Anterior cervical fusion: a biomechanical comparison of 4 techniques
Anterior cervical fusion: a biomechanical comparison of 4 techniques
复制标题
DOI：
10.3171/spi.2008.9.11.444
复制
发表时间：
2008-11-01
影响因子：
2.8
通讯作者：
Fornari, Maurizio
中科院分区：
文献类型：
--
作者：
Galbusera, Fabio;Bellini, Chiara M.;Fornari, Maurizio
Object.颈椎内固定融合目前使用几种固定方法进行。在本论文中，作者比较了以下4种植入方法：独立椎间融合器、椎间融合器辅以前路锁定钢板、椎间融合器辅以前路动力钢板和动力钢板-椎间融合器组合器械。建立了C4-7节段的4个有限元模型，每个模型在C5-6节段均包括不同的内固定类型。对4个模型施加100 N的压缩预载荷，并在屈曲、伸展、右侧弯曲和右轴向旋转时施加2.5螺母的纯力矩。每次模拟均获得节段主要活动范围和椎间融合器分担的载荷。在研究的4种配置中，独立融合器的稳定能力最低，但仍具有显著性。椎间融合器（辅以锁定钢板）在各个方向上都非常坚硬。与完整病例相比，2种动态接骨板配置在所有方向上均降低了灵活性，但它们在植入节段中留下了显著的活动性。这些配置能够通过后路融合器分担大部分载荷（对于组合钢板-融合器，高达40%）。独立融合器模型的下沉风险最高。结论。检测到4种配置的结果存在显著差异。这些差异的实际临床相关性，目前认为不是至关重要的，应该通过随机临床试验进行研究。(DOI：10.3171/SPI.2008.9.11.444）
Object. Cervical instrumented fusion is currently performed using several fixation methods. In the present paper, the authors compare the following 4 implantation methods: a stand-alone cage, a cage supplemented by an anterior locking plate, a cage supplemented by an anterior dynamic plate, and a dynamic combined plate-cage device.Methods. Four finite element models of the C4-7 segments were built, each including a different instrumented fixation type at the C5-6 level. A compressive preload of 100 N combined with a pure moment of 2.5 Nut in flexion, extension, right lateral bending, and right axial rotation was applied to the 4 models. The segmental principal ranges of motion and the load shared by the interbody cage were obtained for each simulation.Results. The stand-alone cage showed the lowest stabilization capability among the 4 configurations investigated, but it was still significant. The cage supplemented by the locking plate was very stiff in all directions. The 2 dynamic plate configurations reduced flexibility in all directions compared with the intact case, but they left significant mobility in the implanted segment. These configurations were able to share a significant part of the load (up to 40% for the combined plate-cage) through the posterior cage. The highest risk of subsidence was obtained with the model of the stand-alone cage.Conclusions. Noticeable differences in the results were detected for the 4 configurations. The actual clinical relevance of these differences, currently considered not of critical importance, should be investigated by randomized clinical trials. (DOI: 10.3171/SPI.2008.9.11.444)