Finite Element Analysis of Internal Fixation in Cervical Spinous Process Fracture
Shen Yan1, Wang Chaoyang1*, Wu Rong1, Chen Bo2
1Department of Orthopedics, The PLA 98th Hospital, Huzhou 313000, Zhejiang, China; 2Department of Orthopedics Institute, Ruijin Hospital, Shanghai Jiaotong University School of Medicine,Shanghai 200025,China
Abstract:The aim of this work is to establish a three-dimensional finite element model of cervical spinous process fracture (extension into the lamina) after internal fixation and assure its availability to surgical treatment. Based on a finite element model of a normal cervical spine, a finite element model of cervical spinous process fracture (extension into the lamina) was developed according to the clinical case, with which an internal fixation therapy on fracture model was simulated. The range of motion (ROM) under flexion, extension, lateral-bending and axial rotation were measured and analyzed in the normal and fracture model and fixation model. The force loading was applied on both vertebra and internal fixation to elucidate the safety of this surgical therapy. It was shown that the finite element model of cervical spinous process fracture (extension into the lamina) had a high similarity and profile to the clinical case. The range of motion (ROM) on C7-T1 segment under each movement in fracture model (flexion+extension 9.20°, lateral-bending 5.83°, axial rotation 13.12°) was larger than that in the normal model(flexion+extension 7.11°, lateral-bending 4.92°, axial rotation 9.59°), especially in the rotation movement. The whole cervical vertebra was more stable under internal fixation (flexion+extension 4.07°, lateral-bending 2.21°, axial rotation 2.91°) with the safety of internal fixation system. In conclusion, the finite element model could be used to simulate the biomechanics of cervical spinous process fracture (extension into the lamina) to indicate the potential for delayed instability.
沈彦,王朝阳,吴荣,陈博. 有限元分析颈椎棘突骨折内固定有效性[J]. 中国生物医学工程学报, 2017, 36(4): 456-463.
Shen Yan, Wang Chaoyang, Wu Rong, Chen Bo. Finite Element Analysis of Internal Fixation in Cervical Spinous Process Fracture. Chinese Journal of Biomedical Engineering, 2017, 36(4): 456-463.
[1] Matar LD,Helms CA, Richardson WJ. “Spinolaminar breach”:an important sign in cervical spinous process fractures[J].Skeletal Radiol,2000,29(2):75-80. [2] 秦德安,张佐伦,崔新刚,等.颈椎棘突骨折与颈椎稳定性[J].中国骨与关节损伤杂志,2006,9(21): 687-689. [3] Han SR, Sohn MJ. Twelve contiguous spinous process fracture of cervico-thoracic spine[J].Korean J Spine,2014, 11(3):212-213. [4] Kazanci A,Gurcan O,Gurcay AG, et al. Six-level isolated spinous process fracture of the thoracic vertebrae (clay-shoveler's fracture) and a review of the literature[J]. Neurol India, 2015,63(2):223-224. [5] Olivier EC,Muller E,Janse Van Rensburg DC.Clay-shoveler fracture in a paddler: A case report[J].Clin J Sport Med, 2016,26(3):69-70. [6] 陈金水,倪斌,陈博,等.寰枢椎脱位三维非线性有限元模型的建立和分析[J].中国脊柱脊髓杂志,2010,20(9):749-753. [7] 郭群峰,陈方经,倪斌,等.带有颅底的全颈椎三维有限元模型的建立及分析[J].中国脊柱脊髓杂志,2014,24(6):550-554. [8] 蔡贤华,王威,王志华,等.不同前路内固定方式治疗枢椎椎体横行骨折合并Hangman骨折稳定性的有限元分析[J].中国脊柱脊髓杂志,2014,24(3):257-265. [9] 柳超,王前,张杰峰,等.不同内固定手术方式治疗寰枢椎复合骨折稳定性的有限元分析[J].中国脊柱脊髓杂志,2015,25(10):904-911. [10] 贾连顺, 袁文. 现代脊柱外科学[M].北京:人民军医出版社,2007,21-24. [11] Brolin K, Halldin P.Development of a finite element model of the upper cervical spine and a parameter study of ligament characteristics[J].Spine (Phila Pa 1976),2004,29(4):376-385. [12] Shirazi-Adl A,Ahmed AM, Shrivastava SC. Mechanical response of a lumbar motion segment in axial torque alone and combined with compression[J].Spine (Phila Pa 1976), 1986,11(9):914-927. [13] El-Rich M,Arnoux PJ,Wagnac E, et al.Finite element investigation of the loading rate effect on the spinal load-sharing changes under impact conditions[J].J Biomech,2009,42(9):1252-1262. [14] Panjabi MM,Crisco JJ,Vasavada A,et al.Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves[J]. Spine (Phila Pa 1976), 2001,26(24):2692-2700. [15] 李连华, 孙天胜.什么是Clay shoveler骨折?[J].中国脊柱脊髓杂志,2010,20(6):528. [16] Umredkar A,Sura S, Mohindra S. Multiple contiguous isolated spinous process fracture (Clay-Shoveler's fracture) of the cervicodorsal spine[J]. Neurol India,2011,595:788-789. [17] Gershon-Cohen J, Glauser F.Whiplash fractures of cervicodorsal spinous processes: resemblance to shoveler's fracture[J]. J Am Med Assoc,1954,1556:560-561. [18] Hirsh LF,Duarte LE,Wolfson EH, et al. Isolated symptomatic cervical spinous process fracture requiring surgery. Case report[J].J Neurosurg,1991,75(1):131-133. [19] Mirvis SE, Shanmuganathan K. Trauma radiology: Part V. Imaging of acute cervical spine trauma[J]. J Intensive Care Med,1995,10(1):15-33.