1
|
Bagheri MA, Aubin CE, Nault ML, Villemure I. Finite element analysis of distraction osteogenesis with a new extramedullary internal distractor. Comput Methods Biomech Biomed Engin 2024:1-15. [PMID: 39340287 DOI: 10.1080/10255842.2024.2406367] [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: 06/12/2024] [Revised: 08/19/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024]
Abstract
Distraction osteogenesis (DO) is a bone regenerative maneuver, which is conventionally done with external fixators and, more recently, with telescopic intramedullary nails. Despite the proven effectiveness, external approaches are intrusive to the patient's life while intramedullary nailing damages the growth plates, making them unsuitable for pediatric patients. An internal DO plate fixator (IDOPF) was developed for pediatric patients to address these limitations. The objective of this study was to test the hypothesis that the IDOPF can withstand a partial weight bearing scenario and create a favorable mechanical microenvironment at the osteotomy gap for bone regeneration as the device elongates. A finite element model of a surrogated long bone diaphysis osteotomy fixation by means of the IDOPF was created and subjected to axial compression, bending and torsion. As the osteotomy gap increased from 2 mm to 20 mm, under compression, The average axial interfragmentary strains decreased from 2.33% to 0.35%. Stress increased from 179 MPa to 281 MPa at the contact interfaces of the telescopic compartments, which exceeded the endurance limit of stainless steel (270 MPa) but was below its yield limit (415 MPa). These results demonstrate, that the IDOPF can withstand a partial load bearing scenario and provide a stable biomechanical environment conductive to bone healing. However, high contact stresses at the telescopic interfaces of the device are likely to cause wear, as is frequently reported in telescopic fixators. This study is a step towards refining the IDOPF design for clinical use.
Collapse
Affiliation(s)
- Mohammad Ali Bagheri
- Polytechnique Montréal, Institut de génie biomédical, Montréal, QC, Canada
- CHU Sainte-Justine, Montréal, QC, Canada
| | - Carl-Eric Aubin
- Polytechnique Montréal, Institut de génie biomédical, Montréal, QC, Canada
- CHU Sainte-Justine, Montréal, QC, Canada
- Université de Montréal, Montréal, QC, Canada
| | - Marie-Lyne Nault
- CHU Sainte-Justine, Montréal, QC, Canada
- Université de Montréal, Montréal, QC, Canada
| | - Isabelle Villemure
- Polytechnique Montréal, Institut de génie biomédical, Montréal, QC, Canada
- CHU Sainte-Justine, Montréal, QC, Canada
| |
Collapse
|
2
|
Lee DH, Lee HJ, Cho JH, Hwang CJ, Yang JJ, Lee CS, Park S. Foraminal Restenosis After Posterior Cervical Foraminotomy for the Treatment of Cervical Radiculopathy. Global Spine J 2023; 13:2357-2366. [PMID: 35323054 PMCID: PMC10538319 DOI: 10.1177/21925682221083268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To elucidate incidence, risk factor, and clinical effect of bone regrowth after posterior cervical foraminotomy (PCF). METHODS Ninety-eight patients who underwent PCF for the treatment of cervical radiculopathy and were followed up for >2 years were retrospectively reviewed. Foraminal dimension, sagittal gap at resected area, facet thickness, lamina length, and cervical range of motion (ROM) were measured. Neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDI) were recorded. Radiographic measures were compared between segments with foraminal narrowing of ≥20% at the 2-years follow-up (restenosis segments) and foraminal narrowing of <20% (patent segments). RESULTS Sixty-nine patients with 109 segments were included. 73.4% (80/109) of foramens demonstrated foraminal narrowing and decrease of foraminal dimension of ≥20% occurred in 30.3% (30/109). Foraminal dimension at postoperative 2-days was significantly higher in the restenosis segments (P = .047). Furthermore, increase of foraminal dimension was significantly associated with foraminal restenosis of ≥20% (P = .018). Facet thickness was significantly higher in the restenosis segments compared to patent segments at postoperative 2-years follow-up (P = .038). Neck pain VAS was significantly aggravated only in the restenosis group at postoperative 2-years follow-up (P < .001). CONCLUSIONS Foraminal narrowing commonly occurs after PCF due to bone healing. Bone growth occurs in all directions while medial facet growth contributes more to foraminal restenosis. Greater widening of foramen during PCF is a risk factor for postoperative foramen restenosis. Therefore, amount of bone resection should be kept optimal and excessive resection should be avoided to prevent foramen restenosis.
Collapse
Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeong-Joo Lee
- Department of Orthopedic surgery, Busan Bumin Hospital, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Yang
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| |
Collapse
|
3
|
Castro-Núñez J, Sifuentes-Cervantes JS, Alemán BO, Rivera I, Bustillo J, Guerrero LM. Histologic features of bone regenerated by means of negative pressure in the context of odontogenic keratocyst. Oral Maxillofac Surg 2023; 27:421-426. [PMID: 35643989 DOI: 10.1007/s10006-022-01080-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The objective of the present research is to describe the histologic features of the bone regenerated by means of negative pressure (sugosteogenesis) in a group of patients diagnosed with odontogenic keratocyst (OKC) who underwent active decompression and distraction sugosteogenesis (ADDS) at our institution. MATERIALS AND METHODS The authors designed a retrospective case series study. The population included patients with a histologic diagnosis of odontogenic keratocyst in whom active decompression and distraction sugosteogenesis followed by enucleation was performed. All patients were seen and followed from July 2019 to January 2021. The investigation was approved by the Institutional Review Board, and it observed the Declaration of Helsinki on medical protocol. Variables of this study included age, gender, anatomic location (mandible or maxilla), and histologic characteristics of the bone regenerated by means of negative pressure. Histologic features were defined as being consistent or inconsistent with viable mature bone. RESULTS Bone biopsies of 6 patients were considered. In total, 83.33% of patients were males and 16.66% females. One hundred percent of the bone samples subjected to negative pressure showed features of viable mature bone. CONCLUSIONS In this study, the histological features of the bone subjected to negative pressure demonstrated the normal characteristics of the mature, normal bone.
