Primary development and biomechanics of single vertebrae internal fixation system for thoracolumbar compression fracture

doi:10.3969/j.issn.2095-4344.2014.09.007

Abstract

Abstract:

BACKGROUND: For severe thoracolumbar compression fracture (> 1/3 compression), ideal therapeutic method is minimally invasive internal fixation, which has good biomechanical functions. Moreover, bone graft is reliable. Injured vertebra reduction and bone graft stability achieved. Motor unit of spinal column and normal physiological function were retained, resulting in lessening nearby segmental degeneration.
OBJECTIVE: To discuss the design of single vertebrae internal fixation system and evaluate its biomechanical performance which apply to treat thoracolumbar compression fracture by endoscope.
METHODS: A brand-new single vertebrae internal fixation system was designed in accordance with data of anatomic measurement of adult thoracolumbar vertebra. Six fresh adult corpse specimens were prepared to produce models of L1 compression fracture, and assigned to control group, fracture injury group, single vertebrae internal fixation system group, AF reduction internal fixation group and anterior plate internal fixation group. Three-dimensional movement range experiments were conducted separately.
RESULTS AND CONCLUSION: The biomechanical comparison showed that there was no significant difference in three-dimensional range of motion among single vertebrae internal fixation system group (anteflexion, left and right lateroflexion), AF reduction internal fixation group and anterior plate internal fixation group (P > 0.05). However, range of motion significantly increased at backward extension, left and right rotation (P < 0.05). Results suggested that the design of single vertebrae internal fixation system was novel and the system had good biomechanical performance at anteflexion, left and right lateroflexion. However, it needs to be improved in which lacks of stability of extension and rotation.

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

全文链接：

Key words: fractures, compression, perioperative period, internal fixators, biomechanics

CLC Number:

R318

Li Ji-cai, Liu Ping-jun, He Yong-li, Zhao Wei-dong, Liang Dong-zhu, Mao Bing-yan. Primary development and biomechanics of single vertebrae internal fixation system for thoracolumbar compression fracture[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(9): 1350-1355.

Figures/Tables 1

References

[1]贺用礼,刘平均,王长青,等.胸腰椎影像学测量及其临床意义[J].中国现代医药杂志,2012,14(9):7-10.

[2]Wilson DR, Myers ER, Mathis JM,et al. Effect of augmentation on the mechanics of vertebral wedge fractures. Spine (Phila Pa 1976). 2000;25(2):158-165.

[3]魏富鑫,刘少喻,赵卫东,等.单节段与双节段椎弓根螺钉固定胸腰椎单椎体骨折的生物力学比较[J].中国脊柱脊髓杂志, 2007, 17(1):46-50.

[4]Korovessis P, Baikousis A, Zacharatos S,et al. Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures.Spine (Phila Pa 1976). 2006;31(8): 859-868.

[5]Pintar FA, Yoganandan N, Maiman DJ,et al. Thoracolumbar spine fractures in frontal impact crashes.Ann Adv Automot Med. 2012;56:277-283.

[6]Jun W, Yi-Jun K, Fei C. Application of a crescent-shaped PMMA strut in anterior spinal reconstruction of thoracolumbar and lumbar burst fractures: a new technique.Turk Neurosurg. 2012;22(2):161-166.

[7]黄刚,陈海云,刘卓勋,等.经皮椎体成形术与经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折[J].南方医科大学学报,2010, 30(12):2729-2732.

[8]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(14):1631-1638.

[9]郑召民,李佛保.经皮椎体成形术和经皮椎体后凸成形术-问题与对策[J].中华医学杂志,2006,86(27):1878-1880.

[10]Hulme PA, Krebs J, Ferguson SJ,et al.Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies.Spine (Phila Pa 1976). 2006;31(17):1983-2001.

[11]Chen B, Li Y, Xie D,et al. Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae.Eur Spine J. 2011;20(8):1272-1280.

[12]Kim YY, Rhyu KW. Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture.Eur Spine J. 2010;19(11):1907-1912.

[13]Heo DH, Chin DK, Yoon YS, et al.Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty.Osteoporos Int. 2009;20(3):473-480.

[14]Bouza C, López T, Magro A,et al. Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review.Eur Spine J. 2006;15(7): 1050-1067.

[15]Dupuy DE, Palmer WE, Rosenthal DI.Vertebral fluid collection associated with vertebral collapse.AJR Am J Roentgenol. 1996; 167(6):1535-1538.

[16]Fribourg D, Tang C, Sra P,et al. Incidence of subsequent vertebral fracture after kyphoplasty.Spine (Phila Pa 1976). 2004;29(20):2270-2276.

[17]Frankel BM, Monroe T, Wang C. Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty.Spine J. 2007; 7(5):575-582.

[18]Garfin SR, Buckley RA, Ledlie J,et al. Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients.Spine (Phila Pa 1976). 2006;31(19):2213-2220.

[19]Tzermiadianos MN, Renner SM, Phillips FM,et al. Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture.Eur Spine J. 2008;17(11):1522-1530.

[20]Berlemann U, Franz T, Orler R,et al. Kyphoplasty for treatment of osteoporotic vertebral fractures: a prospective non-randomized study.Eur Spine J. 2004;13(6):496-501.

