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Szabo E, Bensusan J, Akkus O, Rimnac C. Immature porcine cortical bone mechanical properties and composition change with maturation and displacement rate. J Mech Behav Biomed Mater 2024; 153:106487. [PMID: 38490048 DOI: 10.1016/j.jmbbm.2024.106487] [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: 11/22/2023] [Revised: 02/11/2024] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
Computational models of mature bone have been used to predict fracture; however, analogous study of immature diaphyseal fracture has not been conducted due to sparse experimental mechanical data. A model of immature bone fracture may be used to aid in the differentiation of accidental and non-accidental trauma fractures in young, newly ambulatory children (0-3 years). The objective of this study was to characterize the evolution of tissue-level mechanical behavior, composition, and microstructure of maturing cortical porcine bone with uniaxial tension, Raman spectroscopy, and light microscopy as a function of maturation. We asked: 1) How do the monotonic uniaxial tensile properties change with maturation and displacement rate; 2) How does the composition and microstructure change with maturation; and 3) Is there a correlation between composition and tensile properties with maturation? Elastic modulus (p < 0.001), fracture stress (p < 0.001), and energy absorption (p < 0.014) increased as a function of maturation at the quasistatic rate by 110%, 86%, and 96%, respectively. Fracture stress also increased by 90% with maturation at the faster rate (p = 0.001). Fracture stress increased as a function of increasing displacement rate by 28% (newborn p = 0.048; 1-month p = 0.004; 3-month p= < 0.001), and fracture strain decreased by 68% with increasing displacement rate (newborn p = 0.002; 1-month p = 0.036; 3-month p < 0.001). Carbonate-to-phosphate ratio was positively linearly related to elastic modulus, and fracture stress was positively related to carbonate-to-phosphate ratio and matrix maturation ratio. The results of this study support that immature bone is strain-rate dependent and becomes more brittle at faster rates, contributing to the foundation upon which a computational model can be built to evaluate immature bone fracture.
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Affiliation(s)
- Emily Szabo
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH 44106, USA.
| | - Jay Bensusan
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH 44106, USA
| | - Ozan Akkus
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH 44106, USA
| | - Clare Rimnac
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 2123 Martin Luther King Jr Dr, Cleveland, OH 44106, USA
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Wang J, Liu M, Yang C, Pan Y, Ji S, Han N, Sun G. Biomaterials for bone defect repair: Types, mechanisms and effects. Int J Artif Organs 2024; 47:75-84. [PMID: 38166512 DOI: 10.1177/03913988231218884] [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] [Indexed: 01/04/2024]
Abstract
Bone defects or bone discontinuities caused by trauma, infection, tumours and other diseases have led to an increasing demand for bone grafts and biomaterials. Autologous bone grafts, bone grafts with vascular tips, anastomosed vascular bone grafts and autologous bone marrow components are all commonly used in clinical practice, while oversized bone defects require the use of bone tissue engineering-related biomaterials to repair bone defects and promote bone regeneration. Currently, inorganic components such as polysaccharides and bioceramics, as well as a variety of bioactive proteins, metal ions and stem cells can be loaded into hydrogels or 3D printed scaffold materials to achieve better therapeutic results. In this review, we provide an overview of the types of materials, applications, potential mechanisms and current developments in the repair of bone defects.
