单节段全椎体整块切除术后两种3D打印假体重建的生物力学效应：一项有限元分析
Biomechanical Effects of Two Types of 3D-Printed Prosthesis Reconstruction After Single-Segmental Total En Bloc Spondylectomy: A Finite Element Analysis.
摘要(中文译文)
全椎体整块切除术（TES）已成为脊柱肿瘤治疗的有效手术干预方式。脊柱重建中假体的选择显著影响患者的术后结局。本研究旨在分析和比较两种3D打印假体与钛网笼（TMC）在TES术后的生物力学效应。建立并验证了L1-L5节段的完整有限元模型（FEM）用于仿真。构建了三个L3 TES模型。模型A采用带人工椎弓根的3D打印假体，模型B采用独立3D打印假体，模型C采用钛网笼。记录并分析以下参数以评估三种模型的生物力学效应：（1）活动度（ROM），（2）内固定系统的应力，（3）L2下终板及L4上终板的应力。三种模型在各方向上的活动度均受到显著限制。与钛网笼相比，3D打印假体的植入在后伸过程中显著增强了脊柱稳定性。在后伸过程中，模型A和模型B的活动度显著低于模型C，分别降低了15.2%和36.4%。使用3D打印假体进行前柱重建可降低假体自身及邻近终板的应力。与模型C相比，模型A和模型B终板应力的最大降幅分别在前屈时为41.5%，在右侧弯时为49.1%。在所有方向上，假体应力以模型C最大，模型A次之，模型B最小，差异具有统计学意义。单节段TES术后，终板匹配良好的3D打印假体可获得更好的生物力学效应，从而降低内固定失败的风险并提高术后脊柱稳定性。
Abstract
Total en bloc spondylectomy (TES) has emerged as an effective surgical intervention for spinal tumor management. The selection of prosthesis for spinal reconstruction significantly influences patient's postoperative outcomes. This study aims to analyze and compare the biomechanical effects of two types of 3D-printed prostheses and titanium mesh cage (TMC) after TES. An intact finite element model (FEM) of L1-L5 segment was developed and validated for simulation. Three L3 TES models were constructed. Model A utilized a 3D-printed prosthesis with an artificial pedicle, model B employed a stand-alone 3D-printed prosthesis, and model C used a TMC. Following parameters were recorded and analyzed to evaluate the biomechanical effects of the three models: (1) the range of motion (ROM), (2) stress of the internal fixation systems, and (3) stress of the L2 inferior endplate and L4 superior endplate. The ROMs of all three models were significantly restricted in all directions. Compared with TMC, the implantation of 3D printed prosthesis significantly enhanced spinal stability during extension. The ROMs of models A and B were significantly lower than that of model C during extension, decreasing by 15.2% and 36.4%, respectively. The use of 3D-printed prosthesis for anterior column reconstruction could reduce the stress of prosthesis itself and adjacent endplates. Compared with model C, the maximal decrease in the stress of the endplate of models A and B was 41.5% during flexion and 49.1% during right lateral bending, respectively. In all directions, the stress of the prosthesis was largest in model C, followed by model A and smallest in model B, with statistically significant differences observed. After single-segmental TES, 3D-printed prosthesis with favorable endplate matching could obtain better biomechanical effects, thereby reducing the risk of internal fixation failure and increasing the postoperative spinal stability.
如何引用
AMA
Jiasheng Chen, Ben Wang, Yang Luo, Xiang Li, Yanchao Tang, Zihe Li, et al. Biomechanical Effects of Two Types of 3D-Printed Prosthesis Reconstruction After Single-Segmental Total En Bloc Spondylectomy: A Finite Element Analysis.. Orthopaedic surgery. 2026; doi:10.1111/os.70336.
APA
Jiasheng Chen, Ben Wang, Yang Luo, Xiang Li, Yanchao Tang, Zihe Li, et al (2026). Biomechanical Effects of Two Types of 3D-Printed Prosthesis Reconstruction After Single-Segmental Total En Bloc Spondylectomy: A Finite Element Analysis.. Orthopaedic surgery. https://doi.org/10.1111/os.70336
GB/T 7714
Jiasheng Chen, Ben Wang, Yang Luo, Xiang Li, Yanchao Tang, Zihe Li, et al. Biomechanical Effects of Two Types of 3D-Printed Prosthesis Reconstruction After Single-Segmental Total En Bloc Spondylectomy: A Finite Element Analysis.[J]. Orthopaedic surgery, 2026 doi:10.1111/os.70336.
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