Collapse
Affiliation(s)
- Jaime Castro-Núñez
- PGY 3Oral and Maxillofacial Surgery Residency ProgramSchool of Dental MedicineMedical Sciences Campus, University of Puerto Rico, Paseo Dr. José Celso Barbosa, San Juan, Puerto Rico, 00921.
| | - José S Sifuentes-Cervantes
- PGY 1, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Brayann O Alemán
- PGY 4, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Irelsy Rivera
- PGY 4, Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Jairo Bustillo
- Oral and Maxillofacial Pathology Department, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Lidia M Guerrero
- Oral and Maxillofacial Surgery Residency Program, School of Dental Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| |
Collapse
|
4
|
Chondromodulin is necessary for cartilage callus distraction in mice. PLoS One 2023; 18:e0280634. [PMID: 36795722 PMCID: PMC9934371 DOI: 10.1371/journal.pone.0280634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/05/2023] [Indexed: 02/17/2023] Open
Abstract
Chondromodulin (Cnmd) is a glycoprotein known to stimulate chondrocyte growth. We examined in this study the expression and functional role of Cnmd during distraction osteogenesis that is modulated by mechanical forces. The right tibiae of the mice were separated by osteotomy and subjected to slow progressive distraction using an external fixator. In situ hybridization and immunohistochemical analyses of the lengthened segment revealed that Cnmd mRNA and its protein in wild-type mice were localized in the cartilage callus, which was initially generated in the lag phase and was lengthened gradually during the distraction phase. In Cnmd null (Cnmd-/-) mice, less cartilage callus was observed, and the distraction gap was filled by fibrous tissues. Additionally, radiological and histological investigations demonstrated delayed bone consolidation and remodeling of the lengthened segment in Cnmd-/- mice. Eventually, Cnmd deficiency caused a one-week delay in the peak expression of VEGF, MMP2, and MMP9 genes and the subsequent angiogenesis and osteoclastogenesis. We conclude that Cnmd is necessary for cartilage callus distraction.
Collapse
|
5
|
Yan R, Wu Y, Qi Y, Li H, Dong S, Feng G. One‐Stage Closed Intramedullary Nailing for Delayed Femoral Fracture in Multiple Injured Patients. Orthop Surg 2022; 14:501-512. [PMID: 35098687 PMCID: PMC8926984 DOI: 10.1111/os.13206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 11/21/2021] [Accepted: 12/20/2021] [Indexed: 01/14/2023] Open
Abstract
Objective To tackle the challengeable dilemma of delayed femoral fracture, a technique of fixator‐assisted closed reduction and intramedullary nailing at one stage was introduced herein and its clinical results were investigated. Methods A retrospective study was conducted on delayed femoral shaft fracture between February 2008 and January 2017. The multiple injured patients aged from 18 to 60 years with delayed femoral fracture was included. All patients were treated by one‐stage internal fixation technique and followed up for more than 1 year. Outcome measures including the operation time, intraoperative blood loss and limb alignment, healing time of fracture, visual analog scale (VAS), and range of knee motion were recorded and evaluated. Results A total of 13 patients (16 sides) with a mean injury severity score (ISS) of 32.77 ± 9.98 (range, 19 to 52) participated in the investigation. The median length of time‐after‐fracture was 38 days (range, 21 to 110 days). The average shortening distance of the fracture ends was 35.48 ± 19.24 mm (range, 10.00 to 79.00 mm). The average surgery time was 192.19 ± 29.38 min for unilateral femoral fracture, with blood loss of 587.50 ± 232.02 ml. The postoperative discrepancy of lower limb was 3.87 ± 2.52 mm. No patient had vascular and neurologic complications due to the lengthening. All fractures healed successfully with a mean time of 2.98 ± 0.57 months. The mean VAS and maximal knee flexion were 1.63 ± 1.09 and 131.25° ± 5.32° at final follow‐up, respectively. Conclusions Our findings indicated that fixator‐assisted closed reduction and intramedullary nailing at one stage is an effective treatment for delayed femoral fracture with satisfactory functional recovery.
Collapse
Affiliation(s)
- Ruijian Yan
- Department of Orthopedic Surgery 2nd Affiliated Hospital, School of Medicine, Zhejiang University Zhejiang China
| | - Yifan Wu
- Department of surgery 2nd Affiliated Hospital, School of Medicine, Zhejiang University Zhejiang China
| | - Yiying Qi
- Department of Orthopedic Surgery 2nd Affiliated Hospital, School of Medicine, Zhejiang University Zhejiang China
| | - Hang Li
- Department of Orthopedic Surgery 2nd Affiliated Hospital, School of Medicine, Zhejiang University Zhejiang China
| | - Shurong Dong
- Institute of Microelectronics and Nanoelectronics Key Lab. of Advanced Micro/Nano Electronics Devices & Smart Systems of Zhejiang, College of Information Science & Electronic Engineering, Zhejiang University Hangzhou China
| | - Gang Feng
- Department of Orthopedic Surgery 2nd Affiliated Hospital, School of Medicine, Zhejiang University Zhejiang China
| |
Collapse
|
6
|
Yang S, Wang N, Ma Y, Guo S, Guo S, Sun H. Immunomodulatory effects and mechanisms of distraction osteogenesis. Int J Oral Sci 2022; 14:4. [PMID: 35067679 PMCID: PMC8784536 DOI: 10.1038/s41368-021-00156-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 11/11/2022] Open
Abstract
Distraction osteogenesis (DO) is widely used for bone tissue engineering technology. Immune regulations play important roles in the process of DO like other bone regeneration mechanisms. Compared with others, the immune regulation processes of DO have their distinct features. In this review, we summarized the immune-related events including changes in and effects of immune cells, immune-related cytokines, and signaling pathways at different periods in the process of DO. We aim to elucidated our understanding and unknowns about the immunomodulatory role of DO. The goal of this is to use the known knowledge to further modify existing methods of DO, and to develop novel DO strategies in our unknown areas through more detailed studies of the work we have done.
Collapse
|
7
|
Fu R, Feng Y, Liu Y, Yang H. Mechanical regulation of bone regeneration during distraction osteogenesis. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
8
|
Catelani F, Costa-Júnior JFS, de Andrade MC, Von Krüger MA, Pereira WCDA. Recycled windshield glass as new material for producing ultrasonic phantoms of cortical bone-healing stages. Biomed Phys Eng Express 2021; 7. [PMID: 34340223 DOI: 10.1088/2057-1976/ac19ce] [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: 04/02/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022]
Abstract
The quantitative ultrasound technique was used to evaluate bone-mimicking phantoms; however, these phantoms do not mimic the intermediate stages of cortical bone healing. We propose using windshield glass as an original material to produce phantoms that mimic the characteristics of three different stages of cortical bone healing. This material was processed via a route that included breaking, grinding, compacting, drying, and sintering in four temperature groups: 625 °C, 645 °C, 657 °C, and 663 °C. The parameters evaluated were the ultrasonic longitudinal phase velocity (cL), corrected (αc) ultrasonic attenuation coefficient, and bulk density (ρs). The results showed that the mean values ofcL,αc,andρsvaried from 2, 398 to 4, 406 m·s-1, 3 to 10 dB·cm-1, and 1, 563 to 2, 089 kg·m-3, respectively. The phantoms exhibited properties comparable with the three stages of cortical bone healing and can be employed in diagnostic and therapeutic studies using ultrasound.
