1
|
Du Y, Bian Y, Zhao Y, Yang Y, Lin G, Han B, Zhang H, Li C, Ye X, Li Z, Zhang J, Wang S. A Novel growth guidance system for early onset scoliosis: a preliminary in vitro study. J Orthop Surg Res 2024; 19:259. [PMID: 38659060 PMCID: PMC11040790 DOI: 10.1186/s13018-024-04720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE The purpose of the study was to describe a novel growth guidance system, which can avoid metal debris and reduce the sliding friction forces, and test the durability and glidability of the system by in vitro test. METHOD Two major modifications were made to the traditional Shilla system, including the use of ultra-high molecular weight polyethylene (UHMWPE) gaskets to avoid direct contact between the screw and rod, and polishing the surface of the sliding part of the rod. We tested the durability of the system by a fatigue test, which the samples were test on the MTS system for a 10 million cycle of a constant displacement. Pre and post-testing involved weighing the UHMWPE gaskets and observing the wear conditions. The sliding ability were measured by a sliding displacement test. The maximum sliding displacement of the system was measured after a 300 cycles of dynamic compressive loads in a sinusoidal waveform. RESULTS After the fatigue test, all the UHMWPE gaskets samples showed some of the fretting on the edge of the inner sides, but its still isolated and avoided the friction between the screws and rods. There was no production of metallic fretting around the sliding screws and rods. The average wear mass of the UHMWPE gaskets was 0.002 ± 0.001 g, less than 1.7% of the original mass. In the sliding test, the novel growth guidance system demonstrated the best sliding ability, with an average maximum sliding distance(AMSD) of 35.75 ± 5.73 mm, significantly better than the group of the traditional Shilla technique(AMSD 3.65 ± 0.46 mm, P < 0.0001). CONCLUSION In conclusion, we modified the Shilla technique and designed a novel growth guidance system by changing the friction interface of sliding screw and rod, which may significantly reduce the metallic debris and promote spine growth. The fatigue test and sliding dislocation test demonstrated the better durability and glidability of the system. An in vivo animal experiment should be performed to further verify the system.
Collapse
Affiliation(s)
- You Du
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Yanyan Bian
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Yiwei Zhao
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Yang Yang
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Guanfeng Lin
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Bingtai Han
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Haoran Zhang
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Chenkai Li
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Xiaohan Ye
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Zhiyi Li
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China.
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
2
|
Dursun G, Cetik RM, Guzel D, Demirkiran HG, Ramazanov R, Dede O, Gurses E, Yazici M. The Effect of Apical Vertebra Position on Growing Rod Treatment: A Clinical and Finite Element Study. J Pediatr Orthop 2022; 42:e552-e558. [PMID: 35297388 DOI: 10.1097/bpo.0000000000002135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Growing rods (GRs) is a commonly utilized technique for the management of early-onset scoliosis. The significance of the position of the apical vertebrae relative to the rods is not known. The purpose of this study is to analyze the potential effects of the position of the apical vertebrae in relation to the GRs on deformity control through plain radiographs and finite element analysis (FEA) modeling. METHODS We identified 140 patients treated with GR between 2000 and 2018. Patients who had a congenital vertebral anomaly or <2-year follow-up were excluded. Curve magnitude, traction radiograph under general anesthesia (TRUGA) flexibility, apical rotation, the lengths of T1-12, T1-S1, and the instrumented segments were recorded. Patients were divided into 3 groups according to the apical position on the postoperative radiographs: group 1 (both pedicles are between the rods), group 2 (convex rod is between the apical vertebra pedicles), group 3 (both pedicles are lateral to the convex rod). FEA models were created simulating the 3 groups. Both radiographic and FEA data were analyzed to compare the deformity control and growth in each group. RESULTS Fifty-eight patients were included in the final analyses (mean age 84 mo; range: 38 to 148). Ten patients (17%) were in group 1, 34 (59%) in group 2, and 14 (24%) in group 3. Difference between TRUGA flexibilities was statistically insignificant. Group 3 was the least successful in terms of both height gain and rotational control. FEA showed a decrease in rotation and displacement for every group, however, the residual rotation and displacement was highest in group 3. CONCLUSIONS Bringing the apex in line with the GR increases the capacity of growth preservation as it results in largest height gain and better deformity control. FEA model demonstrated that distraction alone is inadequate for controlling rotation, and with increasing apical translation, residual rotation after distraction also increases. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Gokay Dursun
- Department of Orthopedics and Traumatology, Hacettepe University Hospital
| | - Riza M Cetik
- Department of Orthopedics and Traumatology, Sandikli State Hospital, Afyonkarahisar, Turkey
| | - Dilek Guzel
- Department of Aerospace Engineering, Middle East Technical University
| | | | | | - Ozgur Dede
- Department of Orthopaedic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, 06230 PA
| | - Ercan Gurses
- Department of Aerospace Engineering, Middle East Technical University
| | - Muharrem Yazici
- Department of Orthopedics and Traumatology, Hacettepe University Hospital
| |
Collapse
|
3
|
Migliorini F, Chiu WO, Scrofani R, Chiu WK, Baroncini A, Iaconetta G, Maffulli N. Magnetically controlled growing rods in the management of early onset scoliosis: a systematic review. J Orthop Surg Res 2022; 17:309. [PMID: 35690867 PMCID: PMC9188689 DOI: 10.1186/s13018-022-03200-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Early onset scoliosis (EOS) presents in patients younger than 10 years. Magnetically controlled growing rods (MCGR) were developed as an outpatient distraction system for EOS, allowing to avoid multiple surgeries. This systematic review investigated the efficacy and feasibility of MCGR in EOS. Methods This systematic review was conducted according to the PRISMA guidelines. PubMed, Google scholar, Embase, and Scopus were accessed in May 2022. All the clinical trials which investigate the role of MCGR for early onset scoliosis were accessed. Only studies reporting data in patients younger than 10 years with a preoperative Cobb Angle greater than 40° were eligible. The following data was extracted at baseline and at last follow-up: mean kyphosis angle, overall mean Cobb angle, mean T1–S1 length. Data from complication were also collected. Results Data from 23 clinical studies (504 patients) were included in the present study. 56% (282 of 504) were females. The average length of the follow-up was 28.9 ± 16.0 months. The mean age of the patients was 8.7 ± 1.9 years old. The mean BMI was 17.7 ± 7.6 kg/m2. The mean kyphosis angle had reduced by the last follow-up (P = 0.04), as did the overall mean Cobb angle (P < 0.0001), while the overall T1–S1 length increased (P = 0.0002). Implant-associated complications, followed by spinal alignment failure, wound healing ailments, pulmonary complications, progressive trunk stiffness, persistent back pain, and fracture. Conclusion The management of EOS remains challenging. The current evidence indicates that MCGR may be effective to distract the spine and model the curve in EOS.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Clinic Aachen, RWTH Aachen University Hospital, Pauwelsstraße 31, 52074, Aachen, Germany.
