Finite element analysis and application of unilateral and bilateral bone-filling mesh container in treatment of osteoporotic vertebral compression fracture

doi:10.12307/2023.016

Abstract

Abstract: BACKGROUND: In the treatment of osteoporotic vertebral compression fracture, bone-filling mesh container has a significant curative effect. Considering the operation time, lateral leakage of bone cement and the number of radiation exposure, unilateral approach is better. However, no study compared unilateral bone-filling mesh container and bilateral bone-filling mesh container from the perspective of biomechanics, lacking certain theoretical data support.
OBJECTIVE: To investigate the biomechanical characteristics and clinical effects of unilateral and bilateral bone-filling mesh container approaches in the treatment of osteoporotic vertebral compression fracture.
METHODS: (1) A finite element model was established to simulate the treatment of osteoporotic vertebral compression fracture with unilateral and bilateral bone-filling mesh container. The displacement and stress changes of the whole finite element model of thoracolumbar segment in the unilateral bone-filling mesh container group and bilateral bone-filling mesh container group were compared and analyzed under 400 N vertical downward loading force and 7.5 N·m bending moment load under four working conditions. (2) A retrospective analysis was performed on 99 patients with osteoporotic vertebral compression fracture who were treated with bone-filling mesh container from January 2018 to August 2020 in Wuhan Puren Hospital. Of them, 49 patients were treated with unilateral bone-filling mesh container and 50 patients were treated with bilateral bone-filling mesh container. Bone cement leakage rate, visual analogue scale score, and Cobb angle change were analyzed between the two groups.
RESULTS AND CONCLUSION: (1) Finite element model: There was no significant difference in the maximum displacement between unilateral group and bilateral group under axial, forward flexion, left bending, and left rotation conditions (P > 0.05). There was no significant difference in the maximum stress between unilateral group and bilateral group under axial, forward flexion, left bending, and left rotation conditions (P > 0.05). (2) Clinical trial: The bone cement leakage rates in the unilateral and bilateral approach groups were 12% and 16%, respectively, and the visual analogue scale score and scoliosis angle at 6 months after surgery were significantly improved compared with those before operation in both groups (P < 0.001). There was no significant difference in visual analogue scale score and scoliosis angle between the two groups at 6 months after operation (P > 0.05). (3) From the perspective of biomechanics and clinical efficacy, unilateral bone-filling mesh container approach is more effective than bilateral bone-filling mesh container approach in treating osteoporotic vertebral compression fracture.

Key words: bone-filling mesh container, osteoporotic, vertebral compression fracture, finite element analysis, biomechanics, unilateral approach, bilateral approach

CLC Number:

Lu Hui, Wu Qimei, Liu Rong. Finite element analysis and application of unilateral and bilateral bone-filling mesh container in treatment of osteoporotic vertebral compression fracture[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(3): 391-397.

