背景:脊柱感染或转移性疾病引起的溶骨性病变可引起不稳定。在这种情况下,不同的手术策略可用于恢复稳定性,然而,很少有人知道各种重建技术如何影响脊柱生物力学。
目的:分析和量化三种不同的外科重建技术治疗T12溶骨模型的生物力学效果。
方法:具有T12溶骨性病变的胸椎的有限元分析。
方法:使用一名20岁无结构畸形的男性的CT扫描,模拟了在T12椎体后部有50%缺损的溶骨性病变(前?后?特定)。(缺陷是由力产生的吗?还是在缺陷产生后传递力?)由490N垂直力施加到T9。接下来,对治疗溶骨性病变的三种常用仪器技术进行建模和生物力学测试.其中包括:模型A,短节段固定全身切除术(T11-L1)和两个长节段器械;模型B长节段固定与三杆构建;模型C长节段固定与双杆构建。然后在T9上以垂直向下的方向在脊柱模型上施加480N的载荷。VonMises在圆盘中测量应力(MPa),椎骨,和植入物。
结果:模型A显示了对建筑材料的最低应力,相邻椎体,和椎间盘,但增加了对器械椎骨的压力。与模型C相比,模型B更刚性,结构应力较低。然而,模型C在屈曲时椎体应力最低,扩展,和最上部器械椎体的侧向弯曲,但与模型A和模型B相比,螺钉拔出应力最高。
结论:该溶骨T12模型提供了独特的生物力学数据,可以帮助在特定情况下定制手术策略。虽然通过针对特定患者的稳定需求量身定制的结构可以获得最佳结果,我们的发现可以概括为癌症病变的例子,骨密度低,和传染性原因。
结论:这项研究的结果可以帮助根据患者的特定特征选择合适的外科重建技术。
BACKGROUND: Osteolytic lesions caused by infection or metastatic disease of the spine can induce instability. Different surgical strategies are available to restore stability in this scenario, however little is known how various reconstruction techniques affect spinal biomechanics.
OBJECTIVE: To analyze and quantify the biomechanical effects of three different surgical reconstruction techniques in the treatment of a T12 osteolytic model.
METHODS: Finite element analysis of the thoracic spine with a T12 osteolytic lesion.
METHODS: Using CT scans from a 20-year-old man without structural deformity, simulation of an osteolytic lesion with a 50% defect at the posterior aspect of T12 vertebral body was created by a 490 N vertical force to T9. Next, three common instrumentation techniques treating the osteolytic lesion were modeled and biomechanically tested. These included: Model A, corpectomy with short segment fixation (T11-L1) and two long-segment instrumentations; Model B long segment fixation with triple rod construct; Model C long segment fixation with dual rod construct. A load of 480N was then applied on the spine models in vertically downward direction on T9. Von Mises stresses were measured (MPa) in the discs, vertebrae, and implants.
RESULTS: Model A demonstrated the lowest stress on construct material, adjacent vertebral bodies, and discs but increased stress on the instrumented vertebrae. Model B was more rigid and demonstrated lower construct stress compared to Model C. However, Model C had the lowest vertebral body stress in flexion, extension, and lateral bending in the most upper instrumented vertebral body, but the highest screw pull-out stress when compared to Model A and Model B.
CONCLUSIONS: This osteolytic T12 model provides unique biomechanical data that can help to tailor surgical strategies in select scenarios. While optimal outcomes are best achieved with a construct tailored to a specific patient\'s need for stabilization, our findings can be generalized for instances of cancerous lesions, low bone density, and infectious causes.
CONCLUSIONS: The results of this study can help with the choice of appropriate surgical reconstruction technique based on patient-specific characteristics.