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Fu R, Feng Y, Liu Y, Gao X, Bertrand DT, Du T, Liu Y, Willie BM, Yang H. Effect of the accordion technique on bone regeneration during distraction osteogenesis: A computational study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 227:107232. [PMID: 36371976 DOI: 10.1016/j.cmpb.2022.107232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Distraction osteogenesis (DO), a bone lengthening technique, is widely employed to treat congenital and acquired limb length discrepancies and large segmental bone defects. However, a major issue of DO is the prolonged consolidation phase (10-36 months) during which patients must wear a cumbersome external fixator. Attempts have been made to accelerate the healing process of DO by an alternating distraction and compression mode (so-called "accordion" technique or AT). However, it remains unclear how varied AT parameters affect DO outcomes and what the most effective AT mode is. METHODS Based on an experimentally-verified mechanobiological model, we performed a parametric analysis via in silico simulation of the bone regeneration process of DO under different AT modes, including combinations of varied application times (AT began at week 1-8 of the consolidation phase), durations (AT was used continuously for 1 week, 2 weeks or 4 weeks) and rates (distraction or compression at 0.25, 0.5, 0.75, and 1 mm/12 h). The control group had no AT applied during the consolidation phase. RESULTS Compared with the control group (no AT), AT applied at an early consolidation stage (e.g. week 1 of the consolidation phase) significantly enhanced bone formation and reduced the overall healing time. However, the effect of AT on bone healing was dependent on its duration and rate. Specifically, a moderate rate of AT (e.g. 0.5 mm/12 h) lasting for two weeks promoted blood perfusion recovery and bone regeneration, ultimately shortening the healing time. Conversely, over-high rates (e.g. 1 mm/12 h) and longer durations (e.g. 4 weeks) of AT adversely affected bone regeneration and blood perfusion recovery, thereby delaying bone bridging. CONCLUSIONS These results suggest that the therapeutic effects of AT on DO are highly dependent of the AT parameters of choice. Under appropriate durations and rates, the AT applied at an early consolidation phase is beneficial for blood recovery and bone regeneration. These results may provide a basis for selecting effective AT modes to accelerate consolidation and reduce the overall treatment period of DO.
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Affiliation(s)
- Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Yili Feng
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Yang Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Xing Gao
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - David T Bertrand
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada; Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
| | - Tianming Du
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Bettina M Willie
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada; Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing 100124, China.
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Bachmeier AT, Euler E, Bader R, Böcker W, Thaller PH. Novel approach to estimate distraction forces in distraction osteogenesis and application in the human lower leg. J Mech Behav Biomed Mater 2022; 128:105133. [PMID: 35217291 DOI: 10.1016/j.jmbbm.2022.105133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/18/2022] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE In distraction osteogenesis (DO) of long bones, new bone tissue is distracted to lengthen limbs or reconstruct bone defects. However, mechanical boundary conditions in human application such as arising forces are mainly based on limited empirical data. Our aim was the numerical determination of the callus distraction force (CDF) and the total distraction force (TDF) during DO in the tibia of adults to advance the understanding of callus tissue behavior and optimize DO procedures. METHOD We implemented a mathematical model based on an animal experiment to enable the calculation of forces arising while distracting callus tissue, excluding the influence of surrounding soft tissue (muscles, skin etc.). The CDF progression for the distraction period was calculated using the implemented model and varying distraction parameters (initial gap, area, step size, time interval, length). Further, we estimated the CDF based on reported forces in humans and compared the results to our model predictions. In addition, we calculated the TDF based on our CDF predictions in combination with reported resisting forces due to soft tissue presence in human cadavers. Finally, we compared the progressions to in vivo TDF measurements for validation. RESULTS Due to relaxation, a peak and resting CDF is observable for each distraction step. Our biomechanical results show a non-linear degressive increase of the resting and peak CDF at the beginning and a steady non-linear increase thereafter. The calculated resting and peak CDF in the tibial metaphysis ranged from 0.00075 to 0.0089 N and 0.22-2.6 N at the beginning as well as 20-25 N and 70-75 N at the end of distraction. The comparison to in vivo data showed the plausibility of our predictions and resulted in a 10-33% and 10-23% share of resting CDF in the total resting force for bone transport and elongation, respectively. Further, the percentage of peak CDF in total peak force was found to be 29-58% and 27-55% for bone transport and elongation, respectively. Moreover, our TDF predictions were valid based on the comparison to in vivo forces and resulted in a degressive increase from 6 to 125 N for the peak TDF and from 5 to 76 N for the resting TDF. CONCLUSION Our approach enables the estimation of forces arising due to the distraction of callus tissue in humans and results in plausible force progressions as well as absolute force values for the callus distraction force during DO. In combination with measurements of resisting forces due to the presence of soft tissue, the total distraction force in DO may also be evaluated. We thus propose the application of this method to approximate the behavior of mechanical callus properties during DO in humans as an alternative to in vivo measurements.