Collapse
Affiliation(s)
- Fernanda Catelani
- Brazilian Navy, Rio de Janeiro, RJ, Brazil.,Raul Sertã Municipal Hospital, Nova Friburgo, RJ, Brazil.,Biomedical Engineering Program - COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - José Francisco Silva Costa-Júnior
- Biomedical Engineering Program - COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Brazilian Air Force Academy, Pirassununga, SP, Brazil
| | | | - Marco Antônio Von Krüger
- Biomedical Engineering Program - COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
9
|
Chen J, Hua J, Song W. Screen Key Genes Associated with Distraction-Induced Osteogenesis of Stem Cells Using Bioinformatics Methods. Int J Mol Sci 2021; 22:ijms22126505. [PMID: 34204414 PMCID: PMC8235684 DOI: 10.3390/ijms22126505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Applying mesenchymal stem cells (MSCs), together with the distraction osteogenesis (DO) process, displayed enhanced bone quality and shorter treatment periods. The DO guides the differentiation of MSCs by providing mechanical clues. However, the underlying key genes and pathways are largely unknown. The aim of this study was to screen and identify hub genes involved in distraction-induced osteogenesis of MSCs and potential molecular mechanisms. Material and Methods: The datasets were downloaded from the ArrayExpress database. Three samples of negative control and two samples subjected to 5% cyclic sinusoidal distraction at 0.25 Hz for 6 h were selected for screening differentially expressed genes (DEGs) and then analysed via bioinformatics methods. The Gene Ontology (GO) terms and Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway enrichment were investigated. The protein–protein interaction (PPI) network was visualised through the Cytoscape software. Gene set enrichment analysis (GSEA) was conducted to verify the enrichment of a self-defined osteogenic gene sets collection and identify osteogenic hub genes. Results: Three hub genes (IL6, MMP2, and EP300) that were highly associated with distraction-induced osteogenesis of MSCs were identified via the Venn diagram. These hub genes could provide a new understanding of distraction-induced osteogenic differentiation of MSCs and serve as potential gene targets for optimising DO via targeted therapies.
Collapse
Affiliation(s)
- Jishizhan Chen
- UCL Centre for Biomaterials in Surgical Reconstruction and Regeneration, Division of Surgery & Interventional Science, University College London, London NW3 2PF, UK;
| | - Jia Hua
- UCL Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Stanmore, London HA7 4AP, UK;
- The Griffin Institute (Northwick Park Institute for Medical Research), Harrow, London HA1 3UJ, UK
- Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK
| | - Wenhui Song
- UCL Centre for Biomaterials in Surgical Reconstruction and Regeneration, Division of Surgery & Interventional Science, University College London, London NW3 2PF, UK;
- Correspondence:
| |
Collapse
|
10
|
Iobst CA, Milne E, Khoury A, Ingwer Z, Latta L. A novel way to dynamize a spatial frame and optimize fracture healing. Injury 2021; 52:106-108. [PMID: 33039178 DOI: 10.1016/j.injury.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fracture site motion creates mechanical strains on the healing tissues which influences bone formation. Axial micro-motion maximizes dilatational strains, whereas shearing motions maximize deviatoric strains on the healing tissues. Dilatational strains optimize bone healing, deviatoric strains retard bone healing. Dynamization of external fixation using either an Ilizarov or Spatial Frame platform is used to increase loading on the limb which increases the mechanical stress and strain on the tissues to improve healing. The scientific literature does not address how dynamization of the spatial frame effects fracture site motion. The purpose of this study is to assess the effect of modified shoulder bolts incorporated into a spatial frame during dynamic loading. METHODS Five identical two-ring spatial frame constructed were mounted on Sawbones tibias with an osteotomy performed distal to the tibial tubercle. Sinusoidal load was applied at a rate of 0.25 Hz. Axial force and displacement, in addition to motion of the proximal and distal tibia segments were recorded. Eight constructs were tested: 1) All struts of the Spatial Frame rigid, 2) Strut #1 loose, 3) Struts #1 and #3 loose, 4) Struts #1, #3 and #5 loose, 5) All struts loose, 6) All struts rigid with dynamization bolts on the proximal end, 7) All struts rigid with dynamization bolts on alternating sides, 8) Threaded rods between the rings with two millimeters of dynamization. RESULTS No difference in vertical displacement was observed between the Ilizarov and all struts locked. No significant difference in shear values between all struts locked and modified shoulder bolt struts was observed. Increase in vertical movement with the modified shoulder bolts was an average of 1.83 mm. Significant shear forces at the fracture site were observed with unlocking single or multiple struts of the spatial frame. CONCLUSION Modified shoulder bolts can be used for spatial frame dynamization without increasing shear motion.
Collapse
Affiliation(s)
- Christopher A Iobst
- Nationwide Children's Hospital, 700 Children's Drive, Suite T2E-A2700, Columbus, OH, United States.
| | - Edward Milne
- Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, United States
| | - Anthony Khoury
- Department of Biomedical Engineering, University of Miami, College of Engineering, 1251 Memorial Drive, Coral Gables, FL 33146, United States; Arthrex, Inc., 1370 Creekside Blvd., Naples, Florida 34108 United States
| | - Zachary Ingwer
- Department of Biomedical Engineering, University of Miami, College of Engineering, 1251 Memorial Drive, Coral Gables, FL 33146, United States; Arthrex, Inc., 1370 Creekside Blvd., Naples, Florida 34108 United States
| | - Loren Latta
- Nationwide Children's Hospital, 700 Children's Drive, Suite T2E-A2700, Columbus, OH, United States; Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, United States
| |
Collapse
|
11
|
Abstract
PURPOSE Recently, the terms sugosteogenesis and distraction sugosteogenesis have been introduced to the scientific literature. While the former describes a biologic phenomenon, the latter refers to the clinical technique which relies on the accelerated normal bone healing process that takes place at the osseous walls surrounding a cystic cavity when active negative pressure is applied. The purpose of this study is to provide the biologic bases and the therapeutic principles of this emerging technique. Employing well-stablished biologic principles, clinical evidence from analogous techniques, emerging experimental data, and circumstantial evidence, this study presents the possible mechanism of action of the evacuator for odontogenic cysts (Evocyst), a closed, vacuum-like drain system intended to treat cystic conditions using negative pressure. METHODS A review of the literature was done. Keywords for the Medline search were: marsupialization, decompression, odontogenic cysts, effects of negative pressure on bone, and negative pressure wound therapy. In addition, relevant publications from the reference list of the retrieved studies were considered. The matches were evaluated for relevance and analyzed accordingly. Clinical reports used to illustrate the concept of distraction sugosteogenesis were performed following the Declaration of Helsinki on medical protocol and ethics. RESULTS Currently, the standard of care to manage odontogenic cystic lesions includes marsupialization, enucleation and curettage, decompression, and surgical resection. However, there is a need for an alternative option in which the entity could be treated while promoting bone formation. With large odontogenic cystic conditions treated in a short period of time, distraction sugosteogenesis appears to be a choice. CONCLUSION The application of negative pressure to osseous cells produces a stretching that creates mechanical cues that trigger signaling pathways, promotes fluid flow, and enhances angiogenesis. All of them, combined, may explain sugosteogenesis. The clinical application of such parameters may explain the good clinical results obtained with the Evocyst.
