脊柱和骨盆矢状面平衡指标正常情况下后路腰椎融合模型应力-应变状态的研究

IF 6.3 1区 医学 Q1 DERMATOLOGY Burns & Trauma Pub Date : 2023-09-04 DOI:10.22141/1608-1706.2.24.2023.939
K. Popsuyshapka, O.V. Kovernyk, O.O. Pidgayska, M. Karpinsky, O. Yaresko
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A finite-element model has been developed reflecting the condition that occurs in the combined course of degenerative diseases of the lumbar spine and hip joint and is characterized by normal lordosis of 40º and forward body tilt due to flexion contracture in the hip joints. The following options were modeled: 1 — posterior fusion of the L4-L5 vertebrae using a transpedicular structure with 4 screws and an interbody support; 2 — posterior fusion of the L3-L4-L5 vertebrae using a transpedicular construction with 6 screws; 3 — posterior fusion of L1-L5 vertebrae using a transpedicular structure with 10 screws. When conducting the research, the values of stresses in the Th1-L5 vertebrae, on the screws and rods of the transpedicular structure were studied. Results. Posterior fusion with a transpedicular construction on two L4-L5 vertebrae leads to the occurrence of maximum stresses in vertebral bodies of the lumbar spine, especially L4-L5. The lowest stresses in the lumbar vertebral bodies can be obtained when the transpedicular structure is applied to all 5 vertebrae. The use of all options for posterior fusion, except for the 4-screw scheme, allows to reduce the stress in the vertebral arches of the lumbar spine below the level of the normal spine model, except for the L1 vertebra. This leads to an increase in the level of stress from the Th6 to Th12 vertebrae. The construction placed on all 5 vertebrae ensures the lowest level of stress in the arches of thoracic vertebrae. The construction placed on all the vertebrae of the lumbar spine provides a minimum level of stress in the bone tissue around the fixing screws. Reducing the length of fixation leads to a significant increase in stress in these zones. With all types of installation of the transpedicular construction, the values of the stresses on the screws in the L3-L5 vertebrae are comparable. 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引用次数: 0