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Affiliation(s)
- A T Bachmeier
- 3D-Surgery, Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany; Biomechanics and Implant Technology Research Laboratory, University Medicine Rostock, Rostock, Germany.
| | - E Euler
- Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| | - R Bader
- Biomechanics and Implant Technology Research Laboratory, University Medicine Rostock, Rostock, Germany
| | - W Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
| | - P H Thaller
- 3D-Surgery, Department of General, Trauma and Reconstructive Surgery, University Hospital LMU Munich, Munich, Germany
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Inglis B, Schwarzenberg P, Klein K, von Rechenberg B, Darwiche S, Dailey HL. Biomechanical duality of fracture healing captured using virtual mechanical testing and validated in ovine bones. Sci Rep 2022; 12:2492. [PMID: 35169187 PMCID: PMC8847550 DOI: 10.1038/s41598-022-06267-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/17/2022] [Indexed: 01/08/2023] Open
Abstract
Bone fractures commonly repair by forming a bridging structure called callus, which begins as soft tissue and gradually ossifies to restore rigidity to the bone. Virtual mechanical testing is a promising technique for image-based assessment of structural bone healing in both preclinical and clinical settings, but its accuracy depends on the validity of the material model used to assign tissue mechanical properties. The goal of this study was to develop a constitutive model for callus that captures the heterogeneity and biomechanical duality of the callus, which contains both soft tissue and woven bone. To achieve this, a large-scale optimization analysis was performed on 2363 variations of 3D finite element models derived from computed tomography (CT) scans of 33 osteotomized sheep under normal and delayed healing conditions. A piecewise material model was identified that produced high absolute agreement between virtual and physical tests by differentiating between soft and hard callus based on radiodensity. The results showed that the structural integrity of a healing long bone is conferred by an internal architecture of mineralized hard callus that is supported by interstitial soft tissue. These findings suggest that with appropriate material modeling, virtual mechanical testing is a reliable surrogate for physical biomechanical testing.
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Affiliation(s)
- Brendan Inglis
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, 18015, USA.
| | - Peter Schwarzenberg
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, 18015, USA
| | - Karina Klein
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, 8057, Zurich, Switzerland
| | - Salim Darwiche
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, 8057, Zurich, Switzerland
| | - Hannah L Dailey
- Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, 18015, USA.
