1
|
Meng B, Zhao X, Wang XL, Wang J, Xu C, Lei W. Does the novel artificial cervical joint complex resolve the conflict between stability and mobility after anterior cervical surgery? a finite element study. Front Bioeng Biotechnol 2024; 12:1400614. [PMID: 38887613 PMCID: PMC11180832 DOI: 10.3389/fbioe.2024.1400614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/10/2024] [Indexed: 06/20/2024] Open
Abstract
Background and objective Our group has developed a novel artificial cervical joint complex (ACJC) as a motion preservation instrument for cervical corpectomy procedures. Through finite element analysis (FEA), this study aims to assess this prosthesis's mobility and stability in the context of physiological reconstruction of the cervical spine. Materials and methods A finite element (FE)model of the subaxial cervical spine (C3-C7) was established and validated. ACJC arthroplasty, anterior cervical corpectomy and fusion (ACCF), and two-level cervical disc arthroplasty (CDA) were performed at C4-C6. Range of motion (ROM), intervertebral disc pressure (IDP), facet joint stress (FJS), and maximum von Mises stress on the prosthesis and vertebrae during loading were compared. Results Compared to the intact model, the ROM in all three surgical groups demonstrated a decline, with the ACCF group exhibiting the most significant mobility loss, and the highest compensatory motion in adjacent segments. ACJC and artificial cervical disc prosthesis (ACDP) well-preserved cervical mobility. In the ACCF model, IDP and FJS in adjacent segments increased notably, whereas the index segments experienced the most significant FJS elevation in the CDA model. The ROM, IDP, and FJS in both index and adjacent segments of the ACJC model were intermediate between the other two. Stress distribution of ACCF instruments and ACJC prosthesis during the loading process was more dispersed, resulting in less impact on the adjacent vertebrae than in the CDA model. Conclusion The biomechanical properties of the novel ACJC were comparable to the ACCF in constructing postoperative stability and equally preserved physiological mobility of the cervical spine as CDA without much impact on adjacent segments and facet joints. Thus, the novel ACJC effectively balanced postoperative stability with cervical motion preservation.
Collapse
Affiliation(s)
- Bing Meng
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Xiong Zhao
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Xin-Li Wang
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Jian Wang
- Department of Orthopedics, Affiliated Hospital of NCO School of Army Medical University, Shijiazhuang, Hebei Province, China
| | - Chao Xu
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Department of Health Statistics, Faculty of Preventive Medicine, the Air Force Military Medical University, Xi’an, Shaanxi, China
| | - Wei Lei
- Department of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi Province, China
| |
Collapse
|
2
|
Huang S, Wu X, Zhou C, Zhang X, Tang Z, Qi X, Zhao S. Static study and numerical simulation of the influence of cement distribution in the upper and lower adjacent vertebrae on sandwich vertebrae in osteoporotic patients: Finite element analysis. JOR Spine 2024; 7:e1343. [PMID: 38911099 PMCID: PMC11191753 DOI: 10.1002/jsp2.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/13/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Objective We analyzed the influence of the location of the upper and lower cement on the sandwich vertebrae (SV) by computer finite element analysis. Materials and Methods A finite element model of the spinal segment of T11-L1 was constructed and 6 mL of cement was built into T11 and L1 simultaneously. According to the various distributions of bone cement at T11 and L1, the following four groups were formed: (i) Group B-B: bilateral bone cement reinforcement in both T11 and L1 vertebral bodies; (ii) Group L-B: left unilateral reinforcement in T11 and bilateral reinforcement in L1; (iii) Group L-R: unilateral cement reinforcement in both T11 and L1 (cross); (iv) Group L-L: unilateral cement reinforcement in both T11 and L1 (ipsilateral side). The maximum von Mises stress (VMS) and maximum displacement of the SV and intervertebral discs were compared and analyzed. Results The maximum VMS of T12 was in the order of size: group B-B < L-B < L-R < L-L. Group B-B showed the lowest maximum VMS values for T12: 19.13, 18.86, 25.17, 25.01, 19.24, and 20.08 MPa in six directions of load flexion, extension, left and right lateral bending, and left and right rotation, respectively, while group L-L was the largest VMS in each group, with the maximum VMS in six directions of 21.55, 21.54, 30.17, 28.33, 19.88, and 25.27 MPa, respectively. Conclusion Compared with the uneven distribution of bone cement in the upper and lower adjacent vertebrae (ULAV), the uniform distribution of bone cement in the ULAV reduced and uniformed the stress load on the SV and intervertebral disc. Theoretically, it can lead to the lowest incidence of sandwich vertebral fracture and the slowest rate of intervertebral disc degeneration.
