改良皮质骨轨迹螺钉联合椎弓根螺钉技术对融合节段影响的有限元分析
Effects on Fusion Segment by Combining Modified Cortical Bone Trajectory Screw and Pedicle Screw Techniques:A Finite Element Analysis
肖扬 1王轶希 1张瑞 1张涛 2阿卜杜萨拉木·托合提 1陈琪豪 1木再帕尔·买吐送 1帕尔哈提·热西提3
作者信息
- 1. 新疆医科大学第一附属医院 脊柱微创及精准骨科,乌鲁木齐 830000
- 2. 新疆骨科疾病临床医学研究中心,乌鲁木齐 830000
- 3. 新疆医科大学第一附属医院 脊柱微创及精准骨科,乌鲁木齐 830000;新疆骨科疾病临床医学研究中心,乌鲁木齐 830000;新疆地区高发疾病研究教育部重点实验室(新疆医科大学),乌鲁木齐 830000
- 折叠
摘要
目的 基于 L4～5 节段后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)模型研究双侧椎弓根螺钉(bilateral pedicle screw,BPS)和双侧改良皮质骨轨迹螺钉(bilateral modified cortical bone trajectory screw,BMCS)联合固定技术的生物力学特性.方法 根据 3 具尸体腰椎标本,建立L1～S1 椎体有限元模型.BPS-BPS(TT螺钉位于L4～5)、BPS-BMCS(TT螺钉位于L4,MCBT螺钉位于L5)、BMCS-BPS(MCBT螺钉位于L4,TT螺钉位于L5 节段)和 BMCS-BMCS(MCBT螺钉位于L4～5)植入有限元模型中.在400 N载荷和 7.5 N·m力矩的屈曲、后伸、弯曲和旋转条件下,比较 L4～5 节段运动范围(range of motion,ROM)以及内固定系统、融合器和连接棒的峰值应力.结果 BMCS-BPS组在旋转工况下 ROM 以及融合器、内固定系统和连接棒峰值应力均小于 BPS-BPS 组、BPS-BMCS组、BMCS-BMCS组.BPS-BMCS组和BMCS-BPS组较BPS-BPS组显著降低了弯曲、旋转工况下L4～5 节段ROM,较BMCS-BMCS组显著降低了旋转工况下L4～5 节段ROM.BPS-BMCS组和BMCS-BPS组在弯曲工况下较BPS-BPS组和旋转工况下较传BMCS-BMCS组显著减少融合器沉降的风险.BPS-BMCS组和BMCS-BPS组较BPS-BPS组、BMCS-BMCS组显著降低了弯曲、旋转工况下连接棒断裂失效的风险,且增强了内固定系统的稳定性.结论 PLIF联合BPS-BMCS 和 BMCS-BPS固定技术,可为人体在弯曲和旋转时可提供较好的内固定系统稳定性、椎体稳定性以及较低的融合器沉降和连接棒断裂风险,从而提高手术成功率和患者的康复效果.
Abstract
Objective To evaluate the biomechanical properties of the bilateral pedicle screw(BPS)and bilateral modified cortical bone trajectory screw(BMCS)fixation techniques in the posterior lumbar interbody fusion(PLIF)model of the L4-5 segment.Methods Finite element models of the L1-S1 lumbar spine were established using three cadaveric lumbar spine specimens.BPS-BPS(TT at the L4-5 segment),BPS-BMCS(TT at the L4 segment and MCBT at the L5 segment),BMCS-BPS(MCBT at the L4 segment and TT at the L5 segment),and BMCS-BMCS(MCBT at the L4-5 segment)were implanted into the finite element model.The range of motion(ROM)at the L4-5 segment and the peak von Mises stress on the internal fixation system,cage,and connecting rods were compared under bending,extension,flexion,and rotation conditions with a 400 N load and 7.5 N·m torque.Results The BMCS-BPS group showed lower ROM and von Mises stress on the cage,internal fixation system,and connecting rods under rotational conditions than the BPS-BPS,BPS-BMCS,and BMCS-BMCS groups.The BPS-BMCS and BMCS-BPS groups had significantly reduced ROM of the L4-5 segment under bending and rotational conditions compared with the BPS-BPS group,and significantly decreased ROM under rotational conditions compared with the BMCS-BMCS group.The BPS-BMCS and BMCS-BPS groups had a significantly reduced risk of cage subsidence under bending conditions compared with the BPS-BPS group,and under rotational conditions compared with the BMCS-BMCS group.The BPS-BMCS and BMCS-BPS groups had a significantly reduced risk of connecting rod fractures under bending and rotational conditions compared with the BPS-BPS and BMCS-BMCS groups.This enhanced the stability of the internal fixation system.Conclusions PLIF combined with the BPS-BMCS and BMCS-BPS fixation techniques can provide better stability for the internal fixation system and vertebral body as well as a lower risk of cage subsidence and connecting rod fracture during bending and rotation in the human body.This would improve the success rate of surgery and recovery effect of patients.
关键词
椎弓根螺钉/改良皮质骨轨迹螺钉/后路腰椎椎间融合术/内固定Key words
pedicle screw/modified cortical bone trajectory screw/posterior lumbar interbody fusion/internal fixation引用本文复制引用
出版年
2024
NETL
NSTL
万方数据