Comparison of short-segment monoaxial and polyaxial pedicle screw fixation combined with intermediate screws in traumatic thoracolumbar fractures: a finite element study and clinical radiographic review.
Comparison of short-segment monoaxial and polyaxial pedicle screw fixation combined with intermediate screws in traumatic thoracolumbar fractures: a finite element study and clinical radiographic review.
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DOI：
10.6061/clinics/2017(10)04
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发表时间：
2017-10
期刊：
影响因子：
--
通讯作者：
Xiang L
中科院分区：
文献类型：
--
作者：
Wang H;Zhao Y;Mo Z;Han J;Chen Y;Yu H;Wang Q;Liu J;Li C;Zhou Y;Xiang L
没有研究比较单轴和万向椎弓根螺钉在器械的von Mises应力、相邻节段的椎间盘内压力和相邻节段退变方面的差异。使用有限元方法比较短节段单轴/多轴椎弓根螺钉固定技术，并评价T11-L1节段活动范围的重新分布、器械的最大最大von Mises应力以及位移载荷下相邻节段的椎间盘内压力。回顾性分析230例胸腰椎创伤性骨折患者的X线片结果，计算并评价骨折椎体的矢状面Cobb角、椎体角、椎体前缘高度及相邻节段退变情况。短节段单轴椎弓根螺钉固定模型中椎弓根螺钉的von Mises应力最大值为376.8 MPa，中间单轴椎弓根螺钉固定模型中棒的von Mises应力最大值为439.9 MPa。上相邻节段椎间盘内最大压力均大于下相邻节段。单轴椎弓根螺钉固定模型的椎间盘内最大压力大于正常模型相应节段的椎间盘内最大压力。最终随访评价时的影像学结果显示，中间单轴椎弓根螺钉固定组的矢状面Cobb角、椎体角和前路椎体高度的平均矫正丢失最小。在中间万向椎弓根螺钉固定组中不太可能观察到相邻节段退变，但在中间单轴椎弓根螺钉固定组中更可能观察到相邻节段退变。与单轴椎弓根螺钉固定脊柱模型相比，万向螺钉模型椎弓根螺钉中的von Mises应力较小，相邻节段的椎间盘内压力较低。骨折节段固定可显著纠正脊柱后凸畸形并减少矫正丢失，在中间万向椎弓根螺钉固定组中观察到相邻节段退变的可能性较小。
No studies have compared monoaxial and polyaxial pedicle screws with regard to the von Mises stress of the instrumentation, intradiscal pressures of the adjacent segment and adjacent segment degeneration. Short-segment monoaxial/polyaxial pedicle screw fixation techniques were compared using finite element methods, and the redistributed T11-L1 segment range of motion, largest maximal von Mises stress of the instrumentation, and intradiscal pressures of the adjacent segment under displacement loading were evaluated. Radiographic results of 230 patients with traumatic thoracolumbar fractures treated with these fixations were reviewed, and the sagittal Cobb’s angle, vertebral body angle, anterior vertebral body height of the fractured vertebrae and adjacent segment degeneration were calculated and evaluated. The largest maximal values of the von Mises stress were 376.8 MPa for the pedicle screws in the short-segment monoaxial pedicle screw fixation model and 439.9 MPa for the rods in the intermediate monoaxial pedicle screw fixation model. The maximal intradiscal pressures of the upper adjacent segments were all greater than those of the lower adjacent segments. The maximal intradiscal pressures of the monoaxial pedicle screw fixation model were larger than those in the corresponding segments of the normal model. The radiographic results at the final follow-up evaluation showed that the mean loss of correction of the sagittal Cobb’s angle, vertebral body angle and anterior vertebral body height were smallest in the intermediate monoaxial pedicle screw fixation group. Adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group but more likely to be observed in the intermediate monoaxial pedicle screw fixation group. Smaller von Mises stress in the pedicle screws and lower intradiscal pressure in the adjacent segment were observed in the polyaxial screw model than in the monoaxial pedicle screw fixation spine models. Fracture-level fixation could significantly correct kyphosis and reduce correction loss, and adjacent segment degeneration was less likely to be observed in the intermediate polyaxial pedicle screw fixation group.
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影响因子：
2.8
作者：
Ekman, Per;Moller, Hans;Hedlund, Rune
通讯作者：
Hedlund, Rune
影响因子：
3
作者：
Alanay, A;Acaroglu, E;Surat, A
通讯作者：
Surat, A
影响因子：
3
作者：
Nakashima, Hiroaki;Kawakami, Noriaki;Imagama, Shiro
通讯作者：
Imagama, Shiro
影响因子：
2.3
作者：
KRAMER, DL;RODGERS, WB;MANSFIELD, FL
通讯作者：
MANSFIELD, FL
影响因子：
3
作者：
MCCORMACK, T;KARAIKOVIC, E;GAINES, RW
通讯作者：
GAINES, RW