Browsing by Author "Chen, Chen-Sheng"

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Biomechanical comparison between lumbar disc arthroplasty and fusion
(2009-03-01)
Chen, Shih-Hao
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Zhong, Zheng-Cheng
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Chen, Chen-Sheng
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Chen, Wen-Jer
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Hung, Chinghua
The artificial disc is a mobile implant for degenerative disc replacement that attempts to lessen the degeneration of the adjacent elements. However, inconsistent biomechanical results for the neighboring elements have been reported in a number of studies. The present study used finite element (FE) analysis to explore the biomechanical differences at the surgical and both adjacent levels following artificial disc replacement and interbody fusion procedures. First, a three-dimensional FE model of a five-level lumbar spine was established by the commercially available medical imaging software Amira 3.1.1, and FE software ANSYS 9.0. After validating the five-level intact (INT) model with previous in vitro studies, the L3/L4 level of the INT model was modified to either insert an artificial disc (ProDisc II; ADR) or incorporate bilateral posterior lumbar interbody fusion (PLIF) cages with a pedicle screw fixation system. All models were constrained at the bottom of the L5 vertebra and subjected to 150 N preload and 10 N m moments under four physiological motions. The ADR model demonstrated higher range of motion (ROM), annulus stress, and facet contact pressure at the surgical level compared to the non-modified INT model. At both adjacent levels, ROM and annulus stress were similar to that of the INT model and varied less than 7%. In addition, the greatest displacement of posterior annulus occurred at the superior-lateral region. Conversely, the PLIF model showed less ROM, less annulus stress, and no facet contact pressure at the surgical level compared to the INT model. The adjacent levels had obviously high ROM, annulus stress, and facet contact pressure, especially at the adjacent L2/3 level. In conclusion, the artificial disc replacement revealed no adjacent-level instability. However, instability was found at the surgical level, which might accelerate degeneration at the highly stressed annulus and facet joint. In contrast to disc replacement results, the posterior interbody fusion procedure revealed possibly accelerative degeneration of the annulus and facet joint at both adjacent levels. (C) 2008 IPEM. Published by Elsevier Ltd. All rights reserved.
Biomechanical comparison of instrumented posterior lumbar interbody fusion with one or two cages by finite element analysis
(2006-09-01)
Chiang, Ming-Fu
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Zhong, Zheng-Cheng
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Chen, Chen-Sheng
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Cheng, Cheng-Kung
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Shih, Shih-Liang
Study Design. Using finite element models to study the biomechanics of lumbar instrumented posterior lumbar interbody fusion (PLIF) with one or two cages. Objective. Analyzing the biomechanics of instrumented PLIF with one or two cages as to evaluate whether a single cage is adequate for instrumented PLIF. Summary of Background Data. Implantation of a single cage in instrumented PLIF of lumbar spine is still controversial. Methods. Three validated finite element models of L3-L5 lumbar segment were established [intact model (INT), one cage model (LS-1), and two cages model (LS-2)]. The available finite element program ANSYS 6.0 (Swanson Analysis System Inc., Houston, TX) was applied. To analyze the biomechanics of these models, 10 Nm flexion, extension, rotation, and lateral bending moment with 150 N of preload were respectively imposed on the superior surfaces of the L3. Results. Compared with the INT model, the decrease of ROM in the LS-1 and LS-2 models were exaggerated from 0.67 degrees to 3.73 degrees and ranged from 37.2% to 86.1% in all motions. The mean subsidence was found to be slightly higher in the LS-1 model. Most of the cage dislodgement in both models was less than 0.03 mm. The mean dislodgement was slightly higher in the LS-1 model. The stress of cage was found to be high in the LS-2 model. The mean stress of screw was raised to 4.5% to 9.7% in the LS-1, which was higher than that in the LS-2 model. In general, stress of adjacent disc was more pronounced in the LS-2 model. The most stress distributed at the anterior portion of the adjacent disc, which could be used to interpret the clinical findings of the early adjacent disc degeneration. Conclusions. A single cage inserted in an instrumented PLIF gains approximate biomechanical stability, slight greater subsidence, and a slight increase in screw stress but less early degeneration in adjacent disc. Adjusting these factors, instrumented PLIF with one cage could be encouraged in clinical practice.
