Finite element modelling of posterior occiput-axis fixation and biomechanical analysis of C2 intralaminar screw fixation with offset connectors.
Finite element modelling of posterior occiput-axis fixation and biomechanical analysis of C2 intralaminar screw fixation with offset connectors.
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DOI：
10.1080/02688697.2021.1988056
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发表时间：
2021-10
影响因子：
1.1
通讯作者：
Ji-yong Gu;Minchan Zhao;Yi Wu;Zhi-bin Li;Zize Feng;Yalan Jiang;Huixian Hu;Minggu Zhong;Z. Luan;Zhengyuan Xie;S. Qi;Yuntao Lu
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文献类型：
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作者：
Ji-yong Gu;Minchan Zhao;Yi Wu;Zhi-bin Li;Zize Feng;Yalan Jiang;Huixian Hu;Minggu Zhong;Z. Luan;Zhengyuan Xie;S. Qi;Yuntao Lu
目的枕轴交叉椎板间螺钉（C2LAM）内固定技术可避免椎体损伤，同时夹带偏置接头可方便植入。本三维有限元（FE）研究比较了使用偏置连接器（C2LAM + of）的C2LAM与其他方法的稳定性。材料与方法选择30岁健康男性的枕、颈椎ct图像建立FE模型。将枕骨板- c2椎弓根（C2P）和椎弓根（C2Pars）螺钉、C2LAM和C2LAM + OF等4种内固定器械分别应用于模型，建立4个新模型，使其承受各种运动状态和生理负荷，模拟正常运动，包括屈伸、侧屈、轴向旋转等4种人体基本活动。生理测量和比较包括模型的活动范围（ROM）和应力分布。结果两种固定方法的ROM具有可比性，C2LAM + of固定方法的稳定性与C2P固定方法相似。螺纹入口点、偏置接头和杆是C2LAM + OF系统的主要应力分布区域。屈曲、伸展和旋转时，内壁的平均von Mises应力显著小于外壁（p < 0.05）；然而，侧弯是相似的，表明内壁损伤的风险相对较小。结论C2LAM + of融合技术具有足够的稳定性，在特殊情况下可作为C2P的替代方法。
Abstract Purpose The occiput-axis crossing translaminar screw (C2LAM) fixation technique can help avoid vertebral injury, while the inclusion of offset connectors can facilitate implantation. This three-dimensional finite element (FE) study compared the stability of C2LAM using offset connectors (C2LAM + OF) with other methods. Materials and methods Occipital and cervical spine computed tomography images of a healthy 30-year-old man were selected to build the FE model. Four internal fixation instruments including occiput plate-C2 pedicle (C2P) and pars (C2Pars) screws, as well as C2LAM and C2LAM + OF were applied consecutively to the model respectively to establish four new models, which were subjected to all states of motion and physiological loads to simulate normal movement, including the four kinds of basic activities of human such as flexion, extension, lateral bending, and axial rotation. Physiological measures and comparison included the range of motion (ROM) and stress distribution in the model. Results ROM between the fixation techniques was comparable, and the stability of the C2LAM + OF fixation technique was similar to that of C2P. Screw entry points, offset connectors and rods were the main stress distribution regions in the C2LAM + OF system. The mean von Mises stress of the inner wall was significantly smaller than that of the outer wall in flexion, extension, and rotation (p < 0.05); however, lateral bending was comparable, indicating a relatively small risk of damage to the inner wall. Conclusions The results of this study indicate that the C2LAM + OF fusion technique can provide sufficient stability and can be used as an alternative to C2P under special circumstances.