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EN
The purpose of this study was to investigate pullout strength of three types of pedicle screws with and without cement augmentation in osteoporotic bone using finite element analysis. Methods: Twelve 3D finite element models were created to investigate the effect of pullout strength when comparing between pedicle screw types and bone cement clouds. The bottom side of bone block model was constrained and U-shape head was applied 1 mm in direction of longitudinal axis of pedicle screw to perform pullout resistance. The material properties of the FEA was set as linear elastic, homogenous, isotropic condition. The element sensitivity of convergence testing has been performed and variation of the sequential analytical results was less than 3%. Results: The results showed that the maximum total reaction force (133.8 N) was detected in the model of cannulated pedicle screw combined with a central pin with 4 ml cement augmentation, but, in contrast, the minimum total reaction force (106.8 N) was discovered in the model of cannulated pedicle screw without cement. A strong relationship (r = 0.9626) is found in comparison with the biomechanical results between pullout strength of sawbone testing and reaction forces of the FEA. Conclusions: The study concludes that the cannulated pedicle screw can not only provide an inner guider for cement flow and increase bending resistance (deflection effect) when a central pin is selected, but also can improve the pullout strength in the osteoporotic bone to add cement augmentation. The design of the cannulated pedicle screw is suggested for poor bone quality to change pullout failure.
EN
Purpose: The conventional screw is unable to provide enough screw-bone interface strength for osteoporotic cencellous bone, and complications resulting from loosening or failure of the implants remain a significant clinical problem. Hence, the purpose of this study is to investigate pullout strength and energy in three types of the pedicle screws, including conventional solid pedicle screw, cannulated pedicle screw, and cannulated pedicle screw with a central pin, using osteoporotic sawbone test block with different bone cement volumes through pullout force testing. Methods: The control group (n = 15) of the osteoporotic sawbone test block includes groups A, B, and C to reflect three types of the pedicle screws without bone cement augmentation. The cemented group (n = 45) of the osteoporotic sawbone test block includes groups D1, D2, D3, E1, E2, E3, F1, F2, and F3 to reflect three types of the pedicle screws with PMMA bone cement of 2, 3, and 4 mL augmentation. Results: The results showed that the pullout strength and energy in the cemented group were significantly larger than that in the control group. Moreover, the best performances of the pullout strength and energy in the cemented group were evidenced obviously in the case of cannulated pedicle screw with a central pin with 4 mL bone cement augmentation. Conclusions: This study concludes that cement argumentation in the cannulated pedicle screw with a central pin can increase a pullout strength of pedicle screw for severe osteoporotic patients while bone cement of injective volume is limited.
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