Collapse
Affiliation(s)
- Shaolong Huang
- Department of Orthopedics The Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Xue Wu
- Graduate School of Wenzhou Medical University Wenzhou Zhejiang China
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, Zhejiang China
| | - Chengqiang Zhou
- Department of Orthopedics The Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Xu Zhang
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Zhongjian Tang
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Xiangyu Qi
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Shuai Zhao
- Department of Orthopedics The Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| |
Collapse
|
3
|
Zhou C, Meng X, Huang S, Chen H, Zhou H, Liao Y, Tang Z, Zhang X, Li H, Sun W, Wang Y. Biomechanical study of different bone cement distribution on osteoporotic vertebral compression Fracture-A finite element analysis. Heliyon 2024; 10:e26726. [PMID: 38434291 PMCID: PMC10907677 DOI: 10.1016/j.heliyon.2024.e26726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose This study aimed to compare the biomechanical effects of different bone cement distribution methods on osteoporotic vertebral compression fractures (OVCF). Patients and methods Raw CT data from a healthy male volunteer was used to create a finite element model of the T12-L2 vertebra using finite element software. A compression fracture was simulated in the L1 vertebra, and two forms of bone cement dispersion (integration group, IG, and separation group, SG) were also simulated. Six types of loading (flexion, extension, left/right bending, and left/right rotation) were applied to the models, and the stress distribution in the vertebra and intervertebral discs was observed. Additionally, the maximum displacement of the L1 vertebra was evaluated. Results Bone cement injection significantly reduced stress following L1 vertebral fractures. In the L1 vertebral body, the maximum stress of SG was lower than that of IG during flexion, left/right bending, and left/right rotation. In the T12 vertebral body, compared with IG, the maximum stress of SG decreased during flexion and right rotation. In the L2 vertebral body, the maximum stress of SG was the lowest under all loading conditions. In the T12-L1 intervertebral disc, compared with IG, the maximum stress of SG decreased during flexion, extension, and left/right bending and was basically the same during left/right rotation. However, in the L1-L2 intervertebral discs, the maximum stress of SG increased during left/right rotation compared with that of IG. Furthermore, the maximum displacement of SG was smaller than that of IG in the L1 vertebral bodies under all loading conditions. Conclusions SG can reduce the maximum stress in the vertebra and intervertebral discs, offering better biomechanical performance and improved stability than IG.
Collapse
Affiliation(s)
- Chengqiang Zhou
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiao Meng
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shaolong Huang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Han Chen
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Haibin Zhou
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yifeng Liao
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhongjian Tang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xu Zhang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hua Li
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Sun
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yunqing Wang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Haibier A, Yusufu A, Lin H, Kayierhan A, Abudukelimu Y, Aximu A, Abudurexiti T. Effect of different cement distribution in bilateral and unilateral Percutaneous vertebro plasty on the clinical efficacy of vertebral compression fractures. BMC Musculoskelet Disord 2023; 24:908. [PMID: 37996830 PMCID: PMC10666391 DOI: 10.1186/s12891-023-06997-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/29/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The ramifications of osteoporotic fractures and their subsequent complications are becoming progressively detrimental for the elderly population. This study evaluates the clinical ramifications of postoperative bone cement distribution in patients with osteoporotic vertebral compression fractures (OVCF) who underwent both bilateral and unilateral Percutaneous Vertebroplasty (PVP). OBJECTIVE The research aims to discern the influence of bone cement distribution on the clinical outcomes of both bilateral and unilateral Percutaneous Vertebroplasty. The overarching intention is to foster efficacious preventive and therapeutic strategies to mitigate postoperative vertebral fractures and thereby enhance surgical outcomes. METHODS A comprehensive evaluation was undertaken on 139 patients who received either bilateral or unilateral PVP in our institution between January 2018 and March 2022. These patients were systematically classified into three distinct groups: unilateral PVP (n = 87), bilateral PVP with a connected modality (n = 29), and bilateral PVP with a disconnected modality (n = 23). Several operational metrics were juxtaposed across these cohorts, encapsulating