Collapse
|
12
|
Liu W, He HB, Zhang C, Liu YP, Wan J. Distraction-suppression effect on osteosarcoma. Med Hypotheses 2018; 121:4-5. [PMID: 30396485 DOI: 10.1016/j.mehy.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 08/27/2018] [Accepted: 09/05/2018] [Indexed: 12/28/2022]
Abstract
Osteosarcoma is the most common primary malignant bone tumor. It occurs mainly in children and adolescents. In patients with open growth plate, epiphyseal distraction is used to separate the uninvolved epiphysis from adjacent tumor. This helps preserve the growth potential and restore joint and limb function to a great extent. Interestingly, epiphyseal distraction also appears to inhibit the proliferation of osteosarcoma tumor cells and to increase sensitivity to chemotherapy. Tumor interstitial pressure (TIP) is often elevated in the microenvironment of most solid tumors, including osteosarcoma. Elevated TIP can promote the proliferation, invasion, and migration ability of osteosarcoma cells and also decrease the uptake and distribution of chemotherapeutic agents. Studies have confirmed that the sustained volumetric strain produced in distracted tissue decreases TIP; it stretches extracellular matrix, decreases interstitial density, and increases vessel diameter. We hypothesize that lowering of TIP during the period of epiphyseal distraction inhibits the proliferation and invasion of osteosarcoma cell and, at the same time, increases blood perfusion in the tumor and thus enhances uptake and distribution of chemotherapy agents. If the hypothesis is proved to be true, distraction of tumor segment could be a novel supplementary treatment for osteosarcoma by manipulation of TIP.
Collapse
Affiliation(s)
- Wei Liu
- Xiangya Nursing School, Central South University, Changsha, Hunan Province, PR China
| | - Hong-Bo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, PR China
| | - Can Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, PR China
| | - Yu-Peng Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, PR China
| | - Jun Wan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, PR China.
| |
Collapse
|
13
|
Abstract
Distraction osteogenesis is an effective method for generating large amounts of bone in situ for treating pathologies such as large bone defects or skeletal malformations, for instance leg-length discrepancies. While an optimized distraction procedure might have the potential to reduce the rate of complications significantly, our knowledge of the underlying mechanobiological processes is still insufficient for systematic optimization of treatment parameters such as distraction rate or fixation stiffness. We present a novel numerical model of lateral distraction osteogenesis, based on a mechanically well-controlled in vivo experiment. This model extends an existing numerical model of callus healing with viscoplastic material properties for describing stress relaxation and stimuli history-dependent tissue differentiation, incorporating delay and memory effects. A reformulation of appositional growth based non-local biological stimuli in terms of spatial convolution as well as remeshing and solution-mapping procedures allow the model to cope with severe mesh distortions associated with large plastic deformations. With these enhancements, our model is capable of replicating the in vivo observations for lateral distraction osteogenesis in sheep using the same differentiation rules and the same set of parameters that successfully describes callus healing in sheep, indicating that tissue differentiation hypotheses originally developed for fracture healing scenarios might indeed be applicable to distraction as well. The response of the model to modified distraction parameters corresponds to existing studies, although the currently available data is insufficient for rigorous validation. As such, this study provides a first step towards developing models that can serve as tools for identifying both interesting research questions and, eventually, even optimizing clinical procedures once better data for calibration and validation becomes available.
Collapse
|
14
|
Meyers N, Schülke J, Ignatius A, Claes L. Novel systems for the application of isolated tensile, compressive, and shearing stimulation of distraction callus tissue. PLoS One 2017; 12:e0189432. [PMID: 29228043 PMCID: PMC5724890 DOI: 10.1371/journal.pone.0189432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/25/2017] [Indexed: 12/02/2022] Open
Abstract
Background Distraction osteogenesis is a procedure widely used for the correction of large bone defects. However, a high complication rate persists, likely due to insufficient stability during maturation. Numerical fracture healing models predict bone regeneration under different mechanical conditions allowing fixation stiffness optimization. However, most models apply a linear elastic material law inappropriate for the transient stresses/strains present during limb lengthening or segment transport. They are also often validated using in vivo osteotomy models lacking precise mechanical regulation due to the unavoidable stimulation of secondary interfragmentary motion during ambulation under finitely stiff fixation. Therefore, in order to create a robust numerical model of distraction osteogenesis, it is necessary to both characterize the new tissue’s viscoelasticity during distraction and determine the influence of strictly isolated stimulation in each loading mode (tension, compression, and shear) to account for potential differences in mechanical and histological response. Aim Two electromechanical fixators with integrated load cells were designed to precisely perform and monitor in vivo lateral distraction and isolated stimulation in sheep tibiae using a mobile, hydroxyapatite-coated titanium plate. The novel surgical procedure circumvents osteotomy, eliminating the undesirable and unquantifiable mechanical stimulation during ambulation. Methods After a 10-day post-surgery latency period, two 0.275 mm distraction steps were performed daily for 10 days. The load cell collected data before, during, and after each distraction step and was terminated after no less than one minute from the time of distraction. A 7-day consolidation period separated the distraction phase and 18-day stimulation phase. Stimulation was carried out in isolated tension, compression, or shear while recording force/time data. Each stimulation session consisted of 120 cycles with a magnitude of either 0.1 mm or 0.6 mm in the tension and compression groups and 1.0 mm in the shear group. The animals were euthanized after a 3-day holding period following stimulation. Results Our initial results show that the tissue progressively stiffens and maintains an increasingly large residual traction. The force curves during compressive stimulation show a progressive drift from compression toward tension. We hypothesize that this behavior may be due to the preferential flow of fluid outward from the tissue and a greater resistance to reabsorption during the plate’s return to the starting position.