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The Distraction Osteogenesis Callus: a Review of the Literature. Clin Rev Bone Miner Metab 2022. [DOI: 10.1007/s12018-021-09282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Blázquez-Carmona P, Sanz-Herrera JA, Mora-Macías J, Morgaz J, Domínguez J, Reina-Romo E. Time-Dependent Collagen Fibered Structure in the Early Distraction Callus: Imaging Characterization and Mathematical Modeling. Ann Biomed Eng 2022; 50:1798-1809. [PMID: 35732853 PMCID: PMC9794544 DOI: 10.1007/s10439-022-02992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/09/2022] [Indexed: 12/31/2022]
Abstract
Collagen is a ubiquitous protein present in regenerating bone tissues that experiences multiple biological phenomena during distraction osteogenesis until the deposition of phosphate crystals. This work combines fluorescence techniques and mathematical modeling to shed light on the mechano-structural processes behind the maturation and accommodation-to-mineralization of the callus tissue. Ovine metatarsal bone calluses were analyzed through confocal images at different stages of the early distraction osteogenesis process, quantifying the fiber orientation distribution and mean intensity as fiber density measure. Likewise, a mathematical model based on the experimental data was defined to micromechanically characterize the apparent stiffening of the tissue within the distracted callus. A reorganization of the fibers around the distraction axis and increased fiber density were found as the bone fragments were gradually separated. Given the degree of significance between the mathematical model and previous in vivo data, reorganization, densification, and bundle maturation phenomena seem to explain the apparent mechanical maturation observed in the tissue theoretically.
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Affiliation(s)
- Pablo Blázquez-Carmona
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Avenida Camino de los Descubrimientos s/n, 41092 Seville, Spain
| | - José A. Sanz-Herrera
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Avenida Camino de los Descubrimientos s/n, 41092 Seville, Spain
| | - Juan Mora-Macías
- Escuela Técnica Superior de Ingeniería, Universidad de Huelva, 21007 Huelva, Spain
| | - Juan Morgaz
- Hospital Clínico Veterinario, Universidad de Córdoba, Ctra. Nacional IV-A, Km 396, 14014 Córdoba, Spain
| | - Jaime Domínguez
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Avenida Camino de los Descubrimientos s/n, 41092 Seville, Spain
| | - Esther Reina-Romo
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Avenida Camino de los Descubrimientos s/n, 41092 Seville, Spain
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Fu R, Feng Y, Bertrand D, Du T, Liu Y, Willie BM, Yang H. Enhancing the Efficiency of Distraction Osteogenesis through Rate-Varying Distraction: A Computational Study. Int J Mol Sci 2021; 22:ijms222111734. [PMID: 34769163 PMCID: PMC8583714 DOI: 10.3390/ijms222111734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
Distraction osteogenesis (DO) is a mechanobiological process of producing new bone and overlying soft tissues through the gradual and controlled distraction of surgically separated bone segments. The process of bone regeneration during DO is largely affected by distraction parameters. In the present study, a distraction strategy with varying distraction rates (i.e., "rate-varying distraction") is proposed, with the aim of shortening the distraction time and improving the efficiency of DO. We hypothesized that faster and better healing can be achieved with rate-varying distractions, as compared with constant-rate distractions. A computational model incorporating the viscoelastic behaviors of the callus tissues and the mechano-regulatory tissue differentiation laws was developed and validated to predict the bone regeneration process during DO. The effect of rate-varying distraction on the healing outcomes (bony bridging time and bone formation) was examined. Compared to the constant low-rate distraction, a low-to-high rate-varying distraction provided a favorable mechanical environment for angiogenesis and bone tissue differentiation, throughout the distraction and consolidation phase, leading to an improved healing outcome with a shortened healing time. These results suggest that a rate-varying clinical strategy could reduce the overall treatment time of DO and decrease the risk of complications related to the external fixator.
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Affiliation(s)
- Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China; (R.F.); (Y.F.); (T.D.); (Y.L.)
| | - Yili Feng
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China; (R.F.); (Y.F.); (T.D.); (Y.L.)
| | - David Bertrand
- Department of Pediatric Surgery, McGill University, Montreal, QC H4A 3J1, Canada; (D.B.); (B.M.W.)
- Research Centre, Shriners Hospital for Children-Canada, Montreal, QC H4A 0A9, Canada
| | - Tianming Du
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China; (R.F.); (Y.F.); (T.D.); (Y.L.)
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China; (R.F.); (Y.F.); (T.D.); (Y.L.)
| | - Bettina M. Willie
- Department of Pediatric Surgery, McGill University, Montreal, QC H4A 3J1, Canada; (D.B.); (B.M.W.)