operative duration, aggregate hospital expenses, bone cement administration metrics, VAS (Visual Analogue Scale) scores, ODI (Oswestry Disability Index) scores relative to lumbar discomfort, postoperative vertebral height restitution rates, and the status of the traumatized and adjacent vertebral bodies. Preliminary findings indicated that the VAS scores for the January and December cohorts were considerably reduced compared to the unilateral PVP group (P = 0.015, 0.032). Furthermore, the recurrence of fractures in the affected and adjacent vertebral structures was more pronounced in the unilateral PVP cohort compared to the bilateral PVP cohorts. The duration of the procedure (P = 0.000) and the overall hospitalization expenses for the unilateral PVP group were markedly lesser than for both the connected and disconnected bilateral PVP groups, a difference that was statistically significant (P = 0.015, P = 0.024, respectively). Nevertheless, other parameters, such as the volume of cement infused, incidence of cement spillage, ODI scores for lumbar discomfort, post-surgical vertebral height restitution rate, localized vertebral kyphosis, and the alignment of cement and endplate, did not exhibit significant statistical deviations (P > 0.05). CONCLUSION In juxtaposition with unilateral PVP, the employment of bilateral PVP exhibits enhanced long-term prognostic outcomes for patients afflicted with vertebral compression fractures. Notably, bilateral PVP significantly curtails the prevalence of subsequent vertebral injuries. Conversely, the unilateral PVP cohort is distinguished by its abbreviated operational duration, minimal invasiveness, and reduced overall hospitalization expenditures, conferring it with substantial clinical applicability and merit.
Collapse
Affiliation(s)
- Abuduwupuer Haibier
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Alimujiang Yusufu
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Hang Lin
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Aiben Kayierhan
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Yimuran Abudukelimu
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Alimujiang Aximu
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China
| | - Tuerhongjiang Abudurexiti
- Department of Orthopedics of Trauma, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, People's Republic of China.
- Xinjiang Medical University, Uygur Autonomous Region, Urumqi, Xinjiang, People's Republic of China.
| |
Collapse
|
6
|
Huang S, Ling Q, Lin X, Qin H, Luo X, Huang W. Biomechanical evaluation of a novel anterior transpedicular screw-plate system for anterior cervical corpectomy and fusion (ACCF): a finite element analysis. Front Bioeng Biotechnol 2023; 11:1260204. [PMID: 38026869 PMCID: PMC10665523 DOI: 10.3389/fbioe.2023.1260204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objective: Cervical fusion with vertebral body screw (VBS)-plate systems frequently results in limited biomechanical stability. To address this issue, anterior transpedicular screw (ATPS) fixation has been developed and applied preliminarily to multilevel spinal fusion, osteoporosis, and three-column injury of the cervical spine. This study aimed to compare the biomechanical differences between unilateral ATPS (UATPS), bilateral ATPS (BATPS), and VBS fixation using finite element analysis. Materials and methods: A C6 corpectomy model was performed and a titanium mesh cage (TMC) and bone were implanted, followed by implantation of a novel ATPS-plate system into C5 and C7 to simulate internal fixation with UATPS, BATPS, and VBS. Internal fixation with UATPS comprises ipsilateral transpedicular screw-contralateral vertebral body screw (ITPS-CVBS) and cross transpedicular screw-vertebral body screw (CTPS-VBS) fixations. Mobility, the maximal von Mises stress on TMC, the stress distribution and maximal von Mises stress on the screws, and the maximum displacement of the screw were compared between the four groups. Results: Compared with the original model, each group had a reduced range of motion (ROM) under six loads. After ACCF, the stress was predominantly concentrated at two-thirds of the length from the tail of the screw, and it was higher on ATPS than on VBS. The stress of the ATPS from the cranial part was higher than that of the caudal part. The similar effect happened on VBS. The screw stress cloud maps did not show any red areas reflective of a concentration of the stress on VBS. Compared with VBS, ATPS can bear a greater stress from cervical spine movements, thus reducing the stress on TMC. The maximal von Mises stress was the lowest with bilateral transpedicular TMC and increased with cross ATPS and with ipsilateral ATPS. ITPS-CVBS, CTPS-VBS, and BATPS exhibited a reduction of 2.3%-22.1%, 11.9%-2.7%, and 37.9%-64.1% in the maximum displacement of screws, respectively, compared with that of VBS. Conclusion: In FEA, the comprehensive stability ranked highest for BATPS, followed by CTPS-VBS and ITPS-CVBS, with VBS demonstrating the lowest stability. Notably, utilizing ATPS for fixation has the potential to reduce the occurrence of internal fixation device loosening after ACCF when compared to VBS.
