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Han Y, Ma J, Zhang G, Huang L, Kang H. Percutaneous monoplanar screws versus hybrid fixed axial and polyaxial screws in intermediate screw fixation for traumatic thoracolumbar burst fractures: a case-control study. J Orthop Surg Res 2024; 19:85. [PMID: 38254136 PMCID: PMC10801944 DOI: 10.1186/s13018-024-04547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND To compare the clinical and radiological outcomes of monoplanar screws (MSs) versus hybrid fixed axial and polyaxial screws (HSs) in percutaneous short-segment intermediate screw fixation (PSISF) for traumatic thoracolumbar burst fractures (TTBFs) in patients without neurologic impairment. METHODS A consecutive series of 100 patients with single-segment TTBFs and no neurologic impairment who underwent PSISF with 6 monoplanar screws (MS group) or correct were retrospectively enrolled. The demographic data, radiologic evaluation indicators, perioperative indicators and clinical assessment indicators were analysed between the MS group and HS group. RESULTS The demographic data and perioperative indicators were not significantly different in the two groups (P > 0.05). The postoperative anterior vertebral height ratio (AVHR), kyphosis Cobb angle (KCA), vertebral wedge angle (VWA) and spinal canal encroachment rate (SCER) were significantly improved in both groups (*P < 0.05). The MS group obtained better correction than the HS group in terms of improvement in the AVHR, KCA and VWA after surgery (*P < 0.05). At the last follow-up, the MS group had less correction loss of AVHR, KCA and VWA (*P < 0.05). The MS group presented greater improvement in the SCER at the last follow-up (*P < 0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score of all patients were significantly better postoperatively than those preoperatively (*P < 0.05), and the scores collected at each follow-up visit did not differ significantly between the two groups (P > 0.05). In the MS group, no internal fixation failure was observed during the follow-up period, but, in the HS group, two cases of internal fixation failure were observed at the last follow-up (one case of rod loosening and one case of screw breakage). CONCLUSIONS Both MSs and HSs fixation are effective treatments for TTBFs and have comparable clinical outcomes. In contrast, MSs fixation can improve the correction effect, better improve the SCER, and further reduce correction loss as well as reduce the incidence of instrumentation failure. Therefore, MSs fixation might be a better option for treating TTBFs in patients without neurological deficits.
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Affiliation(s)
- Yaozheng Han
- Medical College, Wuhan University of Science and Technology, Wuhan, 430065, Hubei, China
| | - Jun Ma
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China
| | - Guoquan Zhang
- Medical College, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Liangliang Huang
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.
| | - Hui Kang
- Department of Orthopaedic, General Hospital of Central Theater Command, Wuhan, 430070, Hubei, China.
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Xu H, Feng Q, Ma X, Lan J, Ji J, Zhang Z, Miao J. Biomechanical behaviour of a novel bone cement screw in the minimally invasive treatment of Kummell's disease: a finite element study. BMC Musculoskelet Disord 2023; 24:967. [PMID: 38098003 PMCID: PMC10720208 DOI: 10.1186/s12891-023-07090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To investigate and evaluate the biomechanical behaviour of a novel bone cement screw in the minimally invasive treatment of Kummell's disease (KD) by finite element (FE) analysis. METHODS A validated finite element model of healthy adult thoracolumbar vertebrae T12-L2 was given the osteoporotic material properties and the part of the middle bone tissue of the L1 vertebral body was removed to make it wedge-shaped. Based on these, FE model of KD was established. The FE model of KD was repaired and treated with three options: pure percutaneous vertebroplasty (Model A), novel unilateral cement screw placement (Model B), novel bilateral cement screw placement (Model C). Range of motion (ROM), maximum Von-Mises stress of T12 inferior endplate and bone cement, relative displacement of bone cement, and stress distribution of bone cement screws of three postoperative models and intact model in flexion and extension, as well as lateral bending and rotation were analyzed and compared. RESULTS The relative displacements of bone cement of Model B and C were similar in all actions studied, and both were smaller than that of Model A. The minimum value of relative displacement of bone cement is 0.0733 mm in the right axial rotation of Model B. The maximum Von-Mises stress in T12 lower endplate and bone cement was in Model C. The maximum Von-Mises stress of bone cement screws in Model C was less than that in Model B, and it was the most substantial in right axial rotation, which is 34%. There was no substantial difference in ROM of the three models. CONCLUSION The novel bone cement screw can effectively reduce the relative displacement of bone cement by improving the stability of local cement. Among them, novel unilateral cement screw placement can obtain better fixation effect, and the impact on the biomechanical environment of vertebral body is less than that of novel bilateral cement screw placement, which provides a reference for minimally invasive treatment of KD in clinical practice.
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Affiliation(s)
- Hanpeng Xu
- Tianjin Hospital, Tianjin University, Tianjin, China
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Feng
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xiang Ma
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jie Lan
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jingtao Ji
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Zepei Zhang
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jun Miao
- Tianjin Hospital, Tianjin University, Tianjin, China.
