息

Jacob Alina, Feist Alicia, Zderic Ivan, Gueorguiev Boyko, Caspar Jan, Wirtz Christian R, Richards Geoff, Loibl Markus, Haschtmann Daniel, Fekete Tamas F

机构信息

Department of Neurosurgery, University of Ulm, 89081 Ulm, Germany.

AO Research Institute Davos, 7270 Davos, Switzerland.

出版信息

Bioengineering (Basel). 2025 Mar 24;12(4):337. doi: 10.3390/bioengineering12040337.

Abstract

(1) Cage subsidence in spine surgery is a frequent clinical challenge. This study aimed to assess a novel screw augmentation technique for Transforaminal Lumbar Interbody Fusion in cadavers of reduced bone mineral density (BMD). (2) Forty human lumbar vertebrae (BMD 84.2 ± 24.4 mgHA/cm, range 51-119 mgHA/cm) were assigned to two groups: augmenting screw group and control group. The augmentation technique comprised placement of two additional subcortical screws. Ten constructs per group were loaded with a quasi-static load-to-failure protocol and other ten were cyclically loaded. Failure modes were documented. (3) During the quasi-static load-to-failure testing, the augmenting screw technique showed a significantly higher failure load (1426.0 ± 863.6 N) versus the conventional technique in the control group (682.2 ± 174.5 N, = 0.032). Cyclic loading revealed higher number of cycles and corresponding load until reaching 5 mm subsidence and significantly higher number of cycles and corresponding load until reaching 10 mm subsidence for the augmenting screw technique (9645 ± 3050; 1164.5 ± 305.0 N) versus the conventional technique in the control group (5395 ± 2340; 739.5 ± 234.0 N, < 0.05). Failure modes were different and showed bending of the augmenting screws, followed by cut-out. (4) The investigated augmenting screw technique demonstrated higher failure loads and cycles to failure against cage subsidence compared to conventional cage placement. Failure modes were different between the two techniques and may lead to a different kind of complications.

摘要

(1)脊柱手术中椎间融合器下沉是一个常见的临床挑战。本研究旨在评估一种用于低骨密度尸体经椎间孔腰椎椎间融合术的新型螺钉增强技术。(2)将40个人类腰椎椎体(骨密度84.2±24.4mgHA/cm,范围51 - 119mgHA/cm)分为两组:增强螺钉组和对照组。增强技术包括额外放置两枚皮质下螺钉。每组10个结构采用准静态加载至破坏方案加载,另外10个进行循环加载。记录失败模式。(3)在准静态加载至破坏测试中,增强螺钉技术显示出的破坏载荷(1426.0±863.6N)显著高于对照组的传统技术(682.2±174.5N,P = 0.032)。循环加载显示,与对照组的传统技术相比,增强螺钉技术在达到5mm下沉时具有更多的循环次数和相应载荷,在达到10mm下沉时也具有显著更多的循环次数和相应载荷(9645±3050;1164.5±305.0N)(P < 0.05)。失败模式不同,表现为增强螺钉弯曲,随后穿出。(4)与传统椎间融合器放置相比,所研究的增强螺钉技术在抵抗椎间融合器下沉方面显示出更高的破坏载荷和破坏循环次数。两种技术的失败模式不同,可能导致不同类型的并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5288/12024390/deed5070a577/bioengineering-12-00337-g001.jpg

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