Collapse
Affiliation(s)
- Shengbin Huang
- Department of Human Anatomy, School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, China
- Department of Orthopedics, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi, China
| | - Qinjie Ling
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xinxin Lin
- Department of Orthopedics, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi, China
| | - Hao Qin
- Department of Orthopedics, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi, China
| | - Xiang Luo
- Department of Orthopedics, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi, China
| | - Wenhua Huang
- Department of Human Anatomy, School of Basic Medical Sciences, Guangxi Medical University, Nanning, Guangxi, China
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
7
|
Kong L, Lin W, Kang H, Li M, Hao K, Chang B, Wang F. The effect of femoral prosthesis design on patellofemoral contact stresses in total knee arthroplasty: a case-control study with mid-term follow-up minimum 3-year follow-up. J Orthop Surg Res 2023; 18:781. [PMID: 37853479 PMCID: PMC10583349 DOI: 10.1186/s13018-023-04287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND To investigate the differences in postoperative patellofemoral pressures and patellar tracking during at least three years of follow-up in patients using three prostheses of different designs in total knee arthroplasty (TKA) without patellar resurfacing. METHODS RADIOGRAPHIC INVESTIGATIONS: The study included 401 patients who had a total of 480 knee prostheses implanted without patellar resurfacing. The prostheses used were Genesis II (external rotation design of femoral prosthesis), Triathlon (design with deep trochlear grooves), and Gemini MK II (deepening of trochlear groove and lateral condylar protrusion that closely follows the anatomical shape). The patients' patellar tracking was assessed by measuring patellar tilt and displacement during postoperative follow-up. Furthermore, postoperative knee function and pain were evaluated through range of motion, Knee Society scores (KSS), and Forgotten Joint Score (FJS) to compare the different groups. FINITE ELEMENT ANALYSIS Constructing a finite element model of the knee joint of a normal volunteer after total knee arthroplasty using different prostheses for nonpatellar replacement. The three models' von Mises stress distribution heat map, peak contact pressure, and patellar transverse displacement were compared at 30°, 60°, and 90°, respectively. RESULTS RADIOGRAPHIC INVESTIGATIONS: A total of 456 knees of 384 patients were investigated at a 3-year follow-up after TKA without patellar resurfacing. There were no significant differences in patellar tracking between the three groups. Patients with all three prostheses demonstrated favorable clinical outcomes at 3 years postoperatively, with no statistically significant differences in knee scores (91.9 vs 92.3 vs 91.8) or range of motion (127.9° vs 128.5° vs 127.7°) between the groups. However, there was a significant difference between Genesis II and Gemini MK II in the Forgotten Joint Score (59.7 vs 62.4). Patients with persistent postoperative anterior knee pain were present in all three groups (16 vs 12 vs 10), but the incidence was not significantly different. FINITE ELEMENT ANALYSIS The von Mises stress distribution heat map showed that during flexion, the patellofemoral stresses were mainly concentrated on the lateral side of the prosthesis side, and the contact site gradually shifted downward with increasing flexion angle. At the same time, the peak contact stress of the patellofemoral joint increased with the gradual increase in the flexion angle. Genesis II, with a wider and shallower trochlear groove, showed greater patellofemoral stresses and lateral patellar displacement after TKA without patellar resurfacing. The Gemini MK II with a deeper trochlear groove and slightly protruding lateral condyle is more in line with anatomical design, with smaller patellofemoral joint pressure and better patellar tracking. CONCLUSIONS In TKA without patellar resurfacing, a prosthesis with a deeper trochlear groove, a slightly higher lateral femoral condyle, and a more anatomically designed knee that better matches the patellar morphology should be a better choice.