Figures/Tables 9

References

[1] SVEJME O, AHLBORG HG, NILSSON JÅ, et al. Early menopause and risk of osteoporosis, fracture and mortality: a 34-year prospective observational study in 390 women. BJOG. 2012;119:810-816.
[2] NAKASHIMA D, KANCHIKU T, NISHIDA N, et al. Finite element analysis of compression fractures at the thoracolumbar junction using models constructed from medical images. Exp Ther Med. 2018;15:
3225-3230.
[3] 金成浩,蔡迎,钟杰林,等.单侧与双侧经皮后凸成形治疗骨质疏松性胸腰椎骨折[J].中国矫形外科杂志,2020,28(18):1712-1715.
[4] LIEBERMAN IH, DUDENEY S, REINHARDT MK, et al. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976). 2001;26:1631-1638.
[5] 吴宏梓,汪少波,拉华欠,等.骨填充网袋术治疗骨质疏松性椎体压缩骨折疗效与安全性的Meta分析[J].中华创伤杂志,2020, 36(5):433-441.
[6] ZHENG Z, LUK KEITH DK, KUANG G, et al. Vertebral augmentation with a novel Vessel-X bone void filling container system and bioactive bone cement. Spine (Phila Pa 1976). 2007;32:2076-2082.
[7] STEINMANN J, TINGEY CT, CRUZ G, et al. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa 1976). 2005;30:201-205.
[8] PAPADOPOULOS EC, EDOBOR-OSULA F, GARDNER MJ, et al. Unipedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures: early results. J Spinal Disord Tech. 2008;21:589-596.
[9] LU H, PENG H, PENG Z, et al. The Application of Digital Design Combined with 3D Printing Technology in Skin Flap Transplantation for Fingertip Defects during the COVID-19 Epidemic.Biomed Res Int. 2021;2021:5554500.
[10] ROHLMANN A, BOUSTANI HN, BERGMANN G, et al. A probabilistic finite element analysis of the stresses in the augmented vertebral body after vertebroplasty. Eur Spine J. 2010;19:1585-1595.
[11] BAROUD G, NEMES J, HEINI P, et al. Load shift of the intervertebral disc after a vertebroplasty: a finite-element study. Eur Spine J. 2003;12: 421-426.
[12] GOEL VK, KONG W, HAN JS, et al. A combined finite element and optimization investigation of lumbar spine mechanics with and without muscles. Spine (Phila Pa 1976). 1993;18:153115-153141.
[13] NOAILLY J, LACROIX D, PLANELL JA. Finite element study of a novel intervertebral disc substitute. Spine (Phila Pa 1976). 2005;30:2257-2264.
[14] ZHANG L, YANG G, WU L, et al. The biomechanical effects of osteoporosis vertebral augmentation with cancellous bone granules or bone cement on treated and adjacent non-treated vertebral bodies: a finite element evaluation. Clin Biomech (Bristol, Avon). 2010;25:166-172.
[15] LIANG D, YE L, JIANG X, et al. Biomechanical effects of cement distribution in the fractured area on osteoporotic vertebral compression fractures: a three-dimensional finite element analysis. J Surg Res. 2015;195:246-256.
[16] CHUNG SK, KIM YE, WANG K. Biomechanical effect of constraint in lumbar total disc replacement: a study with finite element analysis. Spine (Phila Pa 1976). 2009;34:1281-1286.
[17] DENIS F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976). 1983;8: 817-831.
[18] ROHLMANN A, ZANDER T, RAO M, et al. Applying a follower load delivers realistic results for simulating standing.J Biomech. 2009;42: 1520-1526.
[19] 赵文韬,秦大平,张晓刚,等.骨质疏松性椎体压缩骨折椎体强化术后不同椎体高度对相邻椎体应力影响的有限元分析[J].中国骨质疏松杂志,2018,24(9):1141-1147.
[20] 秦大平,张晓刚,权祯,等.骨质疏松症患者脊柱胸腰段椎体力学稳定性变化与椎体压缩性骨折风险预测的有限元分析[J].中国医学物理学杂志,2021,38(4):485-494.
[21] CHIU JC, STECHISON MT. Percutaneous vertebral augmentation and reconstruction with an intravertebral mesh and morcelized bone graft. Surg Technol Int. 2005;14:287-296.
[22] GARFIN SR, YUAN HA, REILEY MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976). 2001;26: 1511-1515.
[23] FRIBOURG D, TANG C, SRA P, et al. Incidence of subsequent vertebral fracture after kyphoplasty. Spine (Phila Pa 1976). 2004;29: 2270-2276; discussion 2277.
[24] 赵文韬,秦大平,张晓刚,等.功能复位椎体强化治疗骨质疏松性椎体压缩骨折的有限元分析[J].世界科学技术-中医药现代化, 2018,20(3):439-445.
[25] 王健,李凯,陈博,等.胸腰椎体压缩性骨折三维有限元模型的建立和分析[J].中国矫形外科杂志,2016,24(16):1498-1503.
[26] 叶林强.辨稳论治在经皮椎体强化术治疗骨质疏松性椎体压缩骨折的意义[D].广州:广州中医药大学,2016.
[27] PANJABI MM, KIFUNE M, LIU W, et al. Graded thoracolumbar spinal injuries: development of multidirectional instability. Eur Spine J. 1998; 7(4):332-339.
[28] SVENSSON HK, OLSSON LE, HANSSON T, et al. The effects of person-centered or other supportive interventions in older women with osteoporotic vertebral compression fractures-a systematic review of the literature. Osteoporos Int. 2017;28:2521-2540.
[29] ZHANG H, XU C, ZHANG T, et al. Does Percutaneous Vertebroplasty or Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures Increase the Incidence of New Vertebral Fractures? A Meta-Analysis. Pain Physician. 2017;20:E13-E28.
[30] STEVENSON M, GOMERSALL T, LLOYD JM, et al. Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral fractures: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2014;18:1-290.
[31] TSOUMAKIDOU G, TOO CW, KOCH G, et al. CIRSE Guidelines on Percutaneous Vertebral Augmentation. Cardiovasc Intervent Radiol. 2017;40:331-342.
[32] GENANT HK, WU CY, VAN KC, et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8:1137-1148.
[33] HSU C, CHAO C, WANG J, et al. Increase of pullout strength of spinal pedicle screws with conical core: biomechanical tests and finite element analyses. J Orthop Res. 2005;23:788-794.
[34] KILINÇER C,INCEOGLU S, SOHN MJ, et al. Effects of angle and laminectomy on triangulated pedicle screws. J Clin Neurosci. 2007;14: 1186-1191.
[35] HASHEMI A, BEDNAR D, ZIADA S. Pullout strength of pedicle screws augmented with particulate calcium phosphate: an experimental study. Spine J. 2009;9:404-410.
[36] SAIRYO K, GOEL VK, MASUDA A, et al. Three-dimensional finite element analysis of the pediatric lumbar spine. Part I: pathomechanism of apophyseal bony ring fracture. Eur Spine J. 2006;15:923-929.
[37] SAIRYO K, GOEL VK, MASUDA A, et al. Three dimensional finite element analysis of the pediatric lumbar spine. Part II: biomechanical change as the initiating factor for pediatric isthmic spondylolisthesis at the growth plate. Eur Spine J. 2006;15:930-935.
[38] 刘祥飞,何金国,蒋钰钢,等.单侧与双侧入路椎体成形术治疗老年骨质疏松性椎体压缩骨折的有限元分析及临床应用[J].医用生物力学,2018,33(3):218-223.