A Finite Element Study on the Treatment of Thoracolumbar Fracture with a New Spinal Fixation System

Guo, Hui; Li, Jiantao; Gao, Yuan; Nie, Shaoping; Quan, Chenliang; Li, Jia; Zhang, Wei

doi:10.1155/2021/8872514

Cited by 11 publications

(12 citation statements)

References 27 publications

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“…Finite element analysis of thoracolumbar fracture can provide very meaningful digital orthopedic data for clinical practice, which is helpful for physicians to make appropriate surgical plans and engineering and technical personnel to improve material properties and optimize designs. [19][20][21][22][23][24][25] Based on previous related research, [26][27][28] this study established a finite element model of an L1 burst fracture. Because the finite element model requires the internal structure to be as regular as possible during the meshing process, the model was repaired and slightly modified during the introduction process; however, the basic shape of the structure was basically retained.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Material parameters of various parts of the spine and internal fixation. [18][19][20][21][22][23][24][25]…”

Section: Tablementioning

confidence: 99%

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Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture

2022

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Because burst fractures often involve damage to the column and posterior structures of the spine, the fracture block may invade the spinal canal and compress the spinal cord or the cauda equina, causing corresponding neurological dysfunction. When a thoracolumbar burst fracture is accompanied by the presence of bone in the spinal canal, whether posterior surgery requires spinal canal incision decompression is still controversial. Computed tomography images of the thoracolumbar spine of a 31-year-old male with an L1 burst fracture and Mimics 10.0 were used to establish a three-dimensional fracture model for simulating the indirect reduction process. The model was imported into Ansys 10.0 (ANSYS, Inc., Canonsburg, PA), and a 1 to 10 mm displacement was loaded 10° behind the Z-axis on the upper endplate of the L1 vertebral body to simulate position reduction and open reduction. The displacement and stress changes in the intervertebral disc, fractured vertebral body and posterior longitudinal ligament were observed during reduction. Under a displacement loaded 10° behind the Z-axis, the maximum stress in the vertebral body was concentrated on the upper disc of the injured vertebrae. The maximum displacement was in the anterior edge of the vertebral body of the injured vertebrae, and the vertebral body height and the anterior lobes were essentially restored. When the displacement load was applied in the positive Z-axis direction, the maximum displacement was in the posterior longitudinal ligament behind the injured vertebrae. Under a 6 mm load, the posterior longitudinal ligament displacement was 11.3 mm. Under an 8 mm load, this displacement significantly increased to 15.0 mm, and the vertebral stress was not concentrated on the intervertebral disc. A reduction in the thoracolumbar burst fractures by positioning and distraction allowed the injured vertebrae to be restored to normal height and kyphosis. The reduction in the posterior longitudinal ligament can push the bone block in the spinal canal into the reset space and achieve a good reset.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture

2022

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“…In spite of the significance of the precision osteotomy, it is still rather challenging to develop and apply osteotomy techniques in clinical setting. The rapid development of digital orthopedics has facilitated the fine design of medical device, which would gradually become an emerging trend that will shape the orthopedic field going forward[ 29 , 30 ]. The application of 3D printing and CAD for osteotomy modules in bone biomechanical study would facilitate a shift of osteotomy design from rough operation to precise implementation.…”

Section: Discussionmentioning

confidence: 99%

3D Printing and Computer-Aided Design for Precision Osteotomy-Aided Modules in Bone Biomechanical Study

Wang¹,

Han²,

Xu³

et al. 2022

IJB

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Precise and shape-matching osteotomy models are determinants of the experimental homogeneity in the assessment of orthopedic biomechanical properties. At present, however, publications on detailed description of osteotomy in bone biomechanical study are scanty. The purposes of this study were to design a new method of osteotomy-aided module production for bone biomechanical study with the help of three-dimensional (3D) printing and computer-aided design (CAD) and to test the accuracy of osteotomy. Fourteen fourth-generation composite femurs were analyzed. The composite bone was scanned using computed tomography (CT) scanner and loaded in Mimics for reconstruction and then, imported into 3-Matic software to design intertrochanteric region, distal femur, and rotation control lever models. 3D printer was used to print each component. After assembling Sawbones and osteotomy modules, a horizontal band-saw was used to create fracture models. The volume and mass of intermediate fragments were calculated and analyzed. Satisfactory osteotomies of all composite Sawbones were achieved. The mean volume and mass of intermediate fragments were 21.0 ± 1.5 mm3 and 19.0 ± 1.2 g, respectively. Range of deviation from average of volumes was −1.9 – 2.8 mm3 and most of these deviations fall within the range of −1.4 – 2.1 mm3. Range of deviation from average of mass was −2.0 – 1.6 g and most of these deviations fall within the range of −1.4 – 1.6 g. One-dimensional histogram of deviation from average shows the precise and stable osteotomy performed based on the modules accordingly. A new method of osteotomy-aided module production for bone biomechanical study with the help of 3D printing and CAD was designed and the accuracy of osteotomy was verified. This method is expected to achieve homogeneity and standardization of osteotomy in bone biomechanical study.