Collapse
Affiliation(s)
- Lingce Kong
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Wei Lin
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Huijun Kang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Ming Li
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Kuo Hao
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Bo Chang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
| |
Collapse
|
8
|
Huang S, Zhou C, Zhang X, Tang Z, Liu L, Meng X, Xue C, Tang X. Biomechanical analysis of sandwich vertebrae in osteoporotic patients: finite element analysis. Front Endocrinol (Lausanne) 2023; 14:1259095. [PMID: 37900139 PMCID: PMC10600377 DOI: 10.3389/fendo.2023.1259095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Objective The aim of this study was to investigate the biomechanical stress of sandwich vertebrae (SVs) and common adjacent vertebrae in different degrees of spinal mobility in daily life. Materials and methods A finite element model of the spinal segment of T10-L2 was developed and validated. Simultaneously, T11 and L1 fractures were simulated, and a 6-ml bone cement was constructed in their center. Under the condition of applying a 500-N axial load to the upper surface of T10 and immobilizing the lower surface of L2, moments were applied to the upper surface of T10, T11, T12, L1, and L2 and divided into five groups: M-T10, M-T11, M-T12, M-L1, and M-L2. The maximum von Mises stress of T10, T12, and L2 in different groups was calculated and analyzed. Results The maximum von Mises stress of T10 in the M-T10 group was 30.68 MPa, 36.13 MPa, 34.27 MPa, 33.43 MPa, 26.86 MPa, and 27.70 MPa greater than the maximum stress value of T10 in the other groups in six directions of load flexion, extension, left and right lateral bending, and left and right rotation, respectively. The T12 stress value in the M-T12 group was 29.62 MPa, 32.63 MPa, 30.03 MPa, 31.25 MPa, 26.38 MPa, and 26.25 MPa greater than the T12 stress value in the other groups in six directions. The maximum stress of L2 in M-T12 in the M-L2 group was 25.48 MPa, 36.38 MPa, 31.99 MPa, 31.07 MPa, 30.36 MPa, and 32.07 MPa, which was greater than the stress value of L2 in the other groups. When the load is on which vertebral body, it is subjected to the greatest stress. Conclusion We found that SVs did not always experience the highest stress. The most stressed vertebrae vary with the degree of curvature of the spine. Patients should be encouraged to avoid the same spinal curvature posture for a long time in life and work or to wear a spinal brace for protection after surgery, which can avoid long-term overload on a specific spine and disrupt its blood supply, resulting in more severe loss of spinal quality and increasing the possibility of fractures.
Collapse
Affiliation(s)
- Shaolong Huang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chengqiang Zhou
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xu Zhang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhongjian Tang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Liangyu Liu
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xiao Meng
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Cheng Xue
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xianye Tang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| |
Collapse
|
9
|
Liu L, Song F, Shang J, Zhang J, Ma C, Liu G, Han M. Bipedicular percutaneous kyphoplasty versus unipedicular percutaneous kyphoplasty in the treatment of asymmetric osteoporotic vertebral compression fractures: a case control study. BMC Surg 2023; 23:285. [PMID: 37726728 PMCID: PMC10510266 DOI: 10.1186/s12893-023-02180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Bipedicular/unipedicular percutaneous kyphoplasty are common treatments for OVCF, and there are no studies to show which is more beneficial for AVCF. The purpose of this study was to investigate the clinical efficacy of BPKP or UPKP in the treatment of AVCF. METHODS The clinical data of AVCF patients treated by PKP were retrospectively analyzed. They were divided into two groups according to the surgical approach. General demographic data, perioperative complications, and general information related to surgery were recorded for both groups. The preoperative and postoperative vertebral height difference, vertebral local Cobb angle, lumbar pain VAS score and lumbar JOA score were counted for both groups. The above data were compared preoperatively, postoperatively and between the two groups. RESULTS 25 patients with AVCF were successfully included and all were followed up for at least 12 months, with no complications during the follow-up period. 10 patients in the BPKP group and 15 patients in the UPKP group, with no statistically significant differences in general information between the two groups. The VAS scores of patients in the BPKP group were lower than those in the UPKP group at 12 months after surgery, and the differences were statistically significant, and there were no statistically significant differences between the two groups at other follow-up time points. In the BPKP group, 80% of patients had symmetrical and more homogeneous bone cement dispersion. 50% of patients in the UPKP group had a lateral distribution of bone cement and uneven bone cement distribution, and the difference in bone cement distribution between the two groups was statistically significant. CONCLUSION For the treatment of AVCF, the clinical efficacy of both surgical approaches is basically the same. The distribution of cement is more symmetrical and uniformly diffused in the BPKP group, and the clinical efficacy VAS score is lower in the long-term follow-up. Bipedicular percutaneous kyphoplasty is recommended for the treatment of AVCF. THE ETHICAL REVIEW BATCH NUMBER XZXY-LJ-20161208-047.
