Single iliac screw and dual iliac screws and titanium mesh cage fixation in the reconstruction of lumbosacral defects with finite element analysis

doi:10.3969/j.issn.2095-4344.2016.39.013

Abstract

Abstract:

BACKGROUND: The surgical management to reconstruct the stability in lumbosacral region is very challenging. There are many techniques to reconstruct the stability of the lumbosacral region, but the internal fixation loosening, fracture and pseudoarthosis are not uncommon.

OBJECTIVE: Finite element analysis was used to analyze the stability of two types of reconstruction procedures and the stress of the internal fixation system.

METHODS: A 64-slice spiral CT scan was used in a subject from L₁ to pelvis. The scan data were imported into the Mimics 15.0 software to generate a three-dimensional surface model. The three-dimensional solid model was established using in the SolidWorks software. The solid geometry model of the L_{3, 4}pedicle screws combined with single iliac screw fixation and L_3,4 pedicle screws combined with dual iliac screws and anterior titanium mesh cage support fixation were constructed by the Solidworks software. Two kinds of reconstruction procedures were simulated. The models were given material properties and analyzed by using the ABAQUS software.

RESULTS AND CONCLUSION: (1) The maximum stress was 195.3 MPa in the complete model, 189.5 MPa in single iliac screw model, and 149.2 MPa in dual iliac screw + titanium cage model when constrained the roof of double acetabulum and applied a vertical load of 1 000 N. (2) The axial compression rigidity was 551.572 N/mm in the complete model, 613.87 N/mm in the single iliac screw model and 1 683.50 N/mm in the dual iliac screw+titanium cage model. (3) The bending rigidity of the dual iliac screw + titanium cage model was bigger than other models at 6 directions when applied 7 N•m bending loads. The maximum stress of single iliac screw model was bigger than other models. (4) The results suggest that the dual iliac screw + titanium mesh cage reconstruction can effectively restore the stability of the lumbosacral area. The stress of internal fixation system is smaller and more dispersed. There is obvious stress concentration in the connecting rod and the tail of the single iliac screw. The single iliac screw internal fixation system is easy to fatigue fracture and loosening.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Lumbosacral Region, Internal Fixators, Stress, Finite Element Analysis, Tissue Engineering

CLC Number:

R318

Ma Liang, Guo Wei-chun, Xu Yong-tao. Single iliac screw and dual iliac screws and titanium mesh cage fixation in the reconstruction of lumbosacral defects with finite element analysis[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(39): 5859-5866.

