成人脊柱手术中通过降低硬件密度避免近端交界性失败：计算机模拟病例研究与虚拟队列
Hardware Density Reduction To Avoid Proximal Junction Failure In Adult Spine Surgery: In Silico Case Studies and Virtual Cohort
AI总结：
本研究通过有限元模拟和虚拟队列分析，发现降低硬件密度（HDR）能有效降低中高GAP评分成人脊柱手术患者的近端交界性失败风险，其效果受螺钉分布模式、骨骼及棒材料属性影响。
摘要：
背景：近端交界性失败（PJF）是成人脊柱手术的一种术后并发症，通常需要再次手术。截骨术常用于翻修手术，导致34.8%的并发症。因此，不延长硬件而不进行截骨术可能是次优决策，这会导致严重的全局对齐和比例（GAP）评分。高GAP增加PJF风险，但降低硬件密度（HDR）可能限制该风险。方法：评估了两个临床病例：1）初始手术硬件延伸至T10，GAP 10；2）T11处发生PJF且硬件延伸至T3，GAP 11。通过统计形状建模（SSM）和网格变形构建了两个患者个性化的脊柱有限元（FE）模型。针对病例1）和2），以及具有不同GAP评分的91种虚拟HDR场景，使用有限元（FE）模拟评估了椎间盘（IVD）纤维应变、螺钉拔出力和棒应力。还评估了不同的棒和骨骼材料属性。结果：对于使用钛棒和正常骨骼的病例，HDR可降低IVD纤维应变（最多-70%）并增加螺钉拔出力（最多+142%）。钴铬棒和骨量减少、骨质疏松骨骼具有高PJF风险。权衡分析可确定避免PJF的最佳配置。虚拟队列研究表明，无论使用钛棒还是钴铬棒，GAP 12和13在任何HDR场景下均无法避免PJF。在GAP 11的UIV T10虚拟患者中，若使用钴铬棒，HDR无法降低风险。GAP 13的UIV T3无法从任何HDR策略中获益，且与棒属性无关。相比之下，钛棒可能允许HDR降低GAP 12且UIV T3患者的风险。结论：根据螺钉减少模式、骨骼和棒材料属性，HDR可避免中高GAP评分患者的PJF。值得注意的是，HDR技术可能避免过度脊柱手术并降低手术成本。
英文摘要：
Background: Proximal Junctional Failure (PJF) is a post-operative complication in adult spine surgery, often requiring reoperation. Osteotomy is often used in revision surgeries, leading to 34.8% complications. Hence, suboptimal decisions might be extending hardware without osteotomy, which yields to severe Global Alignment and Proportion (GAP) scores. High GAPs increase PJF risk, but Hardware Density Reduction (HDR) might limit it. Methods: Two clinical cases were evaluated: 1) Initially operated with hardware extended to T10, GAP 10; 2) PJF at T11 and hardware extended to T3, GAP 11. Two patient-personalized spine FE models were constructed through Statistical Shape Modelling (SSM) and mesh morphing. Intervertebral Disk (IVD) fiber strain, screw pull-out force, and rod stress were evaluated for the cases 1) and 2), also for 91 virtual HDR scenarios with different GAP scores, using Finite Element (FE) simulations. Different rod and bone material properties were also assessed. Results: HDR could decrease IVD fiber strain (-70% at most) and increase screw pull-out forces (+142% at most) for cases with Ti rod and normal bone. Cr-Co rod and osteopenia, and osteoporotic bones had high PJF risk. Trade-off analyses could determine the best configurations avoiding PJF. Virtual cohort study showed that GAP 12 and 13 could not avoid PJF in any HDR scenarios either with Ti or Cr-Co rods. HDR in a UIV T10 virtual patient with GAP 11 could not de-risk in case of Cr-Co rods. UIV T3 with GAP 13 could not benefit any HDR strategy, independently of rod properties. In contrast, Ti rods might allow HDR to de-risk GAP 12 patients with UIV T3. Conclusions: HDR could avoid PJF in the patients with medium high GAP scores, depending on the screw reduction pattern, and bone and rod material properties. Remarkably, HDR technique might avoid excessive spine surgeries and minimize the surgery cost.
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