Collapse
Affiliation(s)
- Lei Liu
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Feifei Song
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jie Shang
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jianwei Zhang
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chao Ma
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Guangpu Liu
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Meng Han
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China.
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China.
| |
Collapse
|
10
|
Ma X, Feng Q, Zhang X, Sun X, Lin L, Guo L, An L, Cao S, Miao J. Biomechanical evaluation of a novel minimally invasive pedicle bone cement screw applied to the treatment of Kümmel's disease in porcine vertebrae. Front Bioeng Biotechnol 2023; 11:1218478. [PMID: 37476480 PMCID: PMC10354293 DOI: 10.3389/fbioe.2023.1218478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
Background and objective: Treatment of Kümmel's Disease (KD) with pure percutaneous kyphoplasty carries a greater likelihood of bone cement displacement due to hardened bone and defect of the peripheral cortex. In this study, we designed a novel minimally invasive pedicle bone cement screw and evaluate the effectiveness and safety of this modified surgical instruments in porcine vertebrae. Methods: 18 mature porcine spine specimens were obtained and soaked in 10% formaldehyde solution for 24 h. 0.5000 mmol/L EDTA-Na2 solution was used to develop in vitro osteoporosis models of porcine vertebrae. They were all made with the bone deficiency at the anterior edge of L1. These specimens were randomly divided into 3 groups for different ways of treatment: Group A: pure percutaneous kyphoplasty (PKP) group; Group B: unilateral novel minimally invasive pedicle bone cement screw fixation combined with PKP group; Group C: bilateral novel minimally invasive pedicle bone cement screw fixation combined with PKP group. The MTS multi-degree of freedom simulation test system was used for biomechanical tests, including axial loading of 500 N pressure, range of motion (ROM) in flexion, extension, left/right lateral bending, and left/right axial rotation at 5 Nm, and the displacement of bone cement mass at maximum angles of 5° and 10°. Result: The three groups were well filled with bone cement, no leakage or displacement of bone cement was observed, and the height of the vertebrae was higher than pre-operation (p < 0.05). In the left/right axial rotation, the specimens were still significantly different (p < 0.05) from the intact specimens in terms of ROM after PKP. In other directions, ROM of all group had no significant difference (p < 0.05) and was close to the intact vertebrae. Compared with PKP group, the relative displacement of bone cement in groups B and C was smaller (p < 0.05). Conclusion: In the in vitro animal vertebral models, the treatment of KD with the placement of novel pedicle minimally invasive bone cement screw combined with PKP can effectively restore the vertebral height, improve the stability of the affected vertebra and prevent the displacement of bone cement. Biomechanically, there is no significant difference between bilateral and unilateral fixation.
Collapse
Affiliation(s)
- Xiang Ma
- Tianjin Hospital, Tianjin University, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Qing Feng
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xingze Zhang
- Tianjin Hospital, Tianjin University, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Xiaolei Sun
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Longwei Lin
- Tianjin Hospital, Tianjin University, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Lin Guo
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Lijun An
- Chengde Medical College, Hebei, China
| | | | - Jun Miao
- Tianjin Hospital, Tianjin University, Tianjin, China
| |
Collapse
|