[21]Boszczyk BM, Bierschneider M, Hauck S,et al. Transcostovertebral kyphoplasty of the mid and high thoracic spine.Eur Spine J. 2005;14(10):992-999.

[22]Grohs JG, Matzner M, Trieb K,et al. Minimal invasive stabilization of osteoporotic vertebral fractures: a prospective nonrandomized comparison of vertebroplasty and balloon kyphoplasty.J Spinal Disord Tech. 2005;18(3):238-242.

[23]Ledlie JT, Renfro M.Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels.J Neurosurg. 2003;98(1 Suppl):36-42.

[24]Phillips FM, Ho E, Campbell-Hupp M,et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures.Spine (Phila Pa 1976). 2003;28(19):2260-2265.

[25]Suzuki N, Ogikubo O, Hansson T. Previous vertebral compression fractures add to the deterioration of the disability and quality of life after an acute compression fracture. Eur Spine J. 2010;19(4):567-574.

[26]Schultheiss M, Hartwig E, Sarkar M,et al. Biomechanical in vitro comparison of different mono- and bisegmental anterior procedures with regard to the strategy for fracture stabilisation using minimally invasive techniques.Eur Spine J. 2006; 15(1):82-89.

[27]Verheyden AP, Hoelzl A, Lill H,et al.The endoscopically assisted simultaneous posteroanterior reconstruction of the thoracolumbar spine in prone position.Spine J. 2004;4(5): 540-549.

[28]Schultheiss M, Hartwig E, Kinzl L,et al.Thoracolumbar fracture stabilization: comparative biomechanical evaluation of a new video-assisted implantable system.Eur Spine J. 2004;13(2):93-100.

[29]Verheyden AP, Katscher S, Gonschorek O,et al. Endoscopically assisted minimally invasive reconstruction of the anterior thoracolumbar spine in prone position. Unfallchirurg. 2002;105(10):873-880.

[30]Steib JP, Charles YP, Aoui M. In situ contouring technique in the treatment of thoracolumbar fractures.Eur Spine J. 2010;19 Suppl 1:S66-68.

[31]Wood KB, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study.J Spinal Disord Tech. 2005;18 Suppl:S15-23.

[32]Mahar A, Kim C, Wedemeyer M,et al.Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976). 2007;32(14):1503-1507.

[33]Ringel F, Stoffel M, Stüer C,et al. Endoscopy-assisted approaches for anterior column reconstruction after pedicle screw fixation of acute traumatic thoracic and lumbar fractures.Neurosurgery. 2008;62(5 Suppl 2):ONS445-452.

[34]Arand M, Kinzl L, Hartwig E.Combined posterior and anterior endoscopic supported instrumentation of the thoracic and lumbar spine. Arguments, concepts and first clinical results. Zentralbl Chir. 2002;127(6):490-496.

[35]陈祥和,李孔嘉.应用钛合金椎体植入物行椎体重建的临床报告及其生物力学分析[J].中华创伤骨科杂志,2005,7(10):908-912.

[36]Lee KS, Cho YJ, Choi JH, et al. A small amount of bone cement injected vertebroplasty utilizing percutaneous vertebral body access (PVBA) technique for osteoporotic vertebral fractures.Korean J Spine. 2005;2(4):333-341.

[37]Beisse R.Video-assisted techniques in the management of thoracolumbar fractures.Orthop Clin North Am. 2007;38(3): 419-429.

[38]Beisse R, Mückley T, Schmidt MH, et al.Surgical technique and results of endoscopic anterior spinal canal decompression.J Neurosurg Spine. 2005;2(2):128-136.

[39]明江华,郑慧锋,赵奇,等.Sextant经皮椎弓根钉棒微创系统治疗胸腰椎骨折:随访评价[J].中国组织工程研究, 2013,17(48): 8343-8348.

[40]刘涛,李长青,周跃,等.新型经皮椎弓根螺钉系统的设计与生物力学测试[J] .中华骨科杂志,2010,30(6):594-599.

[41]Schmidt OI, Strasser S, Kaufmann V, et al. Role of early minimal-invasive spine fixation in acute thoracic and lumbar spine trauma. Indian J Orthop. 2007;41(4):374-380.

[42]Wang HW, Li CQ, Zhou Y, et al. Percutaneous pedicle screw Fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases. Chin J Traumatol. 2010; 13(3): 137-145.

[43]Briem D, Windolf J, Lehmann W,et al.Bone grafts endoscopically applied to the spine Ergebnisse der anterioren Fusion und therapeutische Konsequenzen.Unfallchirurg. 2004; 107(12):1152-1161.

[44]Olinger A, Vollmar B, Hildebrandt U,et al. Experimental development and validation of a technique for lumboendoscopic anterior fusion of lumbar spine fractures: comparison of endoscopic and open surgery in a live porcine model.Surg Endosc. 2000;14(9):844-848.

[45]Olinger A, Hildebrandt U, Vollmar B,et al. Laparoscopic- transperitoneal and lumboscopic-retroperitoneal surgery of the spine. Developments from animal experiments for use in clinical practice. Zentralbl Chir. 1999;124(4):311-317.