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Affiliation(s)
- Jiaming Wang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mingchong Liu
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chensong Yang
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yutao Pan
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengchao Ji
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ning Han
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Guixin Sun
- Department of Traumatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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3
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Kovács K, Váncsa S, Agócs G, Harnos A, Hegyi P, Weninger V, Baross K, Kovács B, Soós G, Kocsis G. Anisotropy, Anatomical Region, and Additional Variables Influence Young's Modulus of Bone: A Systematic Review and Meta-Analysis. JBMR Plus 2023; 7:e10835. [PMID: 38130752 PMCID: PMC10731124 DOI: 10.1002/jbm4.10835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/09/2023] [Accepted: 09/25/2023] [Indexed: 12/23/2023] Open
Abstract
The importance of finite element analysis (FEA) is growing in orthopedic research, especially in implant design. However, Young's modulus (E) values, one of the most fundamental parameters, can range across a wide scale. Therefore, our study aimed to identify factors influencing E values in human bone specimens. We report our systematic review and meta-analysis based on the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. We conducted the analysis on November 21, 2021. We included studies investigating healthy human bone specimens and reported on E values regarding demographic data, specimen characteristics, and measurement specifics. In addition, we included study types reporting individual specimen measurements. From the acquired data, we created a cohort in which we performed an exploratory data analysis that included the explanatory variables selected by random forest and regression trees methods, and the comparison of groups using independent samples Welch's t test. A total of 756 entries were included from 48 articles. Eleven different bones of the human body were included in these articles. The range of E values is between 0.008 and 33.7 GPa. The E values were most heavily influenced by the cortical or cancellous type of bone tested. Measuring method (compression, tension, bending, and nanoindentation), the anatomical region within a bone, the position of the bone within the skeleton, and the bone specimen size had a decreasing impact on the E values. Bone anisotropy, specimen condition, patient age, and sex were selected as important variables considering the value of E. On the basis of our results, E values of a bone change with bone characteristics, measurement techniques, and demographic variables. Therefore, the evaluation of FEA should be performed after the standardization of in vitro measurement protocol. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Krisztián Kovács
- Department of OrthopaedicsSemmelweis UniversityBudapestHungary
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - Szilárd Váncsa
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
- Division of Pancreatic Diseases, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Gergely Agócs
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Department of Biophysics and Radiation BiologySemmelweis UniversityBudapestHungary
| | - Andrea Harnos
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Department of BiostatisticsUniversity of Veterinary MedicineBudapestHungary
| | - Péter Hegyi
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
- Division of Pancreatic Diseases, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Viktor Weninger
- Department of OrthopaedicsSemmelweis UniversityBudapestHungary
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - Katinka Baross
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - Bence Kovács
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - Gergely Soós
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - György Kocsis
- Department of OrthopaedicsSemmelweis UniversityBudapestHungary
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
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Cowgill L, Harrington L, MacKinnon M, Kurki HK. Gains in relative cortical area during growth and their relationship to nutrition, body size, and physical activity. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 182:177-193. [PMID: 37377180 DOI: 10.1002/ajpa.24805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/17/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES In studies of growth in the past, low percentage of cortical area (%CA) is commonly attributed to poor general health, due to factors including poor nutrition, low socioeconomic status, or other physiological stressors. What constitutes low relative cortical dimensions has not been established across a diverse range of human skeletal samples. This study examines %CA in a large immature skeletal sample to establish typical variation in humans with consideration of both body mass and subsistence strategy. MATERIALS AND METHODS Percentage of cortical area was calculated at the midshaft of the humerus, femur, and tibia in seven skeletal samples. Age at death was estimated from dental development, and body mass from bone dimensions. Patterns of %CA with age and log-transformed body mass were examined in the pooled sample and compared among samples using LOESS regression, Welch's ANOVA, and Kruskal-Wallis tests. RESULTS Across all samples, %CA displays a generally non-linear pattern, but variation in %CA with age was high, particularly in samples with lower levels of %CA. There was no relationship between %CA and age-adjusted body mass. DISCUSSION The lack of a relationship between %CA and body mass suggests that %CA should not be used as an indicator of mechanical loading. The variation present across samples implies that appositional bone growth is affected by physiological stress in varying ways. Without a deeper understanding of what is "typical" for long bone development, it is impossible to draw conclusions about individual or population level health.
