寰枢椎后路柔性固定的生物力学研究

doi:10.13418/j.issn.1001-165x.2022.1.14

Abstract

Abstract: Objectives To analyze the influence of thin rod and PEEK rod on the stability of the atlantoaxial joint. Methods A series of in vitro biomechanical tests were performed using six fresh adult cervical spines (occipital bone-C4 segment) to simulate different conditions in surgery including the (1) intact state; (2) injury state: type II odontoid process fracture; (3) rigid fixation: All atlantoaxial pedicle screws were connected by titanium rods with a diameter of 3.5 mm; (4) PEEK rod: atlantoaxial pedicle screws were connected by a PEEK rod with a diameter of 3.5 mm; (5) thin rod: atlantoaxial pedicle screws were connected by a thin rod with a diameter of 2.0 mm. Biomechanical studies of samples were performed under intact, injury and various fixation statements using a spinal testing machine, while applying a constant moment of 1.5 Nm in flexion-extension, left-right lateral bending, and left-right axial rotation directions. A repeated measurement design was employed in all tests. Movement were measured consecutively by an Optotrak Certus 3D measurement system in order to analyze the range of motion (ROM) and neutral zone (NZ) of atlantoaxial joint. Results In the atlantoaxial joint, ROM of fixation segments were significantly reduced in all directions when a 3.5 mm diameter titanium rod, a 2.0 mm diameter titanium rod, and a 3.5 mm diameter PEEK rod was used (P<0.05). There were no significant differences in ROM of fixation segments for rigid fixation and 2.0 mm diameter titanium rod in all directions (P>0.05). In lateral bending, ROM of the PEEK rod was significantly larger compared with rigid fixation (P=0.005). NZs of fixation segments for rigid fixation, 2.0 mm diameter titanium rod, and a 3.5 mm diameter PEEK rod fixation were significantly reduced (P<0.05). There were no significant differences among these fixations (P>0.05). Conclusions In the atlantoaxial joint, stability of using 2.0 mm diameter titanium rod fixation was comparable to rigid fixation, but stability of using PEEK rod fixation was weaker in the lateral bending direction.

Key words: , Atlas, 　Axis, 　Posterior, , , Flexible fixation, 　Biomechanics

CLC Number:

R318.01

Tong Jie, Ji Wei, Huang Zhiping, Zhou Ruozhou, Fang Zuozhong, Zhu Qingan. Biomechanical research on posterior flexible fixation at atlantoaxial joint[J]. Chinese Journal of Clinical Anatomy, 2022, 40(1): 72-77.

