ТhХІІ椎体切除术后躯干向后弯曲时胸腰节椎弓根固定变异的数学模型

O. Nekhlopochyn, V. Verbov, I. Cheshuk, Mykhailo Karpinsky, O. Yaresko
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The ТhХІІ vertebra was removed, and an interbody support and transpedicularsystem with 8 screws were implanted to simulate the postsurgical state after a ТhХІІ burst fracture with wide laminectomy, facetectomy, and corpectomy. The influence of transpedicular screw length and the presence of cross-links on the SSS of the model wasexamined. Results. The use of bicortical screws reduced stress levels in the bone elements of the model, except in the regions around the screws in the lumbar vertebrae, when compared to short screws.Installing cross-links decreased stress levels at all control points compared to models without cross-links. Specifically, in the presence of cross-links, the SSS values at the entry points of the short screwsinto the vertebral bodies of ThX, ThXI, LI, and LII were 2.3, 1.8, 1.2, and 5.0MPa, respectively, compared to 2.7, 2.0, 1.5, and 6.1 MPa in the models without cross-links. 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引用次数: 1

摘要

胸腰椎交界处骨折是最常见的创伤性脊柱损伤。椎体置换术中器械的进步显著改善了手术技术。然而,稳定手术的生物力学特性研究还不够充分。目标。研究ТhХІІ椎体切除后躯干向后弯曲时人胸腰椎数学有限元模型的应力应变状态(SSS),考虑不同的经椎弓根固定方案。方法。建立了人胸腰椎- ThIX-LV椎体的数学有限元模型。切除ТhХІІ椎体,植入8颗螺钉的椎间支撑和经椎弓根系统,模拟ТhХІІ爆裂骨折伴宽椎板切除术、面切除术和椎体切除术后的术后状态。研究了椎弓根螺钉长度和交联对模型SSS的影响。结果。与短螺钉相比,双皮质螺钉的使用降低了模型骨单元的应力水平,腰椎螺钉周围区域除外。与没有安装交联的模型相比,安装交联可以降低所有控制点的应力水平。其中,在存在交联的情况下,ThX、ThXI、LI和LII的短螺钉进入椎体的SSS值分别为2.3、1.8、1.2和5.0MPa,而在没有交联的模型中,SSS值分别为2.7、2.0、1.5和6.1 MPa。在无交联双皮质螺钉的情况下,螺钉进入椎弓根处的应力值分别为2.9、1.5、8.2和11.2 MPa,而在有交联的模型中,应力值为2.7、1.5、7.5和10.2 MPa。结论。当树干向后倾斜时,使用交联可以减少模型中所有控制点的应力水平,无论使用的螺钉长度如何。双皮质经椎弓根螺钉增加了螺钉本身及其周围腰椎椎体的应力水平。
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MATHEMATICAL MODELING OF VARIANTS OF TRANSPEDICULAR FIXATION AT THE THORACOLUMBAR JUNCTION AFTER ТHХІІ VERTEBRECTOMY DURING TRUNK BACKWARD BENDING
Fractures at the thoracolumbar junction are the most common traumatic spinal injuries. Advances in instrumentation for vertebral body replacement have significantly improved surgical techniques.However, the biomechanical characteristics of stabilizing surgeries have been insufficiently studied. Objective. To investigate the stressstrain state (SSS) of a mathematical finite element model of the humanthoracolumbar spine during trunk backward bending after ТhХІІ vertebra resection, considering different transpedicular fixation options. Methods. A mathematical finite element model of the humanthoracolumbar spine — ThIX‒LV vertebrae — was developed. The ТhХІІ vertebra was removed, and an interbody support and transpedicularsystem with 8 screws were implanted to simulate the postsurgical state after a ТhХІІ burst fracture with wide laminectomy, facetectomy, and corpectomy. The influence of transpedicular screw length and the presence of cross-links on the SSS of the model wasexamined. Results. The use of bicortical screws reduced stress levels in the bone elements of the model, except in the regions around the screws in the lumbar vertebrae, when compared to short screws.Installing cross-links decreased stress levels at all control points compared to models without cross-links. Specifically, in the presence of cross-links, the SSS values at the entry points of the short screwsinto the vertebral bodies of ThX, ThXI, LI, and LII were 2.3, 1.8, 1.2, and 5.0MPa, respectively, compared to 2.7, 2.0, 1.5, and 6.1 MPa in the models without cross-links. In the case of bicortical screwswithout cross-links, the stress values at the screw entry points into the pedicles of the corresponding vertebrae were 2.9, 1.5, 8.2, and 11.2 MPa, respectively, compared to 2.7, 1.5, 7.5, and 10.2 MPa in the models with cross-links. Conclusions. When the trunk is tilted backward, the use of cross-links reduces stress levels at all control points in the models, regardless of the screw length used. Bicortical transpedicular screws increase stress levels on the screws themselves and in the lumbar vertebral bodies surrounding them.
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