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Affiliation(s)
- Libby Cowgill
- Department of Anthropology, University of Missouri, Columbia, Missouri, USA
| | - Lesley Harrington
- Department of Anthropology, University of Alberta, Edmonton, Alberta, Canada
| | - Marla MacKinnon
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - Helen K Kurki
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
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Kurz S, Gebhardt M, Grundmann F, Heyde CE, Steinke H. Approach to standardized material characterization of the human lumbopelvic system-Specification, preparation and storage. PLoS One 2023; 18:e0289482. [PMID: 37535581 PMCID: PMC10399898 DOI: 10.1371/journal.pone.0289482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
The complexity of the osseo-ligamentous lumbopelvic system has made it difficult to perform both, the overall preparation as well as specimen harvesting and material testing with a reasonable amount of time and personnel. The logistics of such studies present a hurdle for reproducibility. A structured procedure was developed and proved, which allows all necessary steps to be carried out reproducibly and in a reasonable time. This enables the extraction of 26 soft tissue, 33 trabecular and 32 cortical bone specimens from this anatomical region per cadaver. The integrity of the specimens remains maintained while keeping requirements within manageable limits. The practicability of the intended five-day specimen harvesting and testing procedure could be demonstrated on five test and two pre-test sequences. The intended minimization of physical, biological, and chemical external influences on specimens could be achieved. All protocols, instructions and models of preparation and storage devices are included in the supporting information. The high grade of applicability and reproducibility will lead to better comparability between different biomechanical investigations. This procedure proven on the human pelvis is transferable to other anatomical regions.
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Affiliation(s)
- Sascha Kurz
- ZESBO - Center for Research on Musculoskeletal Systems, Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Marc Gebhardt
- Institute of Experimental Mechanics, Faculty of Civil Engineering, Leipzig University of Applied Sciences, Leipzig, Germany
- Institute of Anatomy, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Fanny Grundmann
- Clinic of Trauma, Orthopedic and Septic Surgery, Hospital St. Georg gGmbH, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- ZESBO - Center for Research on Musculoskeletal Systems, Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Hanno Steinke
- Institute of Anatomy, Faculty of Medicine, Leipzig University, Leipzig, Germany
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Qiu J, Liao Z, Xiang H, Li H, Yuan D, Jiang C, Xie J, Qin M, Li K, Zhao H. Effects of different preservation on the mechanical properties of cortical bone under quasi-static and dynamic compression. Front Bioeng Biotechnol 2023; 11:1082254. [PMID: 36911185 PMCID: PMC9995777 DOI: 10.3389/fbioe.2023.1082254] [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: 10/28/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction: Mechanical properties of biological tissue are important for numerical simulations. Preservative treatments are necessary for disinfection and long-term storage when conducting biomechanical experimentation on materials. However, few studies have been focused on the effect of preservation on the mechanical properties of bone in a wide strain rate. The purpose of this study was to evaluate the influence of formalin and dehydration on the intrinsic mechanical properties of cortical bone from quasi-static to dynamic compression. Methods: Cube specimens were prepared from pig femur and divided into three groups (fresh, formalin, and dehydration). All samples underwent static and dynamic compression at a strain rate from 10-3 s-1 to 103 s-1. The ultimate stress, ultimate strain, elastic modulus, and strain-rate sensitivity exponent were calculated. A one-way ANOVA test was performed to determine if the preservation method showed significant differences in mechanical properties under at different strain rates. The morphology of the macroscopic and microscopic structure of bones was observed. Results: The results show that ultimate stress and ultimate strain increased as the strain rate increased, while the elastic modulus decreased. Formalin fixation and dehydration did not affect elastic modulus significantly whereas significantly increased the ultimate strain and ultimate stress. The strain-rate sensitivity exponent was the highest in the fresh group, followed by the formalin group and dehydration group. Different fracture mechanisms were observed on the fractured surface, with fresh and preserved bone tending to fracture along the oblique direction, and dried bone tending to fracture along the axial direction. Discussion: In conclusion, preservation with both formalin and dehydration showed an influence on mechanical properties. The influence of the preservation method on material properties should be fully considered in developing a numerical simulation model, especially for high strain rate simulation.
