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首页> 外文期刊>Spine >Biomechanical analysis of anterior poly-methyl-methacrylate reconstruction following total spondylectomy for metastatic disease.
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Biomechanical analysis of anterior poly-methyl-methacrylate reconstruction following total spondylectomy for metastatic disease.

机译：全脊柱切除术治疗转移性疾病后前部聚甲基丙烯酸甲酯重建的生物力学分析。

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STUDY DESIGN: Three reconstruction options were evaluated biomechanically following total spondylectomy using human cadaveric spine specimens. OBJECTIVES.: To evaluate and compare the stability of combined anterior and posterior fixation incorporating poly-methyl-methacrylate with alternative accepted reconstruction techniques. SUMMARY OF BACKGROUND DATA: Total spondylectomy represents the most radical option for decompression in metastatic spinal cord compression. Poly-methyl-methacrylate is considered a useful adjunct in spinal column stabilization and arthrodesis; however, there is little published biomechanical data to support its use in this setting. METHODS: Ten fresh-frozen human cadaveric spines (T9-L3) were used. After intact analysis, a total spondylectomy was performed at T12. Three potential reconstruction techniques were tested for their ability to restore stiffness to the specimen: 1) multilevel posterior pedicle screw instrumentation from T10-L2; 2) anterior instrumentation (ATL Z plate II) and rib graft at T11-L1 with multilevel posterior pedicle screw instrumentation from T10-L2; and 3) anterior cement (Simplex P) and pins construct (T12) with multilevel posterior pedicle screw instrumentation from T10-L2. Each of the three potential reconstruction techniques was tested on each specimen in random order using nondestructive testing under load control. RESULTS: Only combined stabilization techniques (e.g., anterior instrumentation and rib graft with multilevel posterior pedicle screw instrumentation and anterior cement-and-pins construct with multilevel posterior pedicle screw instrumentation) restored stiffness to a level equivalent to or higher than that of the intact spine in all loading modes (P < 0.05). Anterior cement-and-pins construct with multilevel posterior pedicle screw instrumentation provided more stability to the specimen than anterior instrumentation and rib graft with multilevel posterior pedicle screw instrumentation in compression and flexion testing (P < 0.05). Posterior instrumentation alone did not restore stiffness to the intact level in compression and flexion testing (P < 0.005). CONCLUSIONS: Combined anterior and posterior reconstruction using a cement construct provides equal to or more stability than the intact spine in all testing modes. Posterior stabilization alone is an inferior method of reconstruction following total spondylectomy. Poly-methyl-methacrylate has the advantage over traditional anterior reconstruction techniques in that it can be inserted using a posterior approach.
机译：研究设计：使用人体尸体脊柱标本在全脊椎切除术后对生物重建进行了三种力学选择的评估。目的：评估和比较结合了聚甲基丙烯酸甲酯和其他公认的重建技术的联合前后固定的稳定性。背景资料概述：脊柱全切除术是转移性脊髓压迫术中减压的最根本选择。聚甲基丙烯酸甲酯被认为是脊柱稳定和关节固定术的有用辅助剂。但是，几乎没有公开的生物力学数据来支持其在这种情况下的使用。方法：使用十只新鲜冷冻的人尸体棘（T9-L3）。完整分析后，在T12进行全脊椎切除术。测试了三种潜在的重建技术恢复标本刚度的能力：1）T10-L2多级后椎弓根螺钉器械; 2）T11-L1的前侧器械（ATL Z板II）和肋骨移植，T10-L2的多层后椎弓根螺钉器械。和3）前牙水泥（Simplex P）和大头针构造（T12），采用T10-L2的多级后椎弓根螺钉器械。在负载控制下，使用无损检测以随机顺序对每种标本测试了三种潜在的重建技术。结果：只有结合的稳定技术（例如，前器械和肋骨移植物与多级后椎弓根螺钉器械以及前骨水泥钉结构与多级后椎弓根螺钉器械）才能将刚度恢复到等于或高于完整脊柱的水平在所有加载模式下（P <0.05）。与多级后椎弓根螺钉器械的前路器械和肋骨移植相比，多级后椎弓根螺钉器械的前路水泥钉固定结构对标本的稳定性更高（P <0.05）。仅靠后方器械不能在压迫和屈曲试验中将刚度恢复到完整水平（P <0.005）。结论：在所有测试模式下，采用水泥结构的联合前后重建术可提供与完整脊柱相同或更高的稳定性。单独进行后路稳定是全脊椎切除术后重建的一种较差的方法。聚甲基丙烯酸甲酯相对于传统的前重建技术具有优势，因为它可以使用后入路插入。

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