| | - Wai On Chiu
- Master Program of Biomedical Engineering, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Raffaele Scrofani
- Department of Neurosurgery, University Hospital of Salerno, Fisciano, Italy
| | - Wai Kwong Chiu
- MBBS School of Medicine, Jinan University, Guangzhou, China
| | - Alice Baroncini
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, University Clinic Aachen, RWTH Aachen University Hospital, Pauwelsstraße 31, 52074, Aachen, Germany
| | - Giorgio Iaconetta
- Department of Neurosurgery, University Hospital of Salerno, Fisciano, Italy
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB, Stoke-on-Trent, England, UK.,Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, E1 4DG, London, England, UK
| |
Collapse
|
4
|
Jellesen MS, Lomholt TN, Hansen RQ, Mathiesen T, Gundlach C, Kold S, Nygaard T, Mikuzis M, Olesen UK, Rölfing JD. The STRYDE limb lengthening nail is susceptible to mechanically assisted crevice corrosion: an analysis of 23 retrieved implants. Acta Orthop 2021; 92:621-627. [PMID: 34102950 PMCID: PMC8519523 DOI: 10.1080/17453674.2021.1927506] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - We noted several adverse events in patients in whom the first version of the STRYDE limb-lengthening nail (NuVasive Specialized Orthopaedics, San Diego, CA) had been implanted. Pain, osteolysis, periosteal reactions, and cortical hypertrophy at the nail junction were noted. Here, we present the analysis of 23 retrieved STRYDE implants.Materials and methods - We undertook visual inspection of the retrieved nails and screws, mechanical evaluation of the junction, micro-CT analyses, microscopic inspection of the bushing, screws, screw holes, and separated parts of the implants. Positive material identification (PMI) and energy-dispersive X-ray spectroscopy (EDS) were used to analyze the chemical composition. The hardness of the material was also investigated.Results - 20/23 retrieved nails had visible signs of corrosion, i.e., discoloration at the telescopic junction. Micro-CT verified corrosion attacks in 12/12 scanned bushings. Corrosion, predominantly mechanically assisted crevice corrosion, was observed at the locking screws and screw holes in 20/23 nails. Biological material inside the nail was observed in addition to oozing from the junction of 2 nails during hardware removal, which was experimentally reproducible. Notably, the mechanical construction of the bushing changed from PRECICE P2 to STRYDE nails.Interpretation - STRYDE nails are not hermetically sealed, and liquid can pass the bushing. Biodur 108 itself is corrosion resistant; however, mechanically assisted crevice corrosion of the bushing, locking screws, and screw holes may be aggravated due to manufacturing aiming for increased strength and hardness of the alloy.Observing several adverse events, we recently published a nationwide cross-sectional analysis of all 30 STRYDE limb- lengthening nails (NuVasive, Specialized Orthopedics, San Diego, CA) that were implanted in Denmark (Rölfing et al. 2021a). 27/30 STRYDE nails have now been removed and we present data from metallurgical analysis of 23 of the retrieved implants.
Collapse
Affiliation(s)
| | | | - Rikke Quist Hansen
- Department of Mechanical Engineering, Technical University of Denmark, Lyngby; ,Materials and Product Testing, FORCE Technology, Brøndby;
| | | | | | - Søren Kold
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg;
| | - Tobias Nygaard
- Department of Orthopaedics, Limb Lengthening and Bone Reconstruction Unit, Rigshospitalet, Copenhagen;
| | - Mindaugas Mikuzis
- Department of Orthopaedics, Interdisciplinary Orthopaedics, Aalborg University Hospital, Aalborg;
| | - Ulrik Kähler Olesen
- Department of Orthopaedics, Limb Lengthening and Bone Reconstruction Unit, Rigshospitalet, Copenhagen;
| | - Jan Duedal Rölfing
- Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus, Denmark,Jan Duedal Rölfing Correspondence: Orthopaedic Reconstruction and Children’s Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|