Biomechanical characteristics of percutaneous kyphoplasty versus percutaneous vertebroplasty for spinal sandwich fracture by finite element analysis

doi:10.3969/j.issn.2095-4344.2017.35.021

Abstract

Abstract:

BACKGROUND: Percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) have been shown to obtain satisfactory clinical efficacy in the treatment of spinal sandwich fracture compared with conventional conservative method, but a further investigation on the related biomechanical characteristics is required.

OBJECTIVE: To compare the biomechanics characteristics of PVP and PKP for spinal sandwich fracture.

METHODS: The finite element models of PVP and PKP were constructed based on the finite element model of spinal sandwich fracture. The deformation and stress distribution characteristics were analyzed after loaded.

RESULTS AND CONCLUSION: After PVP for L₁, T₁₁sandwich fracture, the stiffness at the thoracic and lumbar segments, the maximum stress and deformation at the sandwich vertebrae showed no obvious improvement, and the stress concentration at the anterior column of sandwich vertebrae was not improved significantly (from 26.12 Mpa to 23.37 Mpa, reduced by 10.53%). Meanwhile, PKP significantly increased the stiffness at the thoracic and lumbar segments, the maximum stress and deformation of the sandwich vertebrae were significantly decreased (from 27.15 Mpa to 17.52 Mpa, reduced by 36.71%).

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: Spine, Fractures, Bone, Finite Element Analysis, Biomechanics, Tissue Engineering

CLC Number:

R318

Wang Ji-bo. Biomechanical characteristics of percutaneous kyphoplasty versus percutaneous vertebroplasty for spinal sandwich fracture by finite element analysis[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(35): 5703-5708.

Figures/Tables 1

2.1 载荷的工况下两种模型整体的变形采用后凸成形术模型治疗T11-L1骨折后，模拟在前屈、直立、侧弯、右旋及后伸工况下，变形情况相较于经皮椎体成形术模型治疗骨折后的T10-L2变形量显著降低，后凸成形术有限元模型治疗骨折后的变形数值相较于三明治骨折前模型变形数值略为降低；而经皮椎体成形术模型治疗T11-L1三明治骨折后，模拟在前屈、直立、侧弯、右旋及后伸工况下，T10-L2模型变形情况与T11-L1骨折后比较基本无显著变化。在加载相同载荷的工况下，后凸成形术模型治疗后的较经皮椎体成形术模型治疗刚度有明显恢复迹象，实验表明脊柱骨折后应用经皮椎体成形术模型治疗对脊柱三明治骨折后刚度影响很小，而后凸成形术模型治疗能效增加脊柱刚度，且能达到高于骨折前水准。见图5，6。 2.2 不同载荷下两种模型的应力分布经过经皮椎体成形术模型治疗过后，骨折后脊柱前柱处应力集中无明显缓解现象，而后凸成形术模型治疗后应力集中得到显著改善。采用后凸成形术模型治疗后，骨折L1椎体的最大应力明显减小，主要体现在直立、前屈状况下。但经皮椎体成形术模型治疗骨折，实验显示骨折T11、L1后，应用经皮椎体成形术模型治疗后，骨折L1椎体的最大应力相较于术前有所增加。见图7，8。 2.3 两种模型的椎体最大应力 T11-L1骨折后，在侧弯、前屈及右旋工况下，T12最大应力显著增大。以上实验表明脊柱骨折后，采取保守治疗情况下，侧弯、前屈及右旋时，夹心椎最大应力显著增加，椎体再次发生骨折的几率增大。通过经皮椎体成形术治疗脊柱三明治骨折有限元模型及后凸成形术治疗脊柱三明治骨折有限元模型显示采用椎体强化及后凸成形术模型治疗后，夹心椎的最大应力有效且明显大幅度减小，在前屈载荷下体现尤为明显(27.15 MPa减小到17.52 MPa，减小了36.71%)。见图9，10。结果表明，经皮椎体成形术模型治疗L1、T11三明治骨折，治疗前与治疗后情况相比，脊柱处胸腰段刚度变化不明显，夹心椎处最大应力变化及变形量基本没有明显改善，夹心椎前柱处应力集中现象无明显改观(26.12 MPa减小到23.37 MPa，减小了10.53%)。而后凸成形术模型脊柱处胸腰段刚度明显增加，夹心椎处的最大应力变化及变形量明显减少(最大应力减少36.71%)。"

References

[1] Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neuro-Chirurgie.1987; 33(2):166-168.

[2] 董继胜,董力军,闫兵勇,等. 经皮椎体成形术和经皮椎体后凸成形术治疗老年骨质疏松椎体压缩性骨折的疗效观察[J]. 中国矫形外科杂志, 2015,23(8):748-751.

[3] 汤建华,李祥,张世华. 经皮椎体成形术和经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折[J]. 中国伤残医学,2015,6(6): 41-42.

[4] 杨惠林, Hansen A.Yuan, 陆俭,等. 球囊扩张椎体后凸成形术治疗骨质疏松性椎体压缩骨折[J]. 苏州大学学报:医学版, 2002, 22(4):406-409.

[5] 毛海青,杨惠林,陈亮,等. 磷酸钙灌注椎体后凸成形术的生物力学研究[J]. 苏州大学学报:医学版, 2007,27(1):17-20.