摘要

背景。髋关节有明显改变的髋关节-脊柱综合征患者中有21.2 - 49.4%的患者主诉腰椎疼痛。腰椎融合术后,骨盆活动度降低,导致髋关节置换术后脱位和发生撞击的风险增加,这是重复手术干预的原因。目的:研究脊柱矢状面轮廓和腰椎前凸正常情况下腰椎后路融合术模型的应力分布。材料和方法。建立了一个反映腰椎和髋关节退行性疾病合并过程中发生的情况的有限元模型,其特征是由于髋关节屈曲挛缩导致的正常前凸40º和身体前倾。模拟了以下方案:1 - L4-L5椎体后路融合,采用经椎弓根结构,采用4枚螺钉和椎间支撑;2 -采用经椎弓根结构和6枚螺钉后路融合L3-L4-L5椎体;采用经椎弓根结构和10枚螺钉后路融合L1-L5椎体。在进行研究时,研究了Th1-L5椎体、椎弓根结构的螺钉和棒的应力值。结果。两个L4-L5椎体经椎弓根结构的后路融合导致腰椎椎体,特别是L4-L5椎体出现最大应力。当经椎弓根结构应用于所有5个椎体时,腰椎椎体的应力最小。除4螺钉方案外,所有后路融合术的选择都可以减少除L1椎体以外的腰椎椎弓处低于正常脊柱模型水平的应力。这导致从Th6到Th12椎体的压力水平增加。在所有5个椎骨上的结构确保了胸椎弓的最低压力水平。安装在腰椎所有椎骨上的结构为固定螺钉周围的骨组织提供了最小的应力水平。减少固定的长度会导致这些区域的应力显著增加。对于所有类型的经椎弓根结构安装,L3-L5椎体螺钉上的应力值是可比较的。采用腰椎5椎体设计时,L1和L2椎体的锁定螺钉将承受较大的载荷,因此会对其产生较大的应力。当两个L4-L5椎体被置入时,杆状物的最大应力水平发生,当结构被置入腰椎的所有五个椎体时,杆状物的最小应力水平发生。结论。考虑到应力分布,固定长度起着重要的作用:固定长度越长,模型骨单元和金属结构单元的应力水平越低。
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Study of the stress-strain state of the posterior lumbar fusion models in case of normal indicators of the sagittal balance of the spine and pelvis
Background. Patients suffering from hip-spine syndrome with significant changes in the hip joint complain of pain in the lumbar spine in 21.2–49.4 % of cases. After performing lumbar fusion, the mobility of the pelvis decreases, which leads to an increased risk of dislocations and the development of impingement after hip arthroplasty that is the cause for repeated surgical interventions. Goal: to study the stress distribution in the models of posterior lumbar fusion in case of normal values of the sagittal contour of the spine and lumbar lordosis. Materials and methods. A finite-element model has been developed reflecting the condition that occurs in the combined course of degenerative diseases of the lumbar spine and hip joint and is characterized by normal lordosis of 40º and forward body tilt due to flexion contracture in the hip joints. The following options were modeled: 1 — posterior fusion of the L4-L5 vertebrae using a transpedicular structure with 4 screws and an interbody support; 2 — posterior fusion of the L3-L4-L5 vertebrae using a transpedicular construction with 6 screws; 3 — posterior fusion of L1-L5 vertebrae using a transpedicular structure with 10 screws. When conducting the research, the values of stresses in the Th1-L5 vertebrae, on the screws and rods of the transpedicular structure were studied. Results. Posterior fusion with a transpedicular construction on two L4-L5 vertebrae leads to the occurrence of maximum stresses in vertebral bodies of the lumbar spine, especially L4-L5. The lowest stresses in the lumbar vertebral bodies can be obtained when the transpedicular structure is applied to all 5 vertebrae. The use of all options for posterior fusion, except for the 4-screw scheme, allows to reduce the stress in the vertebral arches of the lumbar spine below the level of the normal spine model, except for the L1 vertebra. This leads to an increase in the level of stress from the Th6 to Th12 vertebrae. The construction placed on all 5 vertebrae ensures the lowest level of stress in the arches of thoracic vertebrae. The construction placed on all the vertebrae of the lumbar spine provides a minimum level of stress in the bone tissue around the fixing screws. Reducing the length of fixation leads to a significant increase in stress in these zones. With all types of installation of the transpedicular construction, the values of the stresses on the screws in the L3-L5 vertebrae are comparable. When using the design for 5 vertebrae of the lumbar spine, the locking screws in the L1 and L2 vertebrae will experience significant loads, which, accordingly, will cause significant stress in them. The maximum level of stress in the rods occurs when two L4-L5 vertebrae are instrumented, the minimum is when the structure is placed on all five vertebrae of the lumbar spine. Conclusions. Given the stress distribution, the length of fixation plays an important role: the longer the length of fixation, the lower the stress level, both in the bone elements of the model and in the elements of metal structures.
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来源期刊
Burns & Trauma
Burns & Trauma 医学-皮肤病学
CiteScore
8.40
自引率
9.40%
发文量
186
审稿时长
6 weeks
期刊介绍: The first open access journal in the field of burns and trauma injury in the Asia-Pacific region, Burns & Trauma publishes the latest developments in basic, clinical and translational research in the field. With a special focus on prevention, clinical treatment and basic research, the journal welcomes submissions in various aspects of biomaterials, tissue engineering, stem cells, critical care, immunobiology, skin transplantation, and the prevention and regeneration of burns and trauma injuries. With an expert Editorial Board and a team of dedicated scientific editors, the journal enjoys a large readership and is supported by Southwest Hospital, which covers authors'' article processing charges.
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