- Research Centre, Shriners Hospital for Children-Canada, Montreal, QC H4A 0A9, Canada
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China; (R.F.); (Y.F.); (T.D.); (Y.L.)
- Correspondence: ; Tel.: +86-(010)-6739-6657
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Niño-Sandoval TC, Rodrigues EDR, Vasconcelos BC. Latency phase in mandibular distraction osteogenesis: a systematic review in animal models. Br J Oral Maxillofac Surg 2021; 59:993-1004. [PMID: 34531073 DOI: 10.1016/j.bjoms.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/10/2020] [Indexed: 12/09/2022]
Abstract
The aim of the present study was to perform a systematic review of the need for the latency period in distraction osteogenesis to obtain adequate bone formation. Searches were performed in the Web of Science, Pubmed/MEDLINE, Scopus, and Cochrane electronic databases. Nine articles were selected for qualitative analysis. Quality assessment was performed using the 10-item SYRCLE tool. Clinical stability was evaluated in two articles, histology was analysed in seven, histomorphometry was analysed in three, and mechanical testing was used in two. The results favoured the five-day latency group in two studies and the seven-day latency group in one. No differences were found between latency and no-latency groups in six studies. A latency period greater than seven days did not provide any additional benefit. Important risks of bias were found in all articles. Some of the results were influenced by uncontrolled intervening factors, such as consolidation time. The need for a latency period for distraction osteogenesis in animal models is not yet clear. Caution must be exercised when extrapolating the results of animal protocols to applications with humans in the clinical setting.
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Affiliation(s)
- T C Niño-Sandoval
- Department of Oral and Maxillofacial Surgery and Traumatology, University of Pernambuco - School of Dentistry (UPE/FOP), University Hospital Oswaldo Cruz, Rua Arnóbio Marquês, 310 - Santo Amaro, Recife, PE, CEP: 50.100-130, Brazil.
| | - E D R Rodrigues
- Department of Oral and Maxillofacial Surgery and Traumatology, University of Pernambuco - School of Dentistry (UPE/FOP), University Hospital Oswaldo Cruz, Rua Arnóbio Marquês, 310 - Santo Amaro, Recife, PE, CEP: 50.100-130, Brazil.
| | - B C Vasconcelos
- Department of Oral and Maxillofacial Surgery and Traumatology, University of Pernambuco - School of Dentistry (UPE/FOP), University Hospital Oswaldo Cruz, Rua Arnóbio Marquês, 310 - Santo Amaro, Recife, PE, CEP: 50.100-130, Brazil.
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Ma Y, Yin Q, Wu Y, Wang Z, Sun Z, Gu S, Rui Y, Han X. Retraction of transporting bone segment during Ilizarov bone transport. BMC Musculoskelet Disord 2020; 21:704. [PMID: 33106160 PMCID: PMC7590790 DOI: 10.1186/s12891-020-03702-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retraction of transporting bone segment (TBS) may occur when the fixator of the TBS is removed prior to full consolidation of the distracted callus, which has adverse effect on the healing of the docking site. However, there are few reports on the retraction of TBS. The purpose of this study is to analyze the causes and risk factors of the retraction of TBS. METHODS The clinical data of 37 cases with tibial bone defect treated by Ilizarov bone transport were analyzed retrospectively, in whom the TBS fixator was removed prior to full consolidation of the distracted callus and union of the docking site. Bivariate correlation was used to analyze relationship between the retraction distance of TBS and potential risk factors including age, gender, course, length of bone defect, number of operations, size of TBS, transport distance, timing and time interval of removal of TBS fixator. Risk factors with significant level were further identified using multivariate linear regression. RESULTS Bivariate correlation showed that the timing of removal was negatively correlated with the retraction distance, and the time interval and transport distance were positively correlated with the retraction distance(p < 0.05), the age, gender, course, length of bone defect, size of TBS and number of operations were not correlated with the retraction distance(p > 0.05). Multivariate linear regression of the 3 risk factors showed that the timing of removal and time interval were the main risk factors affecting the retraction distance (p < 0.05), but the transport distance was not (p > 0.05). CONCLUSION The traction forces of TBS endured from the soft tissues and the unconsolidated distracted callus have elastic properties, which can make retraction of TBS. The timing of removal and time interval are the main risk factors of the retraction of TBS. In the case of early removal, another external fixation or quickly converted to internal fixation should be performed to avoid the adverse effect of more retraction.
