2022, Vol. 26 ›› Issue (28): 4435-4440
Biomechanical effects of cement filling location on osteoporotic vertebral compression fracture: a three-dimensional finite element analysis
Ye Linqiang1, Lu Guoliang2, Jiang Xiaobing1, Li Zhen2, Weng Rui3, Liang De1, Huang Xuecheng4, Feng Yonghong2
1Department of Spinal Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405; 2Department of Spinal Surgery, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan 523000; 3Guangzhou University of Chinese Medicine, Guangzhou 510405; 4Department of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510000
Abstract: BACKGROUND: When bipedicular percutaneous vertebral augmentation is performed for osteoporotic vertebral compression fractures, three types of cement filling location in the vertebral body are commonly seen, including anterolateral, anteromedial, and posterolateral, especially in lumbar spine with big volume of vertebral bodies. At present, no relevant biomechanical research has been found to compare the impact of these three bone cement filling locations on the biomechanical properties of fractured vertebral bodies.
OBJECTIVE: To analyze and compare biomechanical effects of three types of cement filling location on osteoporotic vertebral compression fracture using three-dimensional finite element analysis method.
METHODS: Osteoporotic L1-L5 three-dimensional finite element model was constructed and osteoporotic vertebral compression fractures model was simulated in L3. Three types of cement filling location, including anterolateral, anteromedial, and posterolateral, were simulated in osteoporotic vertebral compression fractures model, respectively. Four models were got for the test eventually. Maximum von Mises stress of L3 veretebral body and maximum displacement of L3 fractured area were calculated for the four models under the same loading conditions, including flexion, extension, lateral bending, and rotations.
RESULTS AND CONCLUSION: (1) Under flexion, maximum von Mises stress of L3 veretebral body in anterolateral, anteromedial, and posterolateral sites was about 18.31%, 19.43%, and 28.31% of that in osteoporotic vertebral compression fractures model, respectively. Maximum displacement of L3 fractured area was about 13.92%, 16.49%, and 29.90% of that in osteoporotic vertebral compression fractures model, respectively. Therefore, compared with percutaneous vertebral augmentation pre-operation, maximum von Mises stress and maximum displacement were decreased significantly after percutaneous vertebral augmentation, with those in anterolateral site being decreased the most significantly. Similar changes could be seen in extension, lateral bending, and rotations loading conditions. (2) The results showed that anterolateral cement filling could better restore strength and stability of fractured vertebral body. To make cement fill in the anterolateral fractured area first using precise puncture and cement injection technique is suggested.
Key words: bone cement, osteoporotic, vertebral compression fracture, percutaneous vertebral augmentation, cement filling location, three-dimensional finite element analysis