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“…Thoracolumbar fractures are the most common type of spinal injury, accounting for approximately 90% of spinal injuries, and are often triggered by direct violence and combined with some degree of spinal nerve injury, which can have a serious impact on patient quality of life if not treated promptly or in an inappropriate manner [1] . Rapid and accurate assessment of fracture injury status and appropriate treatment measures are prerequisites for good outcomes, at the same time, the clinical manifestations and treatment of thoracolumbar spine fractures are different from those of thoracic and lumbar spine fractures due to their complexity [2][3][4] . The Denis, AO, and TLICS fracture staging systems are widely used in clinical practice, among which the Denis staging system is too simple to cover all fracture types and has limited clinical signi cance [5] , the AO staging system is too complex and di cult to be clinically applied, and the reliability kappa value for each major category is 0.517, and the reliability kappa value for each subtype is even lower.…”

Section: Introductionmentioning

confidence: 99%

Clinical Application Analysis of Modified Thoracolumbar Spine Injury Classification Scoring System

Deng

Zhang

et al. 2022

Preprint

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Objective: To propose a modified TLISC system with reference to the Thoracolumbar Injury Classification and Severity Score (TLICS) and prospectively study the feasibility of its guiding clinical treatment. Methods: The study cohort population was 120 patients with thoracolumbar segment fractures admitted to the Department of Spine Surgery of the Sixth Hospital of Ningbo from December 2019 to June 2021, all within one week after fracture, with fracture segments of T11-L2 segments, 68 males and 52 females, aged 22-65 (36.7±5.7) years. The fracture morphology, neurological status, posterior ligament complex (PLC) integrity and disc injury status were combined to assess the fracture severity and formulate clinical treatment strategies based on the total score (T, 0-12 points). The anterior height of the injured spine before and after treatment, the posterior convexity Cobb angle, the VAS score and the spinal nerve function classification and recovery were compared. Results: Based on the scores, 28 cases were finally treated conservatively and 92 cases were treated surgically. Of the 92 surgically treated patients, 8(8.7%) were treated with an anterior approach, 81 (88.0%) with a posterior approach, and 3 (3.3%) with a combined anterior-posterior approach. All patients were followed up for 11 to 27 months [(19.2 ± 4.6) months] after discharge from the hospital. The VAS score at the last follow-up after treatment was 1.94±0.52, the height ratio of the anterior margin of the injured spine was 87.10±7.17%, the sagittal index was 90.35±7.72%, and the Cobb angle was 3.05±0.97 degrees, which were not statistically different from 1 month after treatment (P>0.05) and statistically different from before treatment (P<0.05), and the neurological functional status also had The neurological functional status also improved to different degrees. At the last follow-up, there were 2 cases of broken pedicle screws and no case of broken rods, and 7 cases of pedicle screws with different degrees of wear and cut in the vertebral body, manifesting as mild or severe low back pain. Conclusion: The modified TLICS scoring system is practical in the assessment of thoracolumbar fracture staging and injury degree, and has certain guiding significance for clinical treatment.

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A Finite Element Study on the Treatment of Thoracolumbar Fracture with a New Spinal Fixation System

Cited by 11 publications

References 27 publications

Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture

Finite element analysis of the indirect reduction of posterior pedicle screw fixation for a thoracolumbar burst fracture

3D Printing and Computer-Aided Design for Precision Osteotomy-Aided Modules in Bone Biomechanical Study

Clinical Application Analysis of Modified Thoracolumbar Spine Injury Classification Scoring System

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