References 31

[1]	Gornet MF, Chan FW, Coleman JC, et al. Biomechanical assessment of a PEEK rod system for semi-rigid fixation of lumbar fusion constructs[J]. J Biomech Eng, 2011, 133(8): 081009. DOI: 10.1115/1.4004862.
[2]	Galbusera F, Bellini CM, Anasetti F, et al. Rigid and flexible spinal stabilization devices: a biomechanical comparison[J]. Med Eng Phys, 2011, 33(4): 490-496. DOI: 10.1016/j.medengphy.2010.11.018.
[3]	Biswas JK, Roy S, Rana M, et al. A comparison of rigid, semi-rigid and flexible spinal stabilization devices: a finite element study[J]. Proc Inst Mech Eng H, 2019, 233(12): 1292-1298. DOI: 10.1177/0954411919880694.
[4]	Fan W, Guo LX, Zhao D. Stress analysis of the implants in transforaminal lumbar interbody fusion under static and vibration loadings: a comparison between pedicle screw fixation system with rigid and flexible rods[J]. J Mater Sci Mater Med, 2019, 30(10): 118. DOI: 10.1007/s10856-019-6320-0.
[5]	Jacobs E, Roth AK, Arts JJ, et al. Reduction of intradiscal pressure by the use of polycarbonate-urethane rods as compared to titanium rods in posterior thoracolumbar spinal fixation[J]. J Mater Sci Mater Med, 2017, 28(10): 148. DOI: 10.1007/s10856-017-5953-0.
[6]	Hsieh YY, Tsuang FY, Kuo YJ, et al. Biomechanical analysis of single-level interbody fusion with different internal fixation rod materials: a finite element analysis[J]. BMC Musculoskelet Disord, 2020, 21(1): 100. DOI: 10.1186/s12891-020-3111-1.
[7]	Nohara H, Kanaya F. Biomechanical study of adjacent intervertebral motion after lumbar spinal fusion and flexible stabilization using polyethylene-terephthalate bands[J]. J Spinal Disord Tech, 2004, 17(3): 215-219. DOI: 10.1097/00024720-200406000-00008.
[8]	Di Silvestre M, Lolli F, Bakaloudis G, et al. Dynamic stabilization for degenerative lumbar scoliosis in elderly patients[J]. Spine, 2010, 35(2): 227-234. DOI: 10.1097/BRS.0b013e3181bd3be6.
[9]	Di Silvestre M, Lolli F, Bakaloudis G. Degenerative lumbar scoliosis in elderly patients: dynamic stabilization without fusion versus posterior instrumented fusion[J]. Spine J, 2014, 14(1): 1-10. DOI: 10.1016/j.spinee.2012.10.023.
[10]	Park H, Zhang HY, Cho BY, et al. Change of lumbar motion after multi-level posterior dynamic stabilization with bioflex system : 1 year follow up[J]. J Korean Neurosurg Soc, 2009, 46(4): 285-291. DOI: 10.3340/jkns.2009.46.4.285.
[11]	Selim A, Mercer S, Tang F. Polyetheretherketone (PEEK) rods for lumbar fusion: a systematic review and meta-analysis[J]. Int J Spine Surg, 2018, 12(2): 190-200. DOI: 10.14444/5027.
[12]	Wang Q, Liu J, Shi Y, et al. Short-term effects of a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation[J]. Eur Spine J, 2016, 25(5): 1409-1416. DOI: 10.1007/s00586-015-4307-1.
[13]	Hu Y, Gu YJ, Xu RM, et al. Short-term clinical observation of the Dynesys neutralization system for the treatment of degenerative disease of the lumbar vertebrae[J]. Orthop Surg, 2011, 3(3): 167-175. DOI: 10.1111/j.1757-7861.2011.00142.x.
[14]	Mandigo CE, Sampath P, Kaiser MG. Posterior dynamic stabilization of the lumbar spine: pedicle based stabilization with the AccuFlex rod system[J]. Neurosurg Focus, 2007, 22(1): E9. DOI: 10.3171/foc. 2007. 22.1.9.
[15]	Mavrogenis AF, Vottis C, Triantafyllopoulos G, et al. PEEK rod systems for the spine[J]. Eur J Orthop Surg Traumatol, 2014, 24(S1): S111-S116. DOI: 10.1007/s00590-014-1421-4.
[16]	Li ZH, Li FN, Yu SZ, et al. Two-year follow-up results of the Isobar TTL Semi-Rigid Rod System for the treatment of lumbar degenerative disease[J]. J Clin Neurosci, 2013, 20(3): 394-399. DOI: 10.1016/j.jocn.2012.02.043.
[17]	Wu JC, Huang WC, Tsai HW, et al. Pedicle screw loosening in dynamic stabilization: incidence, risk, and outcome in 126 patients[J]. Neurosurg Focus, 2011, 31(4): E9. DOI: 10.3171/2011.7.FOCUS11125.
[18]	Gomleksiz C, Sasani M, Oktenoglu T, et al. A short history of posterior dynamic stabilization[J]. Adv Orthop, 2012, 2012: 1-12. DOI: 10.1155/2012/629698.
[19]	Oikonomidis S, Ashqar G, Kaulhausen T, et al. Clinical experiences with a PEEK-based dynamic instrumentation device in lumbar spinal surgery: 2 years and no more[J]. J Orthop Surg Res, 2018, 13(1): 196. DOI: 10.1186/s13018-018-0905-z.
[20]	Putzier M, Hoff E, Tohtz S, et al. Dynamic stabilization adjacent to single-level fusion: Part II. No clinical benefit for asymptomatic, initially degenerated adjacent segments after 6 years follow-up[J]. Eur Spine J, 2010, 19(12): 2181-2189. DOI: 10.1007/s00586-010-1517-4.
[21]	Zhou ZJ, Xia P, Zhao X, et al. Can posterior dynamic stabilization reduce the risk of adjacent segment deterioration[J]? Turkish Neurosurg, 2013, 23(5): 579-589. DOI: 10.5137/1019-5149.JTN.6573-12.1.
[22]	Lee SE, Jahng T, Kim HJ. Facet joint changes after application of lumbar nonfusion dynamic stabilization[J]. Neurosurg Focus, 2016, 40(1): E6. DOI: 10.3171/2015.10.FOCUS15456.
[23]	Kashkoush A, Agarwal N, Paschel E, et al. Evaluation of a hybrid dynamic stabilization and fusion system in the lumbar spine: a 10 year experience[J]. Cureus, 2016, 8(6): e637. DOI: 10.7759/cureus.637.
[24]	Tan MS, Wang HM, Wang YT, et al. Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass[J]. Spine (Phila Pa 1976), 2003, 28(9): 888-895. DOI: 10.1097/01.BRS.00000 58719. 48596.CC.
[25]	林周胜, 黄志平, 陈建庭, 等. 棒直径对椎弓根螺钉固定稳定性和脊柱承载影响的生物力学研究[J]. 实用医学杂志, 2013, 29(1): 1-3. DOI: 10.3969/j.issn.1006-5725.2013.01.001.
[26]	Kim K, Park WM, Kim YH, et al. Stress analysis in a pedicle screw fixation system with flexible rods in the lumbar spine[J]. Proc Inst Mech Eng H, 2010, 224(3): 477-485. DOI: 10.1243/09544119JEIM611.
[27]	Kim YS, Zhang HY , Moon BJ, et al. Nitinol spring rod dynamic stabilization system and Nitinol memory loops in surgical treatment for lumbar disc disorders: short-term follow up[J]. Neurosurg Focus, 2007, 22(1): E10. PMID: 17608331.
[28]	Heo DH, Cho YJ, Cho SM, et al. Adjacent segment degeneration after lumbar dynamic stabilization using pedicle screws and a nitinol spring rod system with 2-year minimum follow-up[J]. J Spinal Disord Tech, 2012, 25(8): 409-414. DOI: 10.1097/BSD.0b013e318231665d.
[29]	Korovessis P, Papazisis Z, Koureas G, et al. Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis: a correlative radiological and clinical analysis of short-term results[J]. Spine (Phila Pa 1976), 2004, 29(7): 735-742. DOI: 10.1097/01.brs.0000112072.83196.0f.
[30]	Ponnappan RK, Serhan H, Zarda B, et al. Biomechanical evaluation and comparison of polyetheretherketone rod system to traditional titanium rod fixation[J]. Spine J, 2009, 9(3): 263-267. DOI: 10.1016/j.spinee.2008.08.002.
[31]	Abode-Iyamah K, Kim SB, Grosland N, et al. Spinal motion and intradiscal pressure measurements before and after lumbar spine instrumentation with titanium or PEEK rods[J]. J Clin Neurosci, 2014, 21(4): 651-655. DOI: 10.1016/j.jocn.2013.08.010.