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Affiliation(s)
- Yunhong Ma
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Qudong Yin
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Yongwei Wu
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Zongnan Wang
- Department of Orthopaedics, Shuyang People's Hospital, Suqian, 223000, Jiangsu, China
| | - Zhenzhong Sun
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Sanjun Gu
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Yongjun Rui
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Xiaofei Han
- Department of Orthopaedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China.
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Blázquez-Carmona P, Mora-Macías J, Sanz-Herrera JA, Morgaz J, Navarrete-Calvo R, Domínguez J, Reina-Romo E. Mechanical Influence of Surrounding Soft Tissue on Bone Regeneration Processes: A Bone Lengthening Study. Ann Biomed Eng 2020; 49:642-652. [PMID: 32808118 DOI: 10.1007/s10439-020-02592-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Bone lengthening is a bone regeneration technique with multiple clinical applications. One of the most common complications of this treatment is the lack of adaptation of the surrounding soft tissue to their extension. A better understanding of the mechanobiology of the tissues involved in distraction osteogenesis would allow better control of the clinical cases. Bone lengthening treatments were performed in vivo in the metatarsus of Merino sheep, measuring the distraction forces by means of an instrumented fixator. The tissue relaxation after distraction was analyzed in this study. A viscoelastic model was also applied to distraction data to assess the mechanical behavior of the tissues during the distraction phase. Tissue relaxation is similar to other bone regeneration processes which do not imply surrounding soft tissue extension, e.g. bone transport. The effects of this tissue on distraction forces are limited to the first minutes of distraction and elongations above 4% of the original length with the protocol applied. Moreover, the surrounding soft tissue initially loses some of its viscoelasticity and subsequently suffers strain hardening from day 5 of distraction until the end of the distraction phase, day 15. Finally, anatomical changes were also evidenced in the elongated limb of our specimens.
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Affiliation(s)
- Pablo Blázquez-Carmona
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Avenida Camino de los Descubrimientos s/n, 41092, Seville, Spain.
| | - Juan Mora-Macías
- Escuela Técnica Superior de Ingeniería, Universidad de Huelva, 21007, Huelva, Spain
| | - José Antonio Sanz-Herrera
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Avenida Camino de los Descubrimientos s/n, 41092, Seville, Spain
| | - Juan Morgaz
- Departamento Medicina y Cirugía Animal, Campus Universitario de Rabanales, Ctra. Nacional IV-A, Km 396, 14014, Córdoba, Spain
| | - Rocío Navarrete-Calvo
- Departamento Medicina y Cirugía Animal, Campus Universitario de Rabanales, Ctra. Nacional IV-A, Km 396, 14014, Córdoba, Spain
| | - Jaime Domínguez
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Avenida Camino de los Descubrimientos s/n, 41092, Seville, Spain
| | - Esther Reina-Romo
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Avenida Camino de los Descubrimientos s/n, 41092, Seville, Spain
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10
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Blázquez-Carmona P, Sanchez-Raya M, Mora-Macías J, Gómez-Galán JA, Domínguez J, Reina-Romo E. Real-Time Wireless Platform for In Vivo Monitoring of Bone Regeneration. SENSORS 2020; 20:s20164591. [PMID: 32824259 PMCID: PMC7472372 DOI: 10.3390/s20164591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 01/08/2023]
Abstract
For the monitoring of bone regeneration processes, the instrumentation of the fixation is an increasingly common technique to indirectly measure the evolution of bone formation instead of ex vivo measurements or traditional in vivo techniques, such as X-ray or visual review. A versatile instrumented external fixator capable of adapting to multiple bone regeneration processes was designed, as well as a wireless acquisition system for the data collection. The design and implementation of the overall architecture of such a system is described in this work, including the hardware, firmware, and mechanical components. The measurements are conditioned and subsequently sent to a PC via wireless communication to be in vivo displayed and analyzed using a developed real-time monitoring application. Moreover, a model for the in vivo estimation of the bone callus stiffness from collected data was defined. This model was validated in vitro using elastic springs, reporting promising results with respect to previous equipment, with average errors and uncertainties below 6.7% and 14.04%. The devices were also validated in vivo performing a bone lengthening treatment on a sheep metatarsus. The resulting system allowed the in vivo mechanical characterization of the bone callus during experimentation, providing a low-cost, simple, and highly reliable solution.
