青少年特发性脊柱侧凸内固定中三维矫正和骨螺钉力作为杆插入顺序和相对于矢状面方向的作用的生物力学分析

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-07-15 DOI:10.1016/j.clinbiomech.2025.106618

Camille Pillot , Xiaoyu Wang , Alexandria Mallinos , Todd Ritzman , Lorena Floccari , Richard M. Schwend , Carl-Eric Aubin

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引用次数: 0

摘要

背景：在青少年特发性脊柱侧凸内固定术中，椎棒通常在最初的平移操作中与矢状面对齐。外科医生通常根据经验将棒定位于脊柱侧凸曲线稍微相反的方向，但最佳的定位和插入顺序，以及它们对3D矫正和力的影响尚不清楚。本研究探讨了这些杆参数对脊柱侧凸矫正的生物力学影响。方法为30例青少年特发性脊柱侧凸患者（11例低、12例正常、7例高度后凸）建立了患者特异性多体生物力学模型，模拟采用初级节段平移矫正手法进行后路内固定。在两个序列中测试杆插入：首先是凹边，其次是凸边，反之亦然。该结构包括椎弓根螺钉和轮廓为45°（凹侧）和15°（凸侧）的5.5 mm钴铬棒。分析了相对于矢状面（0°，10°，20°，30°）的四种杆方向，用于三维校正和骨螺钉力。结果：主胸椎Cobb角矫正效果显著，杆位≥20°(p <；0.01)。椎体顶端旋转和胸椎后凸矫正不受棒的定向影响(p >；0.05)。骨螺钉受力略有增加，但不明显(p >；0.05)，杆向增大。凸边优先棒插入减少了初始插入时的骨螺钉力，实现了与凹边优先序列相似的矫正。预成形的椎棒与侧凸曲线相对30°，可显著改善冠状面矫正，同时保持相似的胸后凸和椎体旋转，骨螺钉力无显著增加。凸侧优先插入可以减少手术期间的机械应力。

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Biomechanical analysis of 3D correction and bone-screw forces as a function of rod insertion sequence and orientation relative to the sagittal plane in adolescent idiopathic scoliosis instrumentation

Background

In adolescent idiopathic scoliosis instrumentation, rods are typically aligned with the sagittal plane during the initial translation maneuver. Surgeons often empirically orient the rod slightly opposite to the scoliotic curve, but the optimal orientation and insertion sequence, as well as their influence on 3D correction and forces, remain unclear. This study investigates the biomechanical influence of these rod parameters on scoliosis correction.

Methods

Patient-specific multi-body biomechanical models were developed for 30 adolescent idiopathic scoliosis patients (11 hypo-, 12 normo-, 7 hyper-kyphotic thoracic curves) to simulate posterior instrumentation with a primary segmental translation correction maneuver. Rod insertion was tested in two sequences: concave side first, followed by the convex side, and vice versa. The construct included pedicle screws and 5.5-mm Cobalt-Chromium rods contoured to 45° (concave side) and 15° (convex side). Four rod orientations relative to the sagittal plane (0°, 10°, 20°, 30°) were analyzed for 3D correction and bone-screw forces.

Findings

Main thoracic Cobb angle correction improved significantly with rod orientations ≥20° (p < 0.01). Apical vertebral rotation and thoracic kyphosis correction were unaffected by rod orientation (p > 0.05). Bone-screw forces increased slightly but not significantly (p > 0.05) with greater rod orientation. Convex-side-first rod insertion reduced bone-screw forces during initial insertion, achieving corrections similar to the concave-first sequence.

Interpretation

Pre-contoured rods oriented up to 30° opposite the scoliotic curve significantly improved coronal plane correction, while maintaining similar thoracic kyphosis and vertebral rotation, with non-significant increases in bone-screw forces. Convex-side-first insertion may reduce mechanical stress during surgery.

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.