Collapse
Affiliation(s)
- Nicholaus Meyers
- Institute of Orthopedic Research and Biomechanics, Center of Musculoskeletal Research Ulm, University Hospital Ulm, Ulm, Baden-Württemberg, Germany
- * E-mail:
| | - Julian Schülke
- Institute of Orthopedic Research and Biomechanics, Center of Musculoskeletal Research Ulm, University Hospital Ulm, Ulm, Baden-Württemberg, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Center of Musculoskeletal Research Ulm, University Hospital Ulm, Ulm, Baden-Württemberg, Germany
| | - Lutz Claes
- Institute of Orthopedic Research and Biomechanics, Center of Musculoskeletal Research Ulm, University Hospital Ulm, Ulm, Baden-Württemberg, Germany
| |
Collapse
|
15
|
A review of computational models of bone fracture healing. Med Biol Eng Comput 2017; 55:1895-1914. [DOI: 10.1007/s11517-017-1701-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/25/2017] [Indexed: 12/22/2022]
|
16
|
Ghiasi MS, Chen J, Vaziri A, Rodriguez EK, Nazarian A. Bone fracture healing in mechanobiological modeling: A review of principles and methods. Bone Rep 2017; 6:87-100. [PMID: 28377988 PMCID: PMC5365304 DOI: 10.1016/j.bonr.2017.03.002] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/15/2017] [Accepted: 03/15/2017] [Indexed: 02/07/2023] Open
Abstract
Bone fracture is a very common body injury. The healing process is physiologically complex, involving both biological and mechanical aspects. Following a fracture, cell migration, cell/tissue differentiation, tissue synthesis, and cytokine and growth factor release occur, regulated by the mechanical environment. Over the past decade, bone healing simulation and modeling has been employed to understand its details and mechanisms, to investigate specific clinical questions, and to design healing strategies. The goal of this effort is to review the history and the most recent work in bone healing simulations with an emphasis on both biological and mechanical properties. Therefore, we provide a brief review of the biology of bone fracture repair, followed by an outline of the key growth factors and mechanical factors influencing it. We then compare different methodologies of bone healing simulation, including conceptual modeling (qualitative modeling of bone healing to understand the general mechanisms), biological modeling (considering only the biological factors and processes), and mechanobiological modeling (considering both biological aspects and mechanical environment). Finally we evaluate different components and clinical applications of bone healing simulation such as mechanical stimuli, phases of bone healing, and angiogenesis.
Collapse
Affiliation(s)
- Mohammad S. Ghiasi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Jason Chen
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashkan Vaziri
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Edward K. Rodriguez
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
17
|
Dhaliwal K, Kunchur R, Farhadieh R. Review of the cellular and biological principles of distraction osteogenesis: An in vivo bioreactor tissue engineering model. J Plast Reconstr Aesthet Surg 2015; 69:e19-26. [PMID: 26725979 DOI: 10.1016/j.bjps.2015.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/22/2015] [Accepted: 11/14/2015] [Indexed: 02/06/2023]
Abstract
Distraction osteogenesis (DO) is a widely used technique in plastic and orthopaedic surgery. During the process, mechanical force is applied to fractured bone to enhance the regenerative processes and induce new bone formation. Although there is an abundance of literature on the clinical process of DO, there is a distinct lack of focus on the underlying biological principles governing this process. DO follows the basic premises of tissue engineering. The mechanical stress stimulates mesenchymal stem cell differentiation down an osteoblastic lineage on a matrix background. The aim of this review is to give an overview of the current knowledge of the molecular mechanism governing this process.
Collapse
Affiliation(s)
- K Dhaliwal
- St George's NHS Trust, Tooting, London, SW17 0QT, UK.
| | - R Kunchur
- Plastic & Reconstructive Surgery Department, Australian National University, Canberra ACT 0200, Australia
| | - R Farhadieh
- Plastic & Reconstructive Surgery Department, Australian National University, Canberra ACT 0200, Australia
| |
Collapse
|
18
|
Distraction Osteogenesis Using Bone Matrix Osteotensors in Ectodermal Dysplasia: A Case Report. IMPLANT DENT 2015; 24:612-9. [PMID: 26317574 DOI: 10.1097/id.0000000000000310] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ectodermal dysplasia patients require complex oral rehabilitation. Bone matrix Osteotensors activate the patient's own stem cells to promote new bone formation through an autogenous growth factor cascade generated by a targeted flapless bone distraction before implant and/or bone graft therapy. MATERIALS AND METHODS The maxillary and mandibular bone were activated 21 (for type I bone) to 45 days (for type IV bone) before implant and/or bone substitute installation. Purpose-designed Osteotensors initiated massive recruitment of stem cells in the intended bone recipient site, thereby triggering neoangiogenesis and osteogenesis. After new bone formation, root-form implants and Diskimplants were installed. Functional loading was obtained at 48 hours using highly rigid, screw-secured fixed upper and lower full-arch prostheses. RESULTS At 3 years, all implants appeared clinically and radiologically osseointegrated with an excellent functional and esthetic outcome. CONCLUSION Flapless distraction osteogenesis using bone matrix Osteotensors several weeks before surgery improved the initial quality and volume of the recipient bone bed. This minimally invasive approach allows future successful immediate implant-supported complete maxillomandibular fixed rehabilitation without preliminary grafting procedures in patients with an unfavorable initial bone anatomy.