Biomechanical research on posterior flexible fixation at atlantoaxial joint

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References 31

Related Articles 15

Metrics

Comments

Recommended 0

[1]	Jiang Jianhong, Duan Renpeng, Li Xiaofeng. Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 1-4.
[2]	Guo Hongzhi, Wang Yu, Zhang Jiaqi, Liang Haibin, Ma Ziwei, Feng Wei, Wu You, Si Ziyi. Evaluation of placental vascular structure in preeclampsia by vascular casting combined with CT three-dimensional model [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 5-10.
[3]	Li Jiawei, Zhang Jing, Li Canran, Lan Wenjie, Ji Qingyu, Guo Zhiyong, Zhang Yunfeng, Liu Qi, Chen Qingwei, Li Xiaohe. X-ray measurement of proximal femur anatomical parameters in Mongolian population [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 11-16.
[4]	. Digital measurement and clinical significance of occipitocervical Angle and posterior occipitocervical Angle in children and adolescents [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 17-20.
[5]	Li Wen, Yang Siyi, Huang Lei, Qing Jiwen, Jiang Songtao, Zhang Lei. Morphological characteristics and clinical significance of Lisfranc ligament based on MRI [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 21-25.
[6]	Li Fanfan, Xu Yang, Wang Xiaoxu. Therapeutic effect of shikonin on the treatment of granuloma lobular mastitis in model rats by regulating Nrf2/HO-1 signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 26-32.
[7]	Wang Xinghang, Ding Jiayuan, Li Fang, Bao Cuifen, Yan Lijing. Ginsenoside Rg1 reduces the inflammatory response of microglia after oxygen glucose deprivation/resupply by inhibiting the NLRP3 inflammasome pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 33-41.
[8]	Cheng Yingying, Wu Jianjun, Cai Haiyan , Jiao Xunwen, Ma Jiangbo, Ding Yinxiu. Activation and functional changes of astrocytes cultured in vitro under inflammatory stimulation [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 42-46.
[9]	Qi Zhi, Yang Li, Jia Qiuye, Chen Haolun, Duan Zhaoda, Wu Chunyun. Edaravone regulates Sirt3 expression in lipopolysaccharide-activated microglia via MAPKs signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 47-53.
[10]	Zhang Jingjing, Wang Hongxin. Protective effect of Baicalin on rats with pulmonary hypertension through PDGF/P38 MAPK signaling pathway [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 54-58.
[11]	Yue Qin, Chen Rongli, Xiong Jingxi, Wang Tingyi, Cai Zhiheng, Yi Qiushi, Zeng Xinyi. Effect of Bletilla striata polysaccharides on the choke-area of cross-boundary flap in rats [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 59-64.
[12]	Li Xiaoyu , Zhang Lei , Fu Lei , Li Dongbo , Wang Guoyou. Finite element study on the treatment of Sanders type II calcaneal fracture with three-step reduction method [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 65-70.
[13]	Wu Yanfei, Ma Jianxiong, Lu Bin, Wang Ying, Bai Haohao, Jin Hongzhen, Ma Xinlong. Study on the correlation between the reconstruction of grayscale values using CT post-processing technology and the compressive strength of the endplate [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 71-76.
[14]	Zhuang Wanqiang, Tang Yi, Luo Yonggang, Zhang Hui. An early and mid-term retrospective study of the effects of arthroscopy combined with high tibial osteotomy on patellar position and patellofemoral joint function [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 77-82.
[15]	Luo Ying, Dou Weiyu, Wu Xiaohang, Chen Jingkun, Peng Changgui, Pan Jianying . Risk factors of postoperative complications of calcaneal fractures treated with hippocampal plate internal fixation through minimally invasive method [J]. Chinese Journal of Clinical Anatomy, 2024, 42(1): 83-88.