不同体积的骨水泥强化椎弓根螺钉在振动特性中的生物力学差异
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武汉中西医结合骨科医院武汉体育学院附属医院

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Biomechanical Effects of Pedicle Screws Augmented with Different Bone Cement Volumes in Vibration Characteristics
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Wuhan Integrated Traditional Chinese and Western Medicine Hospital (Affiliated Hospital of Wuhan Sports University)

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    摘要:

    目的:本研究旨在确定骨质疏松患者在垂直全身振动(whole-body vibration, WBV)条件下,不同体积的骨水泥强化椎弓根螺钉(bone cement-augmented pedicle screws, CAPS)在经椎间孔腰椎椎间融合(transforaminal lumbar interbody fusion, TLIF)术后的生物力学影响。 方法:有限元分析法(finite element analysis, FEA)建立骨质疏松L4/5 TLIF术后模型。根据聚甲基丙烯酸甲酯(polymethylmethacrylate, PMMA)体积的不同分为三组:对照组(单侧0 mL)、观察1组(单侧1.5 mL)、观察2组(单侧2.5 mL)。利用40 N的正弦垂直载荷(频率为5 Hz)和400 N的预加载负荷来模拟人体的垂直振动以及生理压缩,并将这些模型在轴向循环载荷下的动态响应进行了比较研究。 结果:比较三组邻近节段椎间盘髓核内压力、纤维环最大应力及纤维环后凸位移,观察1组大于对照组大于观察2组,但是三组结果没有显著性差异。而且随着骨水泥体积的增加,L4下终板和L5上终板的最大von-Mises应力在逐渐减小。这种趋势也发生在三组椎弓根周围骨质的最大von-Mises应力中。 结论:在垂直WBV模式下,PMMA在一定范围内随着体积的增加可降低螺钉松动和Cage下沉的风险。但是,在2.5 mL时表现出最好的生物力学性能,这些发现可能有助于指导临床治疗。

    Abstract:

    Objective: This study aims to determine the biomechanical effects of different volumes of bone cement-augmented pedicle screws (CAPS) on osteoporotic patients following transforaminal lumbar interbody fusion (TLIF) under vertical WBV conditions. Methods: A nonlinear finite element (FEA) model of an osteoporotic lumbosacral spine was developed, simulating L4/5 TLIF. Based on the volume of polymethylmethacrylate (PMMA), three groups were created: control group (unilateral 0 mL), observation group 1 (unilateral 1.5 mL), and observation group 2 (unilateral 2.5 mL). A 40 N vertical sinusoidal load (5 Hz frequency) and a 400 N preload were applied to simulate physiological compression due to vertical vibration, and body weight. The dynamic response of these models under axial cyclic loading was compared across the groups. Results: Among the three groups, observation group 1 exhibited greater nucleus pulposus pressure, maximum annulus fibrosus stress, and disc bulge at adjacent segments than the control group, which in turn was greater than observation group 2. Across all three groups, the differences were not statistically significant. The maximum von Mises stress on the L4 inferior endplate and L5 superior endplate were decreasing as bone cement volume increased. This trend also appeared in the maximum von Mises stress in the bone around the pedicle screws. Conclusion: Under vertical WBV, increasing the volume of PMMA within a certain range reduces the risk of screw loosening, and Cage subsidence. But, under vertical WBV, a bone cement volume of 2.5 mL in pedicle screw augmentation exhibits the optimal biomechanical performance. These findings may help guide clinical treatment.

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  • 收稿日期:2025-03-11
  • 最后修改日期:2025-04-07
  • 录用日期:2025-04-08
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