Collapse
|
19
|
Compton J, Fragomen A, Rozbruch SR. Skeletal Repair in Distraction Osteogenesis: Mechanisms and Enhancements. JBJS Rev 2015; 3:01874474-201508000-00002. [PMID: 27490473 DOI: 10.2106/jbjs.rvw.n.00107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jocelyn Compton
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10031
| | - Austin Fragomen
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - S Robert Rozbruch
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| |
Collapse
|
20
|
Guo P, Zeng JJ, Zhou N. Nonvascular transport distraction osteogenesis in bone formation and regeneration. Is it an accidental phenomenon? J Craniomaxillofac Surg 2014; 43:21-7. [PMID: 25457741 DOI: 10.1016/j.jcms.2014.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/03/2014] [Accepted: 10/10/2014] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To explore the osteogenic mechanism of nonvascular transport distraction osteogenesis (NTDO) by constructing mandibular defects in dogs. METHODS Sixty adult dogs were randomly divided into three groups with 20 dogs in each group. Canine mandibular defect models of NTDO were constructed. Animals were euthanized 1, 4 and 12 weeks after distraction, and the transport disc and surrounding tissue were collected and fixed. Histochemical staining using hematoxylin and eosin (H&E) and electron microscopic observations were used to examine bone regeneration. RESULTS Distraction bone regeneration was observed in the distraction gap and around the transport disc, and osseous connections had formed between new bone and the transport disc after one week. Osteoclasts gathered around the transport disc, and bone absorption pit formation could be seen. After 4 weeks of distraction, the new bone around the transport disc was close to maturity with thick sclerostin on the middle of the transport disc. After 12 weeks the new bone and the transport disc were fully integrated, and were difficult to distinguish by H&E staining and electron microscopy. CONCLUSIONS Canine mandibular defects were successfully repaired by NTDO resulting in ideal new bone formation and fully recovered mandibular physiological function. The surrounding tissues, including musculoskeletal tissues, the periosteum and other soft tissues and the nonvascular transport disc, together contribute to bone regeneration and neovascularization in NTDO.
Collapse
Affiliation(s)
- Peng Guo
- College of Stomatology, GuangXi Medical University, Nanning Guangxi, China
| | - Jing-Jing Zeng
- College of Stomatology, GuangXi Medical University, Nanning Guangxi, China
| | - Nuo Zhou
- College of Stomatology, GuangXi Medical University, Nanning Guangxi, China.
| |
Collapse
|
21
|
Swain LD, Cornet DA, Manwaring ME, Collins B, Singh VK, Beniker D, Carnes DL. Negative pressure therapy stimulates healing of critical-size calvarial defects in rabbits. BONEKEY REPORTS 2013; 2:299. [PMID: 23951542 PMCID: PMC3722738 DOI: 10.1038/bonekey.2013.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/28/2013] [Indexed: 01/27/2023]
Abstract
Negative pressure therapy (NPT) is the controlled application of subatmospheric pressure to wounds. It has been shown to stimulate healing across a broad spectrum of soft-tissue wounds, at least in part from the application of mechanical stress on cells and tissues in the wound environment. This study tests the hypothesis that application of NPT to cranial critical-size defects (CSD) in skeletally mature rabbits leads to osseous healing. NPT was delivered 1, 4, 6 or 10 days over CSD-containing calcium phosphate scaffolds placed in contact with intact dura. At 12 weeks after defect creation, NPT groups exhibited significantly greater defect bridging and bone within the scaffolds (P<0.01). Increasing duration of NPT did not result in a greater amount of bone within the scaffolds, but did increase the amount of bone distributed in the upper half of the scaffolds. Appearance of tissue within defects immediately following the removal of NPT at day 6 suggests alternating regions of dural compression and distention indicative of cell stretching. Dura and adjacent tissue were composed of multiple cell layers that extended up into the scaffolds, lining struts and populating pore spaces. An extracellular matrix densely populated with cells and capillaries, as well as larger vessels, infiltrated pores of NPT-treated scaffolds, while scattered spindle-shaped cells and sparse stroma are present within pores of control scaffolds. This rabbit model data suggest that NPT activates within mature dura a natural healing cascade that results in osseous tissue formation without the addition of exogenous factors or progenitor cells.
Collapse
|
22
|
Petitbois R, Scortecci G. La corticotomie alvéolaire : nouvelle approche chirurgicale grâce à l’ostéo-activation. Principe et protocole. Int Orthod 2012. [DOI: 10.1016/j.ortho.2012.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Petitbois R, Scortecci G. Alveolar corticotomy: a new surgical approach based on bone activation: principle and protocol. Int Orthod 2012; 10:432-8. [PMID: 23164922 DOI: 10.1016/j.ortho.2012.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Alveolar corticotomy has proven effective in shortening orthodontic treatments in adults. A new non-invasive and flapless surgical approach has, however, yielded the same results. This technique, based on prior osteogenic alveoli preparation, entails neither anatomical risk nor post-op pain. The present article describes this new protocol and uses a case report to illustrate it.
Collapse
|
24
|
Reina-Romo E, Gómez-Benito M, Domínguez J, García-Aznar J. A lattice-based approach to model distraction osteogenesis. J Biomech 2012; 45:2736-42. [DOI: 10.1016/j.jbiomech.2012.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 08/16/2012] [Accepted: 09/07/2012] [Indexed: 10/27/2022]
|
25
|
Schouman T, Raoul G, Dubois G. [Autologous tissue engineering by means of distraction osteogenesis: Biomechanical considerations]. ACTA ACUST UNITED AC 2011; 112:222-8. [PMID: 21794888 DOI: 10.1016/j.stomax.2011.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Tissue engineering consists in producing functional replacement tissue. Distraction osteogenesis is a tissue engineering technique that uses the mechanical environment of cells to induce tissue regeneration, without need for exogenous biochemical factors. A better understanding of the optimal mechanical conditions of distraction callus stretching may reduce the duration, discomfort, and even social impact of distraction protocols, and complications and failures. We present the current state of knowledge in this field by addressing the fundamentals of elongating bone tissue biomechanics, the influence of rhythm and rate of distraction, and that of vectors and stability. Finally, we present the innovations currently studied, which may modify our clinical protocol in the short term.
Collapse
Affiliation(s)
- T Schouman
- Service de chirurgie maxillofaciale et stomatologie, université Paris 6 - Pierre-et-Marie-Curie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | | | | |
Collapse
|
26
|
Srouji S, Ben-David D, Kohler T, Müller R, Zussman E, Livne E. A model for tissue engineering applications: femoral critical size defect in immunodeficient mice. Tissue Eng Part C Methods 2011; 17:597-606. [PMID: 21254818 DOI: 10.1089/ten.tec.2010.0501] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Animal models for preclinical functionality assays lie midway between in vitro systems such as cell culture and actual clinical trials. We have developed a novel external fixation device for femoral critical size defect (CSD) in the femurs of immunodeficient mice as an experimental model for studying bone regeneration and bone tissue engineering. The external fixation device comprises four pointed rods and dental acrylic paste. A segmental bone defect (2 mm) was created in the midshaft of the mouse femur. The CSD in the femur of the mice were either left untreated or treated with a bone allograft, a cell-scaffold construct, or a scaffold-only construct. The repair and healing processes of the CSD were monitored by digital x-ray radiography, microcomputed tomography, and histology. Repair of the femoral CSD was achieved with the bone allografts, and partial repair of the femoral CSD was achieved with the cell scaffold and the scaffold-only constructs. No repair of the nongrafted femoral CSD was observed. Our results establish the feasibility of this new mouse femoral model for CSD repair of segmental bone using a simple stabilized external fixation device. The model should prove especially useful for in vivo preclinical proof-of-concept studies that involve cell therapy-based technologies for bone tissue engineering applications in humans.