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Affiliation(s)
- Pablo Blázquez-Carmona
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, 41092 Seville, Spain; (J.D.); (E.R.-R.)
- Correspondence: ; Tel.: +34-601-174-347
| | - Manuel Sanchez-Raya
- Escuela Técnica Superior de Ingeniería, Universidad de Huelva, 21007 Huelva, Spain; (M.S.-R.); (J.M.-M.); (J.A.G.-G.)
| | - Juan Mora-Macías
- Escuela Técnica Superior de Ingeniería, Universidad de Huelva, 21007 Huelva, Spain; (M.S.-R.); (J.M.-M.); (J.A.G.-G.)
| | - Juan Antonio Gómez-Galán
- Escuela Técnica Superior de Ingeniería, Universidad de Huelva, 21007 Huelva, Spain; (M.S.-R.); (J.M.-M.); (J.A.G.-G.)
| | - Jaime Domínguez
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, 41092 Seville, Spain; (J.D.); (E.R.-R.)
| | - Esther Reina-Romo
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, 41092 Seville, Spain; (J.D.); (E.R.-R.)
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Becker K, Schwarz F, Rauch NJ, Khalaph S, Mihatovic I, Drescher D. Can implants move in bone? A longitudinal in vivo micro-CT analysis of implants under constant forces in rat vertebrae. Clin Oral Implants Res 2019; 30:1179-1189. [PMID: 31494964 DOI: 10.1111/clr.13531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/24/2019] [Accepted: 08/22/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Whereas stationary stability of implants has been postulated for decades, recent studies suggested a phenomenon termed implant migration. This describes a change in position of implants as a reaction to applied forces. The present study aims at employing image registration of in vivo micro-CT scans from different time points and to assess (a) if migration of continuously loaded implants is possible and (b) migration correlates with the force magnitude. MATERIAL AND METHODS Two customized machined implants were placed in the dorsal portion of caudal vertebrae in n = 61 rats and exposed to standardized forces (0.5 N, 1.0 N, and 1.5 N) applied through a flat nickel-titanium contraction spring, or no forces (control). Micro-CT scans were performed at 0, 1, 2, 4, 6, and 8 weeks after surgery. The baseline image was registered with the forthcoming scans. Implant migration was measured as the Euclidean distance between implant tips. Bone remodeling was assessed between the baseline and the forthcoming scans. RESULTS The findings confirmed a positional change of the implants at 2 and 8 weeks of healing, and a linear association between applied force and velocity of movement (anterior implant: χ2 = 12.12, df = 3, and p = .007 and posterior implant: χ2 = 20.35, df = 3, and p < .001). Bone apposition was observed around the implants and accompanied by formation of load-bearing trabeculae and a general cortical thickening close and also distant to the implants. CONCLUSION The present analysis confirmed that implants can migrate in bone. The applied forces seemed to stimulate bone thickening, which could explain why implants migrate without affecting stability.
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Affiliation(s)
- Kathrin Becker
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.,Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | - Nicole Jasmin Rauch
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Silava Khalaph
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ilja Mihatovic
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Dieter Drescher
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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