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经皮单平面螺钉固定治疗胸腰椎骨折的有限元分析

Finite element analysis of percutaneous uniplanar screw fixation in the treatment of thoracolumbar fractures.

作者信息

Cao Shen, Xuan Tao, Zhang Chengbao, Zhang Yubing

机构信息

Department of Spine Surgery, Anhui No. 2 Provincial People's Hospital, Hefei, China.

出版信息

Eur J Med Res. 2025 Jun 23;30(1):514. doi: 10.1186/s40001-025-02785-z.


DOI:10.1186/s40001-025-02785-z
PMID:40551249
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12183841/
Abstract

OBJECTIVE: To compare the biomechanical characteristics of thoracolumbar fractures treated with uniplanar screws, monoaxial screws, and polyaxial screws using finite element analysis. METHODS: CT data of the thoracolumbar spine T-L from a healthy volunteer were collected, and using finite element software, models of both normal and fractured spines were created. Three different fixation models were constructed with monoaxial screws (Mps group), polyaxial screws (Pps group), and uniplanar screws (Ups group), respectively. The L vertebra was fixed and a compressive load of 150 N and a torque of 10 N•m were applied at the T end to simulate flexion, extension, lateral bending, and rotation movements of the spine. The range of motion (ROM) and internal fixation stress within the screws and rods were recorded for each movement direction. RESULTS: A finite element model of the healthy human spine T-L was established and validated for accuracy. All three fixation models demonstrated decreased ROM in all tested movements. The UPS group showed the lowest percentage of ROM in flexion, extension, and lateral bending movements, with a mid-range percentage of ROM in rotation, and relatively the best stability. The PPS group had the highest ROM percentages in all directions of movement, with the worst relative stability. The maximum von Mises stress for pedicle screws and rods in all fixation modes occurred in flexion, with the MPS group's screws showing significantly higher stress peaks in flexion and both rotations than those of the PPS and UPS groups. The rods of the PPS group had significantly lower stress peaks in all motion states compared to those of the MPS and UPS groups. CONCLUSIONS: Uniplanar screws can effectively distribute stress, reduce the risk of screw and rod breakage, and ensure stability of spinal fixation.

摘要

目的:采用有限元分析比较单平面螺钉、单轴螺钉和多轴螺钉治疗胸腰椎骨折的生物力学特性。 方法:收集一名健康志愿者胸腰椎T-L节段的CT数据,利用有限元软件建立正常和骨折脊柱模型。分别用单轴螺钉(Mps组)、多轴螺钉(Pps组)和单平面螺钉(Ups组)构建三种不同的固定模型。固定L椎体,在T端施加150 N的压缩载荷和10 N•m的扭矩,以模拟脊柱的前屈、后伸、侧屈和旋转运动。记录每个运动方向上的活动范围(ROM)以及螺钉和棒内的内固定应力。 结果:建立了健康人胸腰椎T-L节段的有限元模型,并验证了其准确性。所有三种固定模型在所有测试运动中ROM均降低。Ups组在前屈、后伸和侧屈运动中ROM百分比最低,旋转时ROM百分比处于中等范围,相对稳定性最佳。Pps组在所有运动方向上的ROM百分比最高,相对稳定性最差。所有固定模式下椎弓根螺钉和棒的最大von Mises应力出现在前屈时,Mps组的螺钉在前屈和两种旋转时的应力峰值明显高于Pps组和Ups组。与Mps组和Ups组相比,Pps组的棒在所有运动状态下的应力峰值均显著较低。 结论:单平面螺钉可有效分散应力,降低螺钉和棒断裂风险,确保脊柱固定的稳定性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09a1/12183841/a83937cbc854/40001_2025_2785_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09a1/12183841/19bfafed2991/40001_2025_2785_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09a1/12183841/4d00e929b063/40001_2025_2785_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09a1/12183841/8839bbb24fdf/40001_2025_2785_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09a1/12183841/a83937cbc854/40001_2025_2785_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09a1/12183841/19bfafed2991/40001_2025_2785_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09a1/12183841/4d00e929b063/40001_2025_2785_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09a1/12183841/8839bbb24fdf/40001_2025_2785_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/09a1/12183841/a83937cbc854/40001_2025_2785_Fig4_HTML.jpg

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本文引用的文献

[1]
Study Protocol for a Randomized Controlled Clinical Trial on the Outcome of Surgical Versus Primary Nonsurgical Treatment of Traumatic Thoracolumbar Spine Burst Fractures in Patients Without Neurological Symptoms-A34RCT.

Neurosurg Pract. 2024-4-25

[2]
Impact of Treatment Modalities and Fracture Stability on Survival in Thoracolumbar Fractures: A 5-Year Observational Study.

J Clin Med. 2025-1-31

[3]
Influence of Screw Length and Cement Position Within the Injured Vertebra on Fixation Strength in Short-Segment Fixation of Osteoporotic Thoracolumbar Burst Fractures.

World Neurosurg. 2024-12

[4]
Finite Element Analysis of Bilateral Double Rod Constructs in Thoracolumbar Fractures.

Turk Neurosurg. 2024

[5]
Comparison Clinical Outcomes of Posterior Short Segment Transpedicular Fixation with or without Injured Vertebra Fixation in Thoracolumbar Burst Fracture: A Retrospective Study.

Turk Neurosurg. 2024

[6]
Biomechanical evaluation of different posterior fixation techniques for treating thoracolumbar burst fractures of osteoporosis old patients: a finite element analysis.

Front Bioeng Biotechnol. 2023-11-1

[7]
Evaluating the safe zone for lumbar pedicle screws: are midline crossing screws indicative of pedicle breach?

Spine J. 2024-4

[8]
Comparative finite element analysis of posterior short segment fixation constructs with or without intermediate screws in the fractured vertebrae for the treatment of type a thoracolumbar fracture.

Comput Methods Biomech Biomed Engin. 2024-8

[9]
Single midline skin incision for long segment posterior percutaneous pedicle screw fixation.

Neurochirurgie. 2023-7

[10]
Finite element analysis of dynamic changes in spinal mechanics of osteoporotic lumbar fracture.

Eur J Med Res. 2022-8-6

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