Collapse
Affiliation(s)
- Samer Srouji
- Department of Oral and Maxillofacial Surgery, Carmel Medical Center, Haifa, Israel.
| | | | | | | | | | | |
Collapse
|
27
|
Reina-Romo E, Gómez-Benito MJ, García-Aznar JM, Domínguez J, Doblaré M. An interspecies computational study on limb lengthening. Proc Inst Mech Eng H 2011; 224:1245-56. [PMID: 21218687 DOI: 10.1243/09544119jeim787] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Distraction osteogenesis is a surgical technique that produces large volumes of new bone by gradually separating two osteotomized bone segments. A previously proposed mechanical-based model that includes the effect of pre-traction stresses (stress level in the gap tissue before each distraction step) during limb lengthening is used here. In the present work, the spatial and temporal patterns of tissue distribution during distraction osteogenesis in different species (sheep, rabbit) and in the human are compared numerically to predict experimental results. Interspecies differential characteristics such as size, distraction protocol, and rate of distraction, among others, are chosen according to experiments. Tissue distributions and reaction forces are then analysed as indicators of the healing pattern. The results obtained are in agreement with experimental findings regarding both tissue distribution and reaction forces. The ability of the model to qualitatively predict the two animal models and the human healing pattern in distraction osteogenesis indicates its potential in understanding the influence of mechanics in this complex process.
Collapse
Affiliation(s)
- E Reina-Romo
- Department of Mechanical Engineering, University of Seville, 41092-Seville, Spain.
| | | | | | | | | |
Collapse
|
28
|
Odin G, Misch CE, Binderman I, Scortecci G. Fixed rehabilitation of severely atrophic jaws using immediately loaded basal disk implants after in situ bone activation. J ORAL IMPLANTOL 2010; 38:611-6. [PMID: 21186962 DOI: 10.1563/aaid-joi-d-10-00163] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Rehabilitation of severely atrophic jaws is facilitated when basal disk implants are used after activation of the future bony implant bed with a purpose-designed instrument (Osteotensor) 45 to 90 days before implant surgery. Fabrication of a highly rigid, screw-secured fixed prosthesis that acts as an external orthopedic fixator permits immediate functional loading. This protocol also represents a second chance for patients who have experienced complete implant loss and/or bone graft failure.
Collapse
Affiliation(s)
- Guillaume Odin
- Institut Universitaire de la Face et du Cou, Département de Chirurgie maxillo-faciale, Nice, France
| | | | | | | |
Collapse
|
29
|
Kim IS, Song YM, Hwang SJ. Osteogenic responses of human mesenchymal stromal cells to static stretch. J Dent Res 2010; 89:1129-34. [PMID: 20639509 DOI: 10.1177/0022034510375283] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Molecular signals driving the regenerative process in distraction osteogenesis (DO) involve a complex system of cellular behavior triggered by mechanical strain. However, it remains unclear how mesenchymal stromal cells (MSCs) adapt to osteogenic demands during DO. We hypothesized that human MSCs (hMSCs) modulate early osteogenic metabolism during exposure to static stretch. The proliferation of hMSCs was increased by static stretch, which, in turn, suppressed TGF-β1-mediated decreases in cell proliferation. The amount of stretching force applied had little effect on osteoblast differentiation of hMSCs induced by dexamethasone treatment. However, this strain induced sustained production of nitric oxide and vascular endothelial growth factor (VEGF), which are critical factors in angiogenesis, from differentiated hMSCs. Mechanical stretch involved ERK and p38 mitogen-activated protein kinase pathways, the selective inhibitors of which decreased static-stretch-induced VEGF production. These findings provide evidence that hMSCs act to facilitate early osteogenic metabolism during exposure to static stretch.
Collapse
Affiliation(s)
- I S Kim
- Dental Research Institute, Seoul National University, Korea
| | | | | |
Collapse
|
30
|
Khayyeri H, Checa S, Tägil M, Prendergast PJ. Corroboration of mechanobiological simulations of tissue differentiation in an in vivo bone chamber using a lattice-modeling approach. J Orthop Res 2009; 27:1659-66. [PMID: 19514073 DOI: 10.1002/jor.20926] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It is well established that the mechanical environment modulates tissue differentiation, and a number of mechanoregulatory theories for describing the process have been proposed. In this study, simulations of an in vivo bone chamber experiment were performed that allowed direct comparison with experimental data. A mechanoregulation theory for mesenchymal stem cell differentiation based on a combination of fluid flow and shear strain (computed using finite element analysis) was implemented to predict tissue differentiation inside mechanically controlled bone chambers inserted into rat tibae. To simulate cell activity, a lattice approach with stochastic cell migration, proliferation, and selected differentiation was adopted; because of its stochastic nature, each run of the simulation gave a somewhat different result. Simulations predicted the load-dependency of the tissue differentiation inside the chamber and a qualitative agreement with histological data; however, the full variability found between specimens in the experiment could not be predicted by the mechanoregulation algorithm. This result raises the question whether tissue differentiation predictions can be linked to genetic variability in animal populations.
Collapse
Affiliation(s)
- Hanifeh Khayyeri
- Trinity Centre for Bioengineering, School of Engineering, Trinity College Dublin, Ireland
| | | | | | | |
Collapse
|
31
|
Bone regeneration during distraction osteogenesis. Odontology 2009; 97:63-75. [DOI: 10.1007/s10266-009-0101-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 01/05/2009] [Indexed: 01/09/2023]
|
32
|
Geris L, Vander Sloten J, Van Oosterwyck H. In silico biology of bone modelling and remodelling: regeneration. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2009; 367:2031-2053. [PMID: 19380324 DOI: 10.1098/rsta.2008.0293] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Bone regeneration is the process whereby bone is able to (scarlessly) repair itself from trauma, such as fractures or implant placement. Despite extensive experimental research, many of the mechanisms involved still remain to be elucidated. Over the last decade, many mathematical models have been established to investigate the regeneration process in silico. The first models considered only the influence of the mechanical environment as a regulator of the healing process. These models were followed by the development of bioregulatory models where mechanics was neglected and regeneration was regulated only by biological stimuli such as growth factors. The most recent mathematical models couple the influences of both biological and mechanical stimuli. Examples are given to illustrate the added value of mathematical regeneration research, specifically in the in silico design of treatment strategies for non-unions. Drawbacks of the current continuum-type models, together with possible solutions in extending the models towards other time and length scales are discussed. Finally, the demands for dedicated and more quantitative experimental research are presented.
