2023, Vol. 27 ›› Issue (3): 391-397

Finite element analysis and application of unilateral and bilateral bone-filling mesh container in treatment of osteoporotic vertebral compression fracture

Lu Hui1, 2, Wu Qimei3, Liu Rong2, 4   

Abstract: BACKGROUND: In the treatment of osteoporotic vertebral compression fracture, bone-filling mesh container has a significant curative effect. Considering the operation time, lateral leakage of bone cement and the number of radiation exposure, unilateral approach is better. However, no study compared unilateral bone-filling mesh container and bilateral bone-filling mesh container from the perspective of biomechanics, lacking certain theoretical data support.
OBJECTIVE: To investigate the biomechanical characteristics and clinical effects of unilateral and bilateral bone-filling mesh container approaches in the treatment of osteoporotic vertebral compression fracture.
METHODS: (1) A finite element model was established to simulate the treatment of osteoporotic vertebral compression fracture with unilateral and bilateral bone-filling mesh container. The displacement and stress changes of the whole finite element model of thoracolumbar segment in the unilateral bone-filling mesh container group and bilateral bone-filling mesh container group were compared and analyzed under 400 N vertical downward loading force and 7.5 N·m bending moment load under four working conditions. (2) A retrospective analysis was performed on 99 patients with osteoporotic vertebral compression fracture who were treated with bone-filling mesh container from January 2018 to August 2020 in Wuhan Puren Hospital. Of them, 49 patients were treated with unilateral bone-filling mesh container and 50 patients were treated with bilateral bone-filling mesh container. Bone cement leakage rate, visual analogue scale score, and Cobb angle change were analyzed between the two groups.
RESULTS AND CONCLUSION: (1) Finite element model: There was no significant difference in the maximum displacement between unilateral group and bilateral group under axial, forward flexion, left bending, and left rotation conditions (P > 0.05). There was no significant difference in the maximum stress between unilateral group and bilateral group under axial, forward flexion, left bending, and left rotation conditions (P > 0.05). (2) Clinical trial: The bone cement leakage rates in the unilateral and bilateral approach groups were 12% and 16%, respectively, and the visual analogue scale score and scoliosis angle at 6 months after surgery were significantly improved compared with those before operation in both groups (P < 0.001). There was no significant difference in visual analogue scale score and scoliosis angle between the two groups at 6 months after operation (P > 0.05). (3) From the perspective of biomechanics and clinical efficacy, unilateral bone-filling mesh container approach is more effective than bilateral bone-filling mesh container approach in treating osteoporotic vertebral compression fracture.
Key words: bone-filling mesh container, osteoporotic, vertebral compression fracture, finite element analysis, biomechanics, unilateral approach, bilateral approach