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Xu C, Xi Z, Fang Z, Zhang X, Wang N, Li J, Liu Y. Annulus Calibration Increases the Computational Accuracy of the Lumbar Finite Element Model. Global Spine J 2023; 13:2310-2318. [PMID: 35293827 PMCID: PMC10538312 DOI: 10.1177/21925682221081224] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Mechanical simulations. OBJECTIVE Inadequate calibration of annuli negatively affects the computational accuracy of finite element (FE) models. Specifically, the definition of annulus average radius (AR) does not have uniformity standards. Differences between the elastic moduli in the different layers and parts of the annulus were not fully calibrated when a linear elastic material is used to define its material properties. This study aims to optimize the computational accuracy of the FE model by calibrating the annulus. METHODS We calibrated the annulus AR and elastic modulus in our anterior-constructed lumbar model by eliminating the difference between the computed range of motion and that measured by in vitro studies under a flexion-extension loading condition. Multi-indicator validation was performed by comparing the computed indicators with those measured in in vitro studies. The computation time required for the different models has also been recorded to evaluate the computational efficiency. RESULTS The difference between computed and measured ROMs was less than 1% when the annulus AR and elastic modulus were calibrated. In the model validation process, all the indicators computed by the calibrated FE model were within ±1 standard deviation of the average values obtained from in vitro studies. The maximum difference between the computed and measured values was less than 10% under nearly all loading conditions. There is no apparent variation tendency for the computational time associated with different models. CONCLUSION The FE model with calibrated annulus AR and regional elastic modulus has higher computational accuracy and can be used in subsequent mechanical studies.
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Affiliation(s)
- Chen Xu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhipeng Xi
- Department of Orthopedics, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Zhongxin Fang
- Fluid and Power Machinery Key Laboratory of Ministry of Education, Xihua University, Chengdu, China
| | - Xiaoyu Zhang
- Department of Orthopedics, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Nan Wang
- Department of Orthopedics, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Jingchi Li
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
- Department of Orthopedics, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, China
| | - Yang Liu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
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Jiang Y, Cui X, Ji W, Li J, Shi Y, Zhao J, Wang J, Tang P, Zhang W. Novel uniplanar pedicle screw systems applied to thoracolumbar fractures: a biomechanical study. Front Bioeng Biotechnol 2023; 11:1172934. [PMID: 37324437 PMCID: PMC10267819 DOI: 10.3389/fbioe.2023.1172934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/25/2023] [Indexed: 06/17/2023] Open
Abstract
Objective: In this study, the advantages of the internal fixation configuration composed of uniplanar pedicle screws in the treatment of thoracolumbar fractures were verified by biomechanical experimental methods, which provided the basis for subsequent clinical experiments and clinical applications. Methods: A total of 24 fresh cadaveric spine specimens (T12-L2) were utilized to conduct biomechanical experiments. Two different internal fixation configurations, namely, the 6-screw configuration and the 4-screw/2-NIS (new intermediate screws) configuration, were tested using fixed-axis pedicle screws (FAPS), uniplanar pedicle screws (UPPS), and polyaxial pedicle screws (PAPS) respectively. The spine specimens were uniformly loaded with 8NM pure force couples in the directions of anteflexion, extension, left bending, right bending, left rotation, and right rotation, and the range of motion (ROM) of the T12-L1 and L1-L2 segments of the spine was measured and recorded to access biomechanical stability. Results: No structural damage such as ligament rupture or fracture occurred during all experimental tests. In the 6-screw configuration, the ROM of the specimens in the UPPS group was significantly better than that of the PAPS group but weaker than those of the FAPS group (p < 0.01). In the 4-screw/2-NIS configuration, the results were identical to the biomechanical test results for the 6-screw configuration (p < 0.01). Conclusion: Biomechanical test results show that the internal fixation configuration with UPPS can maintain the stability of the spine well, and the results are better than that of PAPS. UPPS has both the biomechanical advantages of FAPS and the superiority of easy operation of PAPS. We believe it is an optional internal fixation device for minimally invasive treatment of thoracolumbar fractures.
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Affiliation(s)
- Yuheng Jiang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Xiang Cui
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wei Ji
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Jia Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Yanli Shi
- Anesthesia and Operation Center, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jingxin Zhao
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Junsong Wang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wei Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine and Rehabilitation, Beijing, China
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Yang S, Sun T, Zhang L, Cong M, Guo A, Liu D, Song M. Stress Distribution of Different Pedicle Screw Insertion Techniques Following Single-Segment TLIF: A Finite Element Analysis Study. Orthop Surg 2023; 15:1153-1164. [PMID: 36855914 PMCID: PMC10102325 DOI: 10.1111/os.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES At present, a variety of posterior lumbar internal fixation implantation methods have been developed, which makes it difficult for spine surgeons to choose. The stress distribution of the internal fixation system is one of the important indexes to evaluate these technologies. Common insertion technologies include Roy Camille, Magerl, Krag, AO, and Weinstein insertion techniques. This study aimed to compare the distribution of von Mises stresses in different screw fixation systems established by these insertion technologies. METHODS Here, the three-dimensional finite element (FE) method was selected to evaluate the postoperative stress distribution of internal fixation. Following different pedicle screw insertion techniques, five single-segment transforaminal lumbar interbody fusion (TLIF) models were established after modeling and validation of the L1-S1 vertebrae FE model. RESULTS By analyzing the data, we found that stress concentration phenomenon was in all the models. Additionally, Roy-Camille, Krag, AO, and Weinstein insertion techniques led to the great stress on lumbar vertebra, intervertebral disc, and screw-rod fixation systems. Therefore, we hope that the results can provide ideas for clinical work and development of pedicle screws in the future. It is worth noting that flexion, unaffected side lateral bending, and affected side axial rotation should be limited for the patients with cages implanted. CONCLUSIONS Overall, our method obtained the results that Magerl insertion technique was the relatively safe approach for pedicle screw implantation due to its relatively dispersive stress in TLIF models.
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Affiliation(s)
- Simengge Yang
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China.,Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tianze Sun
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liwen Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Menglin Cong
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Anyun Guo
- Department of Joint Trauma, General Hospital of Shenzhen University, Shenzhen, China
| | - Dakai Liu
- Department of Orthopaedics, The Second People's Hospital of Dalian, Dalian, China
| | - Mingzhi Song
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China.,Department of Orthopaedics, The Third Affiliated Hospital of Dalian Medical University, Dalian, China
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