骨盆固定策略和多杆结构对长胸腰椎后路器械融合术近端交界处生物力学的影响:有限元分析。

IF 1.6 Q3 CLINICAL NEUROLOGY Spine deformity Pub Date : 2024-11-01 Epub Date: 2024-08-20 DOI:10.1007/s43390-024-00932-w
Muzammil Mumtaz, Andrew P Collins, Niloufar Shekouhi, Karthika Varier, Sudharshan Tripathi, Christopher P Ames, Vedat Deviren, Aaron J Clark, Vijay K Goel, Alekos A Theologis
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引用次数: 0

摘要

目的:评估各种骨盆固定技术和骨棒数量对长胸腰椎后路器械融合术近端交界处生物力学的影响:方法:对经过验证的脊柱骨盆有限元(FE)模型进行 L5-S1 ALIF 和以下 9 种后路器械配置之一的器械固定:(A) 双侧传统髂骨螺钉("2髂骨/2杆");(B) T10至S1("仅骶骨");(C) 单侧传统髂骨螺钉("1髂骨/2杆");(D) 双侧传统髂骨螺钉加中线辅助杆("2髂骨/3杆");(E) S2AI 螺钉直接与中线杆连接("2 S2AI/2 杆");以及两侧传统髂骨螺钉与两根外侧辅助杆在不同位置与主杆连接(F1:F1:T10-11,F2:T11-12,F3:T12-L1,F4:L1-2)("4 髂/4 杆")。记录了 T10-S1 和 T9-T10 的运动范围 (ROM),并对不同模型进行了比较。除了 T9 和 T10 椎体的 von Mises 应力外,还记录并比较了 T9-T10 椎间盘的椎间盘内压力和 T9-10 椎间盘环的应力:就T10-S1的ROM而言,4根髂骨/4根棒的屈伸ROM最低,而2根S2AI/2根棒的旋转ROM最低。与双杆结构相比,3杆或4杆结构的主杆应力较低。在邻近椎间盘的近端(T9-10),4根髂骨/4根连杆在所有方向上都显示出最低的ROM、最低的椎间盘内压力和最低的椎环应力(屈伸时最为明显)。在屈伸状态下,4 髂骨/4 根螺钉在 T10 椎体上的 von Mises 应力最小,但在 T9 椎体上的应力最大:结论:在腰骶部交界处并延伸至胸腰部交界处的双髂骨螺钉与 4 根螺钉显示出最低的 T10-S1 ROM、最低的相邻节段椎间盘(T9-T10)ROM、椎间盘内压力和椎环应力,以及最低的 UIV 应力,尽管 UIV + 1 应力最高。还需要进行更多的研究,以确认这些生物力学结果是否决定了临床结果以及近端交界处脊柱后凸和失效的影响率。
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Effects of pelvic fixation strategies and multi-rod constructs on biomechanics of the proximal junction in long thoracolumbar posterior instrumented fusions: a finite-element analysis.

Purpose: To assess the effect of various pelvic fixation techniques and number of rods on biomechanics of the proximal junction of long thoracolumbar posterior instrumented fusions.

Methods: A validated spinopelvic finite-element (FE) model was instrumented with L5-S1 ALIF and one of the following 9 posterior instrumentation configurations: (A) one traditional iliac screw bilaterally ("2 Iliac/2 Rods"); (B) T10 to S1 ("Sacral Only"); (C) unilateral traditional iliac screw ("1 Iliac/2 Rods"); (D) one traditional iliac screw bilaterally with one midline accessory rod ("2 Iliac/3 rods"); (E) S2AI screws connected directly to the midline rods ("2 S2AI/2 Rods"); and two traditional iliac screws bilaterally with two lateral accessory rods connected to the main rods at varying locations (F1: T10-11, F2: T11-12, F3: T12-L1, F4: L1-2) ("4 Iliac/4 Rods"). Range of motions (ROM) at T10-S1 and T9-T10 were recorded and compared between models. The T9-T10 intradiscal pressures and stresses of the T9-10 disc's annulus in addition to the von Mises stresses of the T9 and T10 vertebral bodies were recorded and compared.

Results: For T10-S1 ROM, 4 iliac/4 rods had lowest ROM in flexion and extension, while 2 S2AI/2 rods showed lowest ROM in rotation. Constructs with 3 or 4 rods had lower stresses on the primary rods compared to 2-rod constructs. At the proximal adjacent disc (T9-10), 4 iliac/4 rods showed lowest ROM, lowest intradiscal pressures, and lowest annular stress in all directions (most pronounced in flexion-extension). Under flexion and extension, 4 iliac/4 rods also showed the lowest von Mises stresses on the T10 vertebral body but the highest stresses on the T9 vertebral body.

Conclusions: Dual iliac screws with 4 rods across the lumbosacral junction and extending to the thoracolumbar junction demonstrated the lowest T10-S1 ROM, the lowest adjacent segment disc (T9-T10) ROM, intradiscal pressures, and annular stresses, and the lowest UIV stresses, albeit with the highest UIV + 1 stresses. Additional studies are needed to confirm whether these biomechanical findings dictate clinical outcomes and effect rates of proximal junctional kyphosis and failure.

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来源期刊
CiteScore
3.20
自引率
18.80%
发文量
167
期刊介绍: Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
期刊最新文献
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