Biomechanical evaluation of reconstruction plates with locking, nonlocking, and hybrid screws configurations in calcaneal fracture: a finite element model study
(2017-10-01)
Chen, Ching-Hsuan
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Hung, Chinghua
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Hsu, Yu-Chun
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Chen, Chen-Sheng
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Chiang, Chao-Ching
Calcaneal fractures are the most common fractures of the tarsal bones. The stability of fixation is an important factor for successful reconstruction of calcaneal fractures. The purpose of this study was to analyze the biomechanical influence of plate fixation with different combinations of locking and nonlocking screws during early weight-bearing phase. A three-dimensional FE foot model was established using ANSYS software, which comprised bones, cartilages, plantar fascia, and soft tissue. Calcaneal plate was fixed with whole locking (WLS), whole nonlocking (WNS), and hybrid screw configurations for FE analysis. The WNS generated a 6.1A degrees and 2.2A degrees Bohler angle decrease compared with the intact model and WLS (WNS: 18.9; WLS: 21.1; intact: 25.0A degrees). Some hybrid screw configurations (Bohler angle: 21.5A degrees and 21.2A degrees) generated stability similar to WLS. The FE results showed that the fragments at the posterior facet and the posterior tuberosity sustained more stress. This study recommends that the hybrid screw configuration with at least four locking screws, two at the posterior facet fragment and two at the posterior tuberosity fragment, is the optimal choice for the fixation of Sanders type IIB calcaneal fractures.
Effect of the cord pretension of the Dynesys dynamic stabilisation system on the biomechanics of the lumbar spine: a finite element analysis
(2011-11-01)
Liu, Chien-Lin
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Zhong, Zheng-Cheng
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Hsu, Hung-Wei
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Shih, Shih-Liang
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Wang, Shih-Tien
The Dynesys dynamics stabilisation system was developed to maintain the mobility of motion segment of the lumbar spine in order to reduce the incidence of negative effects at the adjacent segments. However, the magnitude of cord pretension may change the stiffness of the Dynesys system and result in a diverse clinical outcome, and the effects of Dynesys cord pretension remain unclear. Displacement-controlled finite element analysis was used to evaluate the biomechanical behaviour of the lumbar spine after insertion of Dynesys with three different cord pretensions. For the implanted level, increasing the cord pretension from 100 to 300 N resulted in an increase in flexion stiffness from 19.0 to 64.5 Nm/deg, a marked increase in facet contact force (FCF) of 35% in extension and 32% in torsion, a 40% increase of the annulus stress in torsion, and an increase in the high-stress region of the pedicle screw in flexion and lateral bending. For the adjacent levels, varying the cord pretension from 100 to 300 N only had a minor influence on range of motion (ROM), FCF, and annulus stress, with changes of 6, 12, and 9%, respectively. This study found that alteration of cord pretension affects the ROM and FCF, and annulus stress within the construct but not the adjacent segment. In addition, use of a 300 N cord pretension causes a much higher stiffness at the implanted level when compared with the intact lumbar spine.
Finite Element Analysis of Tongue Type Calcaneal Fracture with Open Reduction and Internal Fixation with Locking Plate
(2018-02-01)
Chen, Ching-Hsuan
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Huang, Yu-Hsuan
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Hung, Chinghua
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Chen, Chen-Sheng
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Chiang, Chao-Ching
Open reduction and internal fixation (ORIF) with plate is the standard treatment for displaced intra-articular calcaneal fractures. We constructed a three-dimensional complete foot finite element model, which was also modified to evaluate the biomechanical effect of Sanders IIB tongue-type calcaneal fracture treated by ORIF with locking plate. We compared plates with locking screws (LSs) and those with non-locking screws (NSs). Static standing was simulated by applying ground reaction force and the pulling force of the Achilles tendon. ORIF with plate using NS or LS provided good stability for Sanders IIB tongue-type calcaneal fracture and might allow light touch weight-bearing in the early postoperative period.