Figures/Tables 6

References

[1] Uvaraj NR, Bosco A, Gopinath NR. Global Reconstruction for Extensive Destruction in Tuberculosis of the Lumbar Spine and Lumbosacral Junction: A Case Report. Global Spine J. 2015;5(4):e17-e21.
[2] Xu Z, Wang X, Shen X, et al. One-stage lumbopelvic fixation in the treatment of lumbosacral junction tuberculosis. Eur Spine J. 2015;24(8):1800-1805.
[3] Varga PP, Szoverfi Z, Lazary A. Surgical resection and reconstruction after resection of tumors involving the sacropelvic region. Neurol Res. 2014;36(6):588-596.
[4] Bederman SS, Shah KN, Hassan JM, et al.Surgical techniques for spinopelvic reconstruction following total sacrectomy: a systematic review. Eur Spine J. 2014;23(2):305-319.
[5] Le VH, Heckmann N, Jain N, et al.Biomechanical evaluation of supplemental percutaneous lumbo-sacro-iliacscrewsfor spinopelvic fixation following total sacrectomy. J Spinal Disord Tech. 2015; 28(4):E181-185.
[6] Guo LX, Wang ZW, Zhang YM, et al. Material property sensitivity analysis on resonant frequency characteristics of the human spine. J Appl Biomech. 2009;25(1):64-72.
[7] Rohlmann A , Zander T, Schmidt H , et al. Analysis of the influence of disc degeneration on the mechanical behaviour of a lumbar motion segment using the finite element method. J Biomech. 2006; 39(13):2484-2490.
[8] 于滨生,郑召民,庄新明,等.髂骨双钉在腰-髂重建结构中的生物力学优势[J].中华骨科杂志,2010,30(6):589-593.
[9] 李全,张治宇,郑龙坡,等. 骶骨次全切除术后骨盆有限元模型的建立及验证[J].中国组织工程研究与临床康复, 2008,12(44):8649-8652.
[10] Li JH, Zhang ZH, Shi T, et al. Surgical treatment of lumbosacral tuberculosis by one-stage debridement and anterior instrumentation with allograft through an extraperitoneal anterior approach. J Orthop Surg Res. 2015;10:62.
[11] 高延征,余正红,高坤,等.腰骶结核不同手术方式的选择及疗效分析[J].中华骨科杂志,2014,34(2):143-148.
[12] Varga PP, Szövérfi Z, Lazary A. Surgical treatment of primary malignant tumors of thesacrum. Neurol Res. 2014;36(6):577-587.
[13] Zang J, Guo W, Yang R, et al. Is total en bloc sacrectomy using a posterior-only approach feasible and safe for patients with malignant sacral tumors? J Neurosurg Spine. 2015;22(6):563-570.
[14] Phukan R, Herzog T, Boland PJ,et al.How Does the Level of Sacral Resection for Primary Malignant Bone Tumors Affect Physical and Mental Health, Pain, Mobility, Incontinence, and Sexual Function? Clin Orthop Relat Res.2016; (3): 687-696.
[15] Ooi A, Foo L, Tan BK, et al. Massive sacral chordoma resection and reconstruction with a combination of pedicled and free flaps. J Reconstr Microsurg. 2015; 31(1): 76-78.
[16] KayaniB , Hanna SA , Sewell MD, et al.A review of the surgical management of sacral chordoma. Eur J Surg Oncol. 2014;40(11): 1412-1420.
[17] Dudda M, Hoffmann M, Schildhauer TA. Sacrum fractures and lumbopelvic instabilities in pelvic ring injuries: classification and biomechanical aspects. Unfallchirurg. 2013;116(11):972-978.
[18] Wangtaphan W, Oo M, Paholpak P, et al.Traumatic lumbosacral spondyloptosis treated five months after injury occurrence: a case report. Spine. 2012;37(22): E1410-1414.
[19] Sullivan MP, Smith HE, Schuster JM, et al. Spondylopelvic dissociation.Orthop Clin North Am. 2014;45(1):65-75.
[20] Dalbayrak S, Yaman O, Ayten M, et al.Surgical treatment in sacral fractures and traumatic spinopelvic instabilities. Turk Neurosurg. 2014;24(4):498-505.
[21] Schroeder GD, Kepler CK, Mba MD, et al. Axial interbody arthrodesis of the L5-S1 segment: a systematic review of the literature. J Neurosurg Spine. 2015;23(3):314-319.
[22] Whang PG, Sasso RC, Patel VV, et al.Comparison of axial and anterior interbody fusions of the L5-S1 segment: a retrospective cohort analysis.J Spinal Disord Tech. 2013;26(8):437-443.
[23] Mobbs RJ, Loganathan A, Yeung V, et al. Indications for anterior lumbar interbody fusion. Orthop Surg. 2013; 5(3):153-163.
[24] Yoshihara H. Surgical options for lumbosacral fusion: biomechanical stability, advantage, disadvantage and affecting factors in selecting options. Eur J Orthop Surg Traumatol. 2014;24Suppl 1:S73-82.
[25] Roetman B, Schildhauer TA. Lumbopelvic stabilization for bilateral lumbosacral instabilities: indications and techniques. Unfallchirurg. 2013; 116(11):991-999.
[26] Zeng ZY, Zhang JQ, Song YX, et al. Combination of percutaneous unilateral translaminar facet screw fixation and interbody fusion for treatment of lower lumbar vertebra diseases: a follow-up study. Orthop Surg. 2014; 6(2):110-117.
[27] Pola E, Rossi B, Nasto LA, et al.Surgical treatment of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16 Suppl 2:79-85.
[28] Bederman SS, Hassan JM, Shah KN, et al.Fixation techniques for complex traumatic transverse sacral fractures: a systematic review.Spine.2013;38(16): E1028-1040.
[29] Kato M, Taneichi H, Suda K. Advantage of Pedicle Screw Placement Into the Sacral Promontory (Tricortical Purchase) on Lumbosacral Fixation. J Spinal Disord Tech. 2015;28(6):E336-342.
[30] Kim JH, Horton W, Hamasaki T, et al.Spinal instrumentation for sacral-pelvic fixation: a biomechanical comparison between constructs ending with either S2 bicortical, bitriangulated screws or iliac screws.J Spinal Disord Tech. 2010;23(8):506-512.
[31] Néron JB, Gadéa F, Fournier J, et al.Lumbosacral arthrodesis for neuromuscular scoliosis using a simplified Jackson technique.Orthop Traumatol Surg Res. 2013;99(7):845-851.
[32] Zwingmann J, Hauschild O, Bode G, et al. Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis.Arch Orthop Trauma Surg. 2013;133(9):1257-1266.
[33] Ilyas H, Place H, Puryear A. A Comparison of Early Clinical and Radiographic Complications of Iliac Screw Fixation Versus S2Alar Iliac (S2AI) Fixation in the Adult and Pediatric Populations.J Spinal Disord Tech. 2015; 28(4):E199-205.
[34] Baek SW, Park YS, Ha KY, et al. The analysis of spinopelvic parameters and stability following long fusions with S1, S2 or iliacfixation. Int Orthop. 2013; 37(10):1973-1980.
[35] Park SA, Kwak DS, You SL. Entry zone ofiliac screwfixation to maintain proper entry width andscrewlength. Eur Spine J. 2015;24 (11): 2573-2579.
[36] Fridley J, Fahim D, Navarro J, et al. Free-hand placement of iliac screws for spinopelvic fixation based on anatomical landmarks: technical note. Int J Spine Surg. 2014;8. doi: 10.14444/1003. eCollection 2014.
[37] Santos ER, Sembrano JN, Mueller B, et al. Optimizing iliac screw fixation: a biomechanical study on screw length, trajectory, and diameter. J Neurosurg Spine. 2011;14(2):219–225.
[38] Wang T, Liu H, Zheng Z, et al.Biomechanical effect of 4-rod technique on lumbosacral fixation: an in vitro human cadaveric investigation.Spine. 2013;38(15): E925-929.
[39] Amaritsakul Y, Chao CK, Lin J. Multiobjective optimization design of spinal pedicle screws using neural networks and genetic algorithm: mathematical models and mechanical validation. Comput Math Methods Med. 2013;2013:462875.
[40] Zhao Y, Zhang S, Sun T, et al. Mechanical comparison between lengthened and short sacroiliac screws in sacral fracture fixation: afinite element analysis. Orthop TraumatolSurg Res. 2013;99(5):601-606.