Biomechanical Study of Posterior Fixation for Thoracolumbar Burst Fractures
Pei Baoqing1*, Shi Zhenpeng1, Wang Wei1, Lu Shibao2, Kong Chao2
1School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China 2Department of Orthopaedics, Beijing Xuanwu Hospital, Capital Medical University,Beijing 100053, China 3Beijing Advaced Innovation Centre for Biomedical Engineering, Beihang University, Beijing 100000, China
Abstract:In order to provide theoretical support and clinical basis for the choice of surgical methods for patients with thoracolumbar burst fractures, five finite element models of the T10-L2 segment were established in this work including intact model, burst fracture model, mono-segment pedicle screw fixation, intermediate bilateral pedicle screw fixation, and traditional short-segment pedicle screw fixation. To analyze the biomechanics of the three fixation models, flexion, extension, lateral bending, and rotation moments of 7.5N-m with a compressive preload of 400 N were imposed on the superior surfaces of the T10 vertebral body. Results showed that the range of motion at the three fixation models decreased for all loading cases, compared with that at the intact model. Compared with the intermediate bilateral pedicle screw fixation model, the largest maximal stress of the pedicle screw at mono-segment pedicle screw fixation model increased by78.1% in flexion, 87.8% in extension, 90.5% in left bend, 81.3% in right bend, 51.3% in left rotation,72.3% in right rotation. In conclusion, the range of motion of the mono-segment pedicle screw fixation model was the most similar to that of the intact model, and it was most likely to protect the original mechanical properties of the spine while restoring the stability of the spine, but the largest maximal stress of pedicle screws was much higher than the intermediate bilateral pedicle screw fixation. For severe damage to the instability, the intermediate bilateral pedicle screw fixation significantly reduced the pedicle screw stress while improving the stability of the spine.
裴葆青, 师振鹏, 王唯, 鲁世保, 孔超. 后路固定术治疗胸腰椎爆裂骨折的生物力学研究[J]. 中国生物医学工程学报, 2017, 36(6): 718-723.
Pei Baoqing, Shi Zhenpeng, Wang Wei, Lu Shibao, Kong Chao. Biomechanical Study of Posterior Fixation for Thoracolumbar Burst Fractures. Chinese Journal of Biomedical Engineering, 2017, 36(6): 718-723.
[1] Eno JT, Chen L, Mitsunaga MM. Short same-segment fixation of thoracolumbar burst fractures.[J]. Hawai′i Journal of Medicine & Public Health, 2012,71(1):19-22. [2] Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture-Short-segment pedicle fixation versus long-segment instrumentation[J].Journal of Spinal Disorders & Techniques, 2005,18(6):485-488. [3] Li C, Zhou Y, Wang H, et al. Treatment of unstable thoracolumbar fractures through short segment pedicle screw fixation techniques using pedicle fixation at the level of the fracture: a finite element analysis[J]. PLoS ONE, 2014,9:e991566. [4] Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture.[J]. Spine, 2007,32(14):1503-1507. [5] 董健文, 戎利民, 刘斌, 等. 经伤椎与跨节段固定治疗无脊髓损伤的胸腰段A3型骨折[J]. 中华外科杂志, 2009,47(24):1883-1887. [6] 曾忠友, 黄伟, 张建乔, 等. 椎弓根螺钉系统同时经伤椎置钉固定治疗胸腰椎骨折[J]. 中国脊柱脊髓杂志, 2009,19(8):609-613. [7] Anekstein Y, Brosh T, Mirovsky Y. Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures-A biomechanical study[J].Journal of Spinal Disorders & Techniques, 2007,20(1):72-77. [8] Ibrahim FMF, Abd EL-rady AEM. Mono segmental fixation of selected types of thoracic and lumbar fractures: A prospective study[J]. International Orthopaedics, 2016,40(6):1083-1089. [9] Natarajan RN, Andersson GB. The influence of lumbar disc height and cross-sectional area on the mechanical response of the disc to physiologic loading[J]. Spine, 1999,24(18):1873\|1877. [10] Akamaru T, Kawahara N, Sakamoto J, et al. The transmission of stress to grafted bone inside a titanium mesh cage used in anterior column reconstruction after total spondylectomy: A finite-element analysis[J]. Spine, 2005,30(24):2783-2787. [11] Kim Y, Kim T. Finite element analysis of the effects of pedicle screw fixation nut loosening on lumbar interbodyfusion based on the elasto-plateau plasticity of bone characteristics[J]. Spine, 2010,35(6):599-606. [12] Kim H, Chun H, Moon S, et al. Analysis of biomechanical changes after removal of instrumentation in lumbar arthrodesis by finite element analysis[J].Medical & Biological Engineering & Computing, 2010,48(7):703-709. [13] Yamamoto I, Panjabi MM, Crisco T, et al. Three-dimensional movements of the whole lumbar spine and lumbosacral joint.[J]. Spine, 1989,14(11):1256-1260. [14] Pflugmacher R, Schleicher P, Schaefer J, et al. Biomechanical comparison of expandable cages for vertebral body replacement in the thoracolumbar spine[J]. Spine, 2004,29(13):1413-1419. [15] Denozière G, Ku DN. Biomechanical comparison between fusion of two vertebrae and implantation of an artificial intervertebral disc[J]. Journal of Biomechanics, 2006,39(4):766-775. [16] 李熙雷, 车武, 董健, 等. 经伤椎单节段椎弓根螺钉固定治疗胸腰椎爆裂骨折的生物力学研究[J]. 中华创伤骨科杂志, 2012,14(3):225-227. [17] Azam F, Shah M. Treatment of traumatic unstable thoracolumbar junction fractures with transpedicular screw fixation.[J]. Journal of the Pakistan Medical Association, 2011,61(10):1005-1008. [18] Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit[J]. Spine, 2001,26(9):1038-1045.