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Affiliation(s)
- Jinlong Qiu
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Zhikang Liao
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Hongyi Xiang
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Haocheng Li
- Department of Medical Engineering, General Hospital of Central Theater Command, Wuhan, China
| | - Danfeng Yuan
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Chengyue Jiang
- School of Vehicle Engineering, Chongqing University of Technology, Chongqing, China
| | - Jingru Xie
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Mingxin Qin
- College of Biomedical Engineering, Army Medical University, PLA, Chongqing, China
| | - Kui Li
- Daping Hospital of Army Medical University, PLA, Chongqing, China
| | - Hui Zhao
- Daping Hospital of Army Medical University, PLA, Chongqing, China
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Fan R, Liu J, Jia Z. Biomechanical evaluation of different strain judging criteria on the prediction precision of cortical bone fracture simulation under compression. Front Bioeng Biotechnol 2023; 11:1168783. [PMID: 37122861 PMCID: PMC10133557 DOI: 10.3389/fbioe.2023.1168783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction: The principal strain or equivalent strain is mainly used in current numerical studies to determine the mechanical state of the element in the cortical bone finite element model and then perform fracture simulation. However, it is unclear which strain is more suitable for judging the element mechanical state under different loading conditions due to the lack of a general strain judging criterion for simulating the cortical bone fracture. Methods: This study aims to explore a suitable strain judging criterion to perform compressive fracture simulation on the rat femoral cortical bone based on continuum damage mechanics. The mechanical state of the element in the cortical bone finite element model was primarily assessed using the principal strain and equivalent strain separately to carry out fracture simulation. The prediction accuracy was then evaluated by comparing the simulated findings with different strain judging criteria to the corresponding experimental data. Results: The results showed that the fracture parameters predicted using the principal strain were closer to the experimental values than those predicted using the equivalent strain. Discussion: Therefore, the fracture simulation under compression was more accurate when the principal strain was applied to control the damage and failure state in the element. This finding has the potential to improve prediction accuracy in the cortical bone fracture simulation.
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Affiliation(s)
- Ruoxun Fan
- Department of Traffic Engineering, Yangzhou Polytechnic Institute, Yangzhou, China
- *Correspondence: Ruoxun Fan,
| | - Jie Liu
- Department of Aerospace Engineering, Jilin Institute of Chemical Technology, Jilin, China
| | - Zhengbin Jia
- Department of Mechanical and Aerospace Engineering, Jilin University, Changchun, China
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Naghavi SA, Tamaddon M, Marghoub A, Wang K, Babamiri BB, Hazeli K, Xu W, Lu X, Sun C, Wang L, Moazen M, Wang L, Li D, Liu C. Mechanical Characterisation and Numerical Modelling of TPMS-Based Gyroid and Diamond Ti6Al4V Scaffolds for Bone Implants: An Integrated Approach for Translational Consideration. Bioengineering (Basel) 2022; 9:504. [PMID: 36290472 PMCID: PMC9598079 DOI: 10.3390/bioengineering9100504] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 07/25/2023] Open
Abstract
Additive manufacturing has been used to develop a variety of scaffold designs for clinical and industrial applications. Mechanical properties (i.e., compression, tension, bending, and torsion response) of these scaffolds are significantly important for load-bearing orthopaedic implants. In this study, we designed and additively manufactured porous metallic biomaterials based on two different types of triply periodic minimal surface structures (i.e., gyroid and diamond) that mimic the mechanical properties of bone, such as porosity, stiffness, and strength. Physical and mechanical properties, including compressive, tensile, bending, and torsional stiffness and strength of the developed scaffolds, were then characterised experimentally and numerically using finite element method. Sheet thickness was constant at 300 μm, and the unit cell size was varied to generate different pore sizes and porosities. Gyroid scaffolds had a pore size in the range of 600-1200 μm and a porosity in the range of 54-72%, respectively. Corresponding values for the diamond were 900-1500 μm and 56-70%. Both structure types were validated experimentally, and a wide range of mechanical properties (including stiffness and yield strength) were predicted using the finite element method. The stiffness and strength of both structures are comparable to that of cortical bone, hence reducing the risks of scaffold failure. The results demonstrate that the developed scaffolds mimic the physical and mechanical properties of cortical bone and can be suitable for bone replacement and orthopaedic implants. However, an optimal design should be chosen based on specific performance requirements.
