Three-dimensional finite element analysis of a newly developed aliform internal fixation system for occipitocervical fusion.

For patients with occipital malformation, it is difficult to obtain reliable stability using three screws on the midline. A new aliform occipitocervical internal fixation system was designed. The occiput was fixed with 3, 7, or 11 screws, and a three-dimensional finite element model of the system was established. A compressive preload of 40N combined with a pure moment of 1.5Nm was applied to simulate normal flexion, extension, lateral bending, and axial rotation. The stress distribution across the screws on the occiput and the occipital displacement produced by the newly developed system were compared with those produced by the DePuy SUMMIT system. Compared with the SUMMIT system (control group), in the new system, the maximum stress on the occiputs fixed with 3 screws (group A) and 7 screws (group B) increased by 16.5% and 15.0%, respectively. In contrast, the maximum stress on the occiput fixed with 11 screws (group C) decreased by 15.6%. In addition, the maximum occipital displacements under extension decreased by 10.0%, 11.4%, and 11.8% in the A, B, and, C groups, respectively. Our results indicate that both group A and the control group exhibited sufficient strength and instant stability; however, group C exhibited the highest stability and the lowest maximum von Mises stress.