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Biomechanical effects of pedicle screw adjustments on the thoracolumbar burst fractures

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Background Posterior pedicle screw device is widely used in treatment of thoracolumbar burst fractures.As the clinical operation is not based upon quantitative data of adjustments,the results are not optimal.At present,no study has assessed the associations between the device adjustments and the restoration of stiffness.We investigated the biomechanical effects that adjustments of a pedicle screw device had on the burst fracture,and explored an optimal adjustment.Methods Burst fractures were produced at L1 vertebra in 24 fresh calf spines (T12-L3).The specimens were divided into four groups at random.Pedicle screw devices were attached to T13 and L2.Four device adjustments,consisting of distraction and extension,were applied.Adjustment 1 was pure 6° extension,adjustment 2 was pure 5 mm distraction,adjustment 3 was 6° extension followed by 5 mm distraction,and adjustment 4 was 5 mm distraction followed by 6° extension.The effect of each adjustment on the stiffness restoration,anatomical reduction,and neural decompression for the burst fractures was analyzed and evaluated.Results Pure extension (Group 1) produced the closest segment height and the least restoration of the canal to the intact.Pure distraction (Group 2) restored stiffness most,but with only 60% stiffness of the intact value,and lost the segmental angle most to the intact.The combination of extension-distraction (Group 3 and Group 4) produced the maximum reduction of the anatomy and restoration of the canal in the burst fracture,and the least stiffness restoration.The sequence of extension and distraction did not affect stiffness restoration,anatomical reduction,and neural decompression.Conclusions The device adjustments affected stiffness restoration,anatomical reduction,and neural decompression.The combined extension-distraction adjustment may be the most suitable considering the anatomical reduction and neural decompression,but the stiffness decreased the most; it should be considered to reconstruct L1 vertebra.

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作者单位: The First Affiliated Hospital of Harbin Medical University, Haerbin, Heilongjiang 150001, China [1] The Third Affiliated Hospital of Harbin Medical University,Haerbin, Heilongjiang 150081, China [2] Harbin Institute of Technology, Haerbin, Heilongjiang 150081,China [3]
期刊: 《中华医学杂志(英文版)》2013年126卷2期 300-305页 SCIMEDLINEISTICCSCDBP
栏目名称: ORIGINAL ARTICLES
DOI: 10.3760/cma.j.issn.0366-6999.20122206
发布时间: 2013-04-19
基金项目:
This work was supported in part by a grant from the Science and Technology Plan Projects of Education Department of Heilongjiang province
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