Comparison of the short-segment and long-segment
cement-augmented pedicle screw fixation for osteoporotic thoracolumbar
fracture: a finite element study

doi:10.3969/j.issn.2095-4344.1926

Abstract

Abstract:

BACKGROUND: Pedicle screw fixation combined with cement-augmented is an effective method for the treatment of severe osteoporotic vertebral fractures, but there is no uniform standard. The range of fixed segments is one of the focuses of clinical controversy.

OBJECTIVE: To establish a three-dimensional finite element model of the short-segment and long-segment cement-augmented pedicle screw fixation for osteoporotic thoracolumbar fracture, and to analyze the biomechanical characteristics of adjacent segment structures, fractured vertebral bodies and internal fixation devices.

METHODS: The T₉-L₅ segment of a volunteer without obvious degenerative disease was selected for CT scan. The CT images of Dicom format were obtained, and the engineering software was imported to establish a finite element geometric model to simulate the thoracolumbar fracture and the short-segment and long-segment cement-augmented pedicle screw fixation models. The relevant material parameters were set and the biomechanical characteristics of the two groups were compared and analyzed.

RESULTS AND CONCLUSION: (1) The stress on the vertebrae was mainly concentrated on the periphery of the vertebral body and the small facet of the attachment. In the four directions flexion, extension, left-sided and right-sided curvature, the maximum stress of the proximal and distal adjacent vertebrae in the long-segment group was greater than that in the short-segment group. The stress of the intervertebral disc was mainly concentrated in the peripheral annulus. The maximum stress of the proximal and distal adjacent intervertebral discs was greater in the short-segment than in the long-segment, but the high stress area of the long-segment was larger than that of the short-segment. Therefore, long-segment fixation might accelerate the degeneration of adjacent segments. (2) The vertebral bodies of the long-segment group and the short-segment group were displaced to different extents, and the displacements in the left and right directions were the most obvious. In the six movement directions, the displacement and maximum stress of the injured segment of the short-segment group were greater than those of the long-segment group. So the long-segment fixation could better maintain the stability of the fractured vertebra. (3) The stress on the internal fixing device was mainly concentrated on the screws at both ends and the part of the rod. The maximum stress of the long-segment group was greater than that of the short-segment group, but the main stress area of the screws at both ends was smaller compared with the short-segment group.

Key words: osteoporosis, thoracolumbar fracture, long segment fixation, short segment fixation, cement augmentation, nail augmentation, pedicle screw fixation, biomechanics, finite element analysis

CLC Number:

R459.9

R683

R318

Luo Peijie, Yuan Kai, Li Daxing, Zhang Shuncong, Guo Huizhi, Tang Yongchao, Zhou Tengpeng, Guo Danqing, Li Yongxian, Mo Guoye. Comparison of the short-segment and long-segment cement-augmented pedicle screw fixation for osteoporotic thoracolumbar fracture: a finite element study[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(3): 342-347.

Figures/Tables 8

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