Influence of Dynesys System Screw Profile on Adjacent Segment and Screw
(2010-08-01)
Liu, Chien-Lin
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Zhong, Zheng-Cheng
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Shih, Shih-Liang
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Hung, Chinghua
;
Lee, Yong-Eng
Study Design: Displacement-controlled finite element analysis was used to evaluate the mechanical behavior of the lumbar spine after insertion of the Dynesys dynamic stabilization system. Objective: This study aimed to investigate whether different depths of screw placement of Dynesys would affect load sharing of screw, range of motion (ROM), annulus stress, and facet contact force. Summary of Background Data: In clinical follow-up, a high rate of screw complications and adjacent segment disease were found after using Dynesys. The pedicle screw in the Dynesys system is not so easy to implant into the standard position and causes the screw to protrude more prominently from the pedicle. Little is known about how the biomechanical effects are influenced by the Dynesys screw profile. Methods: The Dynesys was implanted in a 3-dimensional, nonlinear, finite element model of the L1 to L5 lumbar spine. Different depths of screw position were modified in this model by 5 and 10mm out of the pedicle. The model was loaded to 150 N preload and controlled the same ROMs by 20, 15, 8, and 20 degrees in flexion, extension, torsion, and lateral bending, respectively. Resultant ROM, annulus stress, and facet contact force were analyzed at the surgical and adjacent level. Results: Under flexion, extension, and lateral bending, the Dynesys provided sufficient stability at the surgical level, but increased the ROM at the adjacent level. Under flexion and lateral bending, the Dynesys alleviated annulus stress at the surgical level, but increased annulus stress at the adjacent level. Under extension, the Dynesys decreased facet loading at the surgical level but increased facet loading at the adjacent level. Conclusions: This study found that the Dynesys system was able to restore spinal stability and alleviate loading on disc and facet at the surgical level, but greater ROM, annulus stress, and facet loading were found at the adjacent level. In addition, profile of the screw placement caused only a minor influence on the ROM, annulus stress, and facet loading, but the screw stress was noticeably increased.
The influence of different magnitudes and methods of applying preload on fusion and disc replacement constructs in the lumbar spine: a finite element analysis
(2013-09-01)
Zhong, Zheng-Cheng
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Hung, Chinghua
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Lin, Hung-Ming
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Wang, Ying-Hui
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Huang, Chang-Hung
In a finite element (FE) analysis of the lumbar spine, different preload application methods that are used in biomechanical studies may yield diverging results. To investigate how the biomechanical behaviour of a spinal implant is affected by the method of applying the preload, hybrid-controlled FE analysis was used to evaluate the biomechanical behaviour of the lumbar spine under different preload application methods. The FE models of anterior lumbar interbody fusion (ALIF) and artificial disc replacement (ADR) were tested under three different loading conditions: a 150N pressure preload (PP) and 150 and 400N follower loads (FLs). This study analysed the resulting range of motion (ROM), facet contact force (FCF), inlay contact pressure (ICP) and stress distribution of adjacent discs. The FE results indicated that the ROM of both surgical constructs was related to the preload application method and magnitude; differences in the ROM were within 7% for the ALIF model and 32% for the ADR model. Following the application of the FL and after increasing the FL magnitude, the FCF of the ADR model gradually increased, reaching 45% at the implanted level in torsion. The maximum ICP gradually decreased by 34.1% in torsion and 28.4% in lateral bending. This study concluded that the preload magnitude and application method affect the biomechanical behaviour of the lumbar spine. For the ADR, remarkable alteration was observed while increasing the FL magnitude, particularly in the ROM, FCF and ICP. However, for the ALIF, PP and FL methods had no remarkable alteration in terms of ROM and adjacent disc stress.