Construct-construct "rail technique" decreases screw strain during spinal deformity corrective maneuvers across a thoracic vertebral column resection: a cadaveric analysis.
Alekos A Theologis, Jason DePhillips, Izabella T Lachcik, Jonathan M Mahoney, Brandon S Bucklen
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引用次数: 0
Abstract
Purpose: To biomechanically compare screw strains above and below a vertebral column resection (VCR) during segmental compression (SC) and cantilever bending (CB) performed via traditional methods and a novel, construct-to-construct accessory rod ("rail") technique.
Methods: Eight cadaveric torsos underwent a VCR with 250 kyphosis at T8 with pedicle screws implanted three levels above and below the VCR (T5-7; T9-11). Four screws (T6, T7, T9, T10) were instrumented with strain gauges to capture screw strains during SC and CB. Both deformity corrective maneuvers were performed over a traditional construct (central rod) and over a construct-to-construct accessory ("rail") rod. Real-time screw strains were collected and peak strains were compared between corrective techniques.
Results: Strains in screws closest to the VCR were significantly less during "rail" compression compared to traditional SC (T7: p = 0.015). Maximum screw strains were significantly lower during "rail" SC and CB compared to traditional SC (T6: p = 0.037; T7: p = 0.015) and CB (T6: p = 0.018; T9: p < 0.001). Total screw strain was more evenly distributed over all screws during "rail" compression and CB compared to traditional techniques, which concentrated strain at individual screws adjacent to the VCR.
Conclusions: Performing segmental compression and cantilever bending across a lateral accessory construct-to-construct ("rail") rod resulted in significantly lower strain on individual pedicle screws adjacent to a thoracic VCR compared to traditional SC and CB. As such, the "rail" may lessen risk of screw pull-out and screw plough during maneuvers to correct spinal deformities across a VCR.
目的：从生物力学角度比较椎体切除术（VCR）在节段压缩（SC）和悬臂弯曲（CB）期间，通过传统方法和一种新型的结构对结构附属杆（“rail”）技术进行的螺钉上下应变。方法：8具尸体在T8处行椎弓根椎弓根螺钉植入椎弓根椎弓根螺钉，椎弓根椎弓根螺钉植入椎弓根椎弓根螺钉上下三节位（T5-7; T9-11）。4个螺钉（T6, T7, T9, T10）在SC和CB过程中使用应变片测量螺钉应变。两种畸形矫正操作均在传统结构体（中心杆）和结构体对结构体附件（“轨道”）杆上进行。实时采集螺旋应变并比较两种矫正方法的峰值应变。结果：与传统SC相比，靠近VCR的螺钉在“导轨”压缩期间的应变明显减少（T7: p = 0.015）。与传统的椎弓根置换术（T6: p = 0.037; T7: p = 0.015）和椎弓根置换术（T6: p = 0.018; T9: p）相比，“轨道”置换术和椎弓根置换术的最大螺钉应变显著降低（T6: p = 0.018; T9: p）。结论：与传统的椎弓根置换术和椎弓根置换术相比，通过横向附属结构对结构（“轨道”）棒进行节段压缩和悬臂弯曲可显著降低胸椎弓根置换术相邻椎弓根螺钉的应变。因此，“导轨”可以减少螺钉拔出和螺钉犁的风险，在操作过程中纠正脊柱畸形在VCR。
期刊介绍：
Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
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