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Contribution à l'analyse biomécanique et à l'évaluation des implants rachidiens

Abstract : INTRODUCTION : Recent appearance of the first spinal implants, in the middle of the twentieth century, marks not only an acceleration of the development of spinal surgery, but also birth of a specific technology, which is yet only at its beginnings. How to evaluate these spinal implants, both at the time of their design and during surgery planning? Our research tasks were articulated around these issues.MATERIALS & METHODS : The first of our two axes of investigation relates to the normative evaluation in fatigue of spinal implants, and more particularly of osteosynthesis implants. We animated thus a work group, composed of implants manufacturers and researchers of the LBM, in order to propose a project of international standard defining methods for functional evaluation of spinal implants, taking into account the last scientific knowledge, particularly concerning the constraints undergone by spinal instrumentations in vivo. Our second axis of investigation relates to the biomechanical analysis, using numerical method, of the lumbar spine surgery. We worked for that on personalized geometrical and mechanical numerical model and finite elements simulation of the lumbar spine and its surgery. We have, within the framework of the Orthosim European project, contributed to make this tool evolve. Then, an extensive evaluation of the tool, as a help for surgical planning, was carried out. We finally carried out a preliminary evaluation of the influence of the operator on the answer of the tool and took part in its integration within the framework of an Internet website. RESULTS : The tests carried out according to the suggested protocol made it possible to highlight failure modes of the implants similar to those observed in vivo, confirming the functional aspect of the evaluation. Technical contents of the draft standard obtain a consensus from the ISO experts in September 2006. The final publication as an international standard is effective since April 2008. Then, the simulations tool was developed and improved, initially by making the process reliable, then by widening the panel of the surgery options available. The retrospective evaluation confirmed the predictive aspect of simulations, regarding the influence of a given surgical strategy on the clinical result. Lastly, the provision of the clinicians of the simulations tool was committed. CONCLUSION : This work enabled us to contribute, on the one hand to the evolution of standards for spinal implants evaluation, with a more biomechanical dimension, and on the other hand to take part in installation of an innovating tool, based on numerical simulations, for surgery planning and biomechanical analysis of the lumbar spine surgery
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https://pastel.archives-ouvertes.fr/pastel-00004569
Contributor : Ecole Arts Et Métiers Paristech <>
Submitted on : Friday, January 23, 2009 - 8:00:00 AM
Last modification on : Saturday, February 15, 2020 - 1:53:00 AM
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Thomas Mosnier. Contribution à l'analyse biomécanique et à l'évaluation des implants rachidiens. Sciences du Vivant [q-bio]. Arts et Métiers ParisTech, 2008. Français. ⟨NNT : 2008ENAM0046⟩. ⟨pastel-00004569⟩

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