[6] 粟迎春. 经皮椎体成形术和经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的疗效[J]. 实用医学杂志, 2017, 40(2):74-75.

[7] 张大鹏,强晓军,王振江,等. 高黏度骨水泥椎体成形术与低黏度骨水泥椎体后凸成形术治疗骨质疏松性胸腰椎压缩骨折疗效分析[J]. 中国矫形外科杂志,2016,24(4):289-294.

[8] 潘爱星,杨晋才,海涌,等. 单侧与双侧穿刺经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折的对比研究[J]. 中国骨与关节杂志,2016,5(1):44-47.

[9] 林金丁,郑毓嵩. 经皮椎体成形术与经皮后凸成形术治疗椎体骨折疗效比较[J].福建医药杂志,2015,37(2):45-48.

[10] 董继胜,董力军,闫兵勇,等. 经皮椎体成形术和经皮椎体后凸成形术治疗老年骨质疏松椎体压缩性骨折的疗效观察[J]. 中国矫形外科杂志, 2015,23(8):748-751.

[11] 汤建华,李祥,张世华. 经皮椎体成形术和经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折[J].中国伤残医学, 2015, 6(6): 41-42.

[12] 张亮,王静成,冯新民,等.唑来膦酸在骨质疏松性椎体压缩骨折椎体后凸成形术后的应用[J]. 实用医学杂志, 2015, 31(2): 283-285.

[13] 崔冠宇,田伟,刘波,等. 椎体强化后椎弓根螺钉内固定术治疗骨质疏松性胸腰椎爆裂骨折[J].中华创伤骨科杂志, 2015,17(6): 502-508.

[14] Hierholzer J, Fuchs H, Westphalen K, et al. Incidence of symptomatic vertebral fractures in patients after percutaneous vertebroplasty. Cardiovasc Intervent Radiol. 2008;31(6):1178-1183.

[15] Pitton MB,Herber S,Bletz C,et al.CT-guided vertebroplasty in osteoprotic vertebral fractures: incidence of secondary fractures and impact of intradiscal cement leakages during follow-up.Eur Radiol.2008;18(1):43-50.

[16] 汪李军,杨惠林,罗宗平,等.椎体强化术后夹心椎体骨折的相关因素分析[J].中华创伤骨科杂志,2011,13(10):911-915.

[17] Bliemel C,Oberkircher L,Buecking B,et al.Higher incidence of new vertebral fractures following percutaneous vertebroplasty and kyphoplasty--fact or fiction.Acta Orthopaedica Belgica. 2012;78(2):220-229.

[18] Mudano A, Bian J,Cope JJ,et al.Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population- based cohort study. Osteoporos Int. 2009;20(5): 819-826.

[19] Papanastassiou ID, Phillips FM, Meirhaeghe JV, et al. Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies. Eur Spine J.2012;21(9):1826-1843.

[20] Movrin I. Adjacent level fracture after osteoporotic vertebral compression fracture: a nonrandomized prospective study comparing balloon kyphoplasty with conservative therapy. Wiener klinische Wochenschrift, 2012; 124(9):304-311.

[21] Zhao Y, Robson Brown KA,Jin ZM,et al.Trabecular level analysis of bone cement augmentation: a comparative experimental and finite element study. Ann Biomed Eng. 2012;40(10): 2168-2176.

[22] Mirzaei M,Zeinali A,Razmjoo A,et al. On prediction of the strength levels and failure patterns of human vertebrae using quantitative computed tomography (QCT)-based finite element method. Biomech.2009; 42(11):1584-1591.

[23] Wijayathunga VN，Jones AC，Oakland RJ，et al.Development of specimen-specific finite element models of human vertebrae for the analysis of vertebroplasty. Proc Inst Mech Eng H.2008; 222(2):221-228.

[24] Zhao Y, Robson Brown K A Jin Z M Wilcox R K. Trabecular level analysis of bone cement augmentation: a comparative experimental and finite element study.Ann Biomed Eng.2012; 40(10): 2168-2176.

[25] Chae SW,Kang HD,Lee MK,et al.The effect of vertebral material description during vertebroplasty.Proc Inst Mech Eng H.2010;224(1):87-95.

[26] Movrin I, Vengust R, Komadina R.Adjacent vertebral fractures after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture: a comparison of balloon kyphoplasty and vertebroplasty. Arch Orthop Trauma Surg. 2010;130(9):1157-1166.

[27] Bliemel C, Oberkircher L, Buecking B, et al. Higher incidence of new vertebral fractures following percutaneous vertebroplasty and kyphoplasty--fact or fiction? Acta Orthopaedica Belgica. 2012;78(2):220.

[28] Wang H, Sribastav S S, Ye F, et al. Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures: a meta-analysis of the literature. Pain Physician. 2015;18(3): 209.

[29] Klazen CA,Venmans A,De VJ,et al.Percutaneous vertebroplasty is not a risk factor for new osteoporotic compression fractures: results from VERTOS II.Ajnr Am J Neuroradiol.2010; 31(8):1447-1450.

[30] Papanastassiou ID,Phillips FM,Meirhaeghe JV,et al. Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies. Eur Spine J.2012;21(9):1826-18 43.

[31] Sun K, Liebschner MA. Evolution of vertebroplasty: a biomechanical perspective. Ann Biomed Eng. 2004;32(1):77-91.