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Affiliation(s)
- Seyed Ataollah Naghavi
- Institute of Orthopaedic & Musculoskeletal, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, London HA7 4LP, UK
| | - Maryam Tamaddon
- Institute of Orthopaedic & Musculoskeletal, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, London HA7 4LP, UK
| | - Arsalan Marghoub
- Department of Mechanical Engineering, University College London, London WC1E 7JE, UK
| | - Katherine Wang
- Department of Mechanical Engineering, University College London, London WC1E 7JE, UK
| | - Behzad Bahrami Babamiri
- Aerospace and Mechanical Engineering Department, The University of Arizona, Tucson, AZ 85721, USA
| | - Kavan Hazeli
- Aerospace and Mechanical Engineering Department, The University of Arizona, Tucson, AZ 85721, USA
| | - Wei Xu
- Institute of Orthopaedic & Musculoskeletal, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, London HA7 4LP, UK
- National Engineering Research Center for Advanced Rolling and Intelligent Manufacturing, Institute of Engineering Technology, University of Science and Technology Beijing, Beijing 100083, China
| | - Xin Lu
- National Engineering Research Center for Advanced Rolling and Intelligent Manufacturing, Institute of Engineering Technology, University of Science and Technology Beijing, Beijing 100083, China
| | - Changning Sun
- Institute of Orthopaedic & Musculoskeletal, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, London HA7 4LP, UK
- State Key Laboratory for Manufacturing Systems Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an 710049, China
- National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi’an Jiaotong University, Xi’an 710054, China
| | - Liqing Wang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, London WC1E 7JE, UK
| | - Ling Wang
- State Key Laboratory for Manufacturing Systems Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an 710049, China
- National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi’an Jiaotong University, Xi’an 710054, China
| | - Dichen Li
- State Key Laboratory for Manufacturing Systems Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an 710049, China
- National Medical Products Administration (NMPA) Key Laboratory for Research and Evaluation of Additive Manufacturing Medical Devices, Xi’an Jiaotong University, Xi’an 710054, China
| | - Chaozong Liu
- Institute of Orthopaedic & Musculoskeletal, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital, Stanmore, London HA7 4LP, UK
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Pei B, Lu D, Wu X, Xu Y, Ma C, Wu S. Kinematic and biomechanical responses of the spine to distraction surgery in children with early onset scoliosis: A 3-D finite element analysis. Front Bioeng Biotechnol 2022; 10:933341. [PMID: 35910017 PMCID: PMC9336159 DOI: 10.3389/fbioe.2022.933341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Periodical and consecutive distraction is an effective treatment for severe early onset scoliosis (EOS), which enables the spinal coronal and sagittal plane deformity correction. However, the rate of rod fractures and postoperative complications was still high mainly related to the distraction process. Previous studies have primarily investigated the maximum safe distraction force without a rod broken, neglecting the spinal re-imbalance and distraction energy consumption, which is equally vital to evaluate the operative value. This study aimed to reveal the kinematic and biomechanical responses occurring after spinal distraction surgery, which were affected by traditional bilateral fixation. The spinal models (C6-S1) before four distractions were reconstructed based on CT images and the growing rods were applied with the upward displacement load of 0–25 mm at an interval of 5 mm. Relationships between the distraction distance, the distraction force and the thoracic and lumbar Cobb angle were revealed, and the spinal displacement and rotation in three-dimensional directions were measured. The spinal overall imbalance would also happen during the distraction process even under the safe force, which was characterized by unexpected cervical lordosis and lateral displacement. Additionally, the law of diminishing return has been confirmed by comparing the distraction energy consumption in different distraction distances, which suggests that more attention paid to the spinal kinematic and biomechanical changes is better than to the distraction force. Notably, the selection of fixed segments significantly impacts the distraction force at the same distraction distance. Accordingly, some results could provide a better understanding of spinal distraction surgery.
