Effects of tumor location, shape and surface serration on burst fracture risk in the metastatic spine
Effects of tumor location, shape and surface serration on burst fracture risk in the metastatic spine
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DOI：
10.1016/j.jbiomech.2003.09.027
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发表时间：
2004-05-01
影响因子：
2.4
通讯作者：
Whyne, CM
中科院分区：
文献类型：
--
作者：
Tschirhart, CE;Nagpurkar, A;Whyne, CM
脊柱转移性疾病发生在所有癌症患者的三分之一。晚期扩散可导致椎体爆裂性骨折，这可能导致神经功能受损。更好地了解影响爆裂性骨折风险的因素具有重要的临床意义，因为早期干预可以预防高危患者的椎体骨折。本研究的主要目的是使用多孔弹性参数有限元建模量化肿瘤位置和形状对转移性脊柱椎体稳定性和爆裂性骨折风险的影响。本研究还比较了两种不同的表面建模技术在溶解性缺陷的表示。共分析了16个椭球体肿瘤场景。单发肿瘤位于中央、前方、后方、上级、下方和侧方，肿瘤表面光滑或呈锯齿状。还分析了两种中心形状和两种锯齿状表面多肿瘤场景。最大椎体膨出和轴向位移的结局参数被评估为爆裂性骨折风险的代表。肿瘤的后移导致椎体隆起增加最多。肿瘤形状也影响爆裂性骨折的风险。多肿瘤方案在椎体膨出和轴向位移方面的减少最大。锯齿状肿瘤的情况下，遵守类似的趋势，光滑的肿瘤的情况下，虽然肿瘤锯齿引起骨折的风险略有增加。肿瘤形状和体积最好通过平滑表面建模来控制。对导致转移性爆裂性骨折风险的因素的进一步了解将有助于指导未来的建模工作和制定准确的风险评估标准。(C)2003爱思唯尔有限公司。保留所有权利。
Spinal metastatic disease occurs in up to one-third of all cancer patients. Advanced spread can lead to vertebral burst fracture, which may result in neurologic compromise. Developing a better understanding of factors affecting burst fracture risk has significant clinical importance, as early intervention can prevent vertebral fracture in high-risk patients. The primary objective of this study was to quantify the effects of tumor location and shape on vertebral body stability and burst fracture risk in the metastatic spine using poroelastic parametric finite element modeling. This study also compared two distinct surface modeling techniques in the representation of lytic defects. A total of 16 ellipsoidal tumor scenarios were analyzed. Single tumors were situated in central, anterior, posterior, superior, inferior, and lateral locations, with smooth and serrated tumor surfaces. Two central shapes and two serrated surface multi-tumor Scenarios were also analyzed. Outcome parameters of maximum vertebral bulge and axial displacement were assessed as representative of burst fracture risk. Posterior movement of the tumor caused the greatest increase in vertebral bulge. Tumor shape also affected burst fracture risk. The multi-tumor scenarios yielded the greatest reductions in both vertebral bulge and axial displacement. Serrated tumor scenarios abided by similar trends as smooth tumor scenarios, although tumor serration caused a slight increase in fracture risk. Tumor shape and volume are best controlled by smooth surface modeling. Improved understanding of factors contributing to metastatic burst fracture risk will aid in directing future modeling efforts and in the development of accurate risk assessment criteria. (C) 2003 Elsevier Ltd. All rights reserved.