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Affiliation(s)
- Baoqing Pei
- Beijing key laboratory for design and evaluation technology of advanced implantable and interventional medical devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Da Lu
- Beijing key laboratory for design and evaluation technology of advanced implantable and interventional medical devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xueqing Wu
- Beijing key laboratory for design and evaluation technology of advanced implantable and interventional medical devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- *Correspondence: Xueqing Wu, ; Shuqin Wu,
| | - Yangyang Xu
- Beijing key laboratory for design and evaluation technology of advanced implantable and interventional medical devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Chenghao Ma
- Beijing key laboratory for design and evaluation technology of advanced implantable and interventional medical devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shuqin Wu
- School of Big Data and Information, Shanxi College of Technology, Shanxi, China
- *Correspondence: Xueqing Wu, ; Shuqin Wu,
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10
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Pei B, Lu D, Wu X, Xu Y, Ma C, Wu S. Effects of Growing Rod Technique with Different Surgical Modes and Growth Phases on the Treatment Outcome of Early Onset Scoliosis: A 3-D Finite Element Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042057. [PMID: 35206246 PMCID: PMC8872610 DOI: 10.3390/ijerph19042057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022]
Abstract
Early onset scoliosis (EOS) is emerging as a serious threat to children’s health and is the third largest threat to their health after myopia and obesity. At present, the growing rod technique (GRT), which allows patients to regain a well-balanced sagittal profile, is commonly considered as an invasive surgical procedure for the treatment of EOS. However, the risk of postoperative complications and instrumentation breakage remains high, which is mainly related to the choice of fixed mode. Several authors have studied primary stability and instrumentation loads, neglecting the mechanical transmission of the spinal long-segment model in different growth phases, which is fundamental to building a complete biomechanical environment. The present study aimed to investigate the kinematic and biomechanical properties that occur after GRT, across the long spinal structure and the posterior instrumentation, which are affected by unilateral or bilateral fixation. Accordingly, spinal segments (C6-S1) were loaded under flexion (Flex), extension (Ext), left lateral bending (LB), right lateral bending (RB), left torsion (LT), and right torsion (RT) using 11 established spinal models, which were from three growth phases. The stress distribution, spinal and intervertebral range of motion (ROM), counter torque of the vertebra, and bracing force on the rods were measured. The results showed that bilateral posterior fixation (BPF) is more stable than unilateral posterior fixation (UPF), at the expense of more compensations for the superior adjacent segment (SAS), especially when the superior fixed segment is closer to the head. Additionally, the bracing force of the instrumentation on the spine increases as the Cobb angle decreases. Accordingly, this biomechanical analysis provides theoretical suggestions for the selection of BPF or UPF and fixed segments in different growing phases.
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Affiliation(s)
- Baoqing Pei
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China; (B.P.); (D.L.); (Y.X.); (C.M.)
| | - Da Lu
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China; (B.P.); (D.L.); (Y.X.); (C.M.)
| | - Xueqing Wu
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China; (B.P.); (D.L.); (Y.X.); (C.M.)
- Correspondence: (X.W.); (S.W.)
| | - Yangyang Xu
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China; (B.P.); (D.L.); (Y.X.); (C.M.)
| | - Chenghao Ma
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable & Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China; (B.P.); (D.L.); (Y.X.); (C.M.)
| | - Shuqin Wu
- School of Big Data and Information, Shanxi College of Technology, Shuozhou 036000, China
- Correspondence: (X.W.); (S.W.)
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