Collapse
Affiliation(s)
- L Geris
- Division of Biomechanics and Engineering Design, Katholieke Universiteit Leuven, Celestijnenlaan 300C, PB 2419, 3001 Leuven, Belgium.
| | | | | |
Collapse
|
33
|
Djasim UM, Mathot BJ, Wolvius EB, van Neck JW, van der Wal KGH. Histomorphometric comparison between continuous and discontinuous distraction osteogenesis. J Craniomaxillofac Surg 2009; 37:398-404. [PMID: 19457679 DOI: 10.1016/j.jcms.2009.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 03/17/2009] [Accepted: 03/24/2009] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Experimental research on optimising the distraction protocol has been performed extensively in the past. However, relatively little research has been done on the rhythm of distraction. Findings in the orthopaedic literature showed that the outcome of distraction osteogenesis (DO) is positively influenced by increasing the rhythm of distraction. The aim of this study is to quantitatively compare continuous with discontinuous rhythms of distraction in rabbits. MATERIALS AND METHODS Tissue blocks of regenerated bone were harvested from thirty-eight young adult female New-Zealand White rabbits. After a latency period of three days, rabbits were subjected for eleven days to either single daily activation of the distractor at a rate of 0.9 mm/d, or triple daily activation at a rate of 0.9 mm/d, or continuous activation at a rate of 0.9 mm/d. After three weeks of consolidation, bone regenerates were analysed using histomorphometry. RESULTS The continuous DO group showed significantly (p<.01) more regenerate bone volume in the central part of the regenerate than the discontinuous DO groups. Higher osteoblastic activity was seen, as well as more blood vessels (p<.05). Bone volume and the number of blood vessels correlated significantly in the central part of the regenerate (p<.05). Also, the early mineral apposition rate (MAR) was higher than the late MAR (p<.05). CONCLUSIONS Continuous DO significantly accelerates bone formation when compared with discontinuous DO.
Collapse
Affiliation(s)
- U M Djasim
- Department of Oral and Maxillofacial Surgery, The Netherlands
| | | | | | | | | |
Collapse
|
34
|
Checa S, Prendergast PJ. A Mechanobiological Model for Tissue Differentiation that Includes Angiogenesis: A Lattice-Based Modeling Approach. Ann Biomed Eng 2008; 37:129-45. [DOI: 10.1007/s10439-008-9594-9] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 10/29/2008] [Indexed: 11/30/2022]
|
35
|
Modeling distraction osteogenesis: analysis of the distraction rate. Biomech Model Mechanobiol 2008; 8:323-35. [DOI: 10.1007/s10237-008-0138-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 08/04/2008] [Indexed: 10/21/2022]
|
36
|
Pérez MA, Prendergast PJ. Random-walk models of cell dispersal included in mechanobiological simulations of tissue differentiation. J Biomech 2006; 40:2244-53. [PMID: 17173925 DOI: 10.1016/j.jbiomech.2006.10.020] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Accepted: 10/18/2006] [Indexed: 11/19/2022]
Abstract
Computational models have shown that biophysical stimuli can be correlated with observed patterns of tissue differentiation, and simulations have been performed that predict the time course of tissue differentiation in, for example, long bone fracture healing. Some simulations have used a diffusion model to simulate the migration and proliferation of cells with the differentiating tissue. However, despite the convenience of the diffusion model, diffusion is not the mechanism of cell dispersal: cells disperse by crawling or proliferation, or are transported in a moving fluid. In this paper, a random-walk model (i.e., a stochastic model), with and without a preferred direction, is studied as an approach to simulate cell proliferation/migration in differentiating tissues and it is compared with the diffusion model. A simulation of tissue differentiation of gap tissue in a two-dimensional model of a bone/implant interface was performed to demonstrate the differences between diffusion vs. random walk with a preferred direction. Results of diffusion and random-walk models are similar with respect to the change in the stiffness of the gap tissue but rather different results are obtained regarding tissue patterning in the differentiating tissues; the diffusion approach predicted continuous patterns of tissue differentiation whereas the random-walk model showed a more discontinuous pattern-histological results are not available that can unequivocally establish which is most similar to experimental observation. Comparing isotropic to anisotropic random walk (preferred direction of proliferation and cell migration), a more rapid reduction of the relative displacement between implant and bone is predicted. In conclusion, we have shown how random-walk models of cell dispersal and proliferation can be implemented, and shown where differences between them exist. Further study of the random-walk model is warranted, given the importance of cell seeding and cell dispersal/proliferation in many mechanobiological problems.
Collapse
Affiliation(s)
- M A Pérez
- Trinity Centre for Bioengineering, School of Engineering, Trinity College, Dublin, Ireland
| | | |
Collapse
|
37
|
Isaksson H, Comas O, van Donkelaar CC, Mediavilla J, Wilson W, Huiskes R, Ito K. Bone regeneration during distraction osteogenesis: mechano-regulation by shear strain and fluid velocity. J Biomech 2006; 40:2002-11. [PMID: 17112532 DOI: 10.1016/j.jbiomech.2006.09.028] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 09/18/2006] [Indexed: 11/22/2022]
Abstract
Corroboration of mechano-regulation algorithms is difficult, partly because repeatable experimental outcomes under a controlled mechanical environment are necessary, but rarely available. In distraction osteogenesis (DO), a controlled displacement is used to regenerate large volumes of new bone, with predictable and reproducible outcomes, allowing to computationally study the potential mechanisms that stimulate bone formation. We hypothesized that mechano-regulation by octahedral shear strain and fluid velocity can predict the spatial and temporal tissue distributions seen during experimental DO. Variations in predicted tissue distributions due to alterations in distraction rate and frequency could then also be studied. An in vivo ovine tibia experiment evaluating bone-segment transport (distraction, 1 mm/day) over an intramedullary nail was used for comparison. A 2D axisymmetric finite element model, with a geometry originating from the experimental data, was created and included into a previously developed model of tissue differentiation. Cells migrated and proliferated into the callus, differentiating into fibroblasts, chondrocytes or osteoblasts, dependent on the biophysical stimuli. Matrix production was modelled with an osmotic swelling model to allow tissues to grow at individual rates. The temporal and spatial tissue distributions predicted by the computational model agreed well with those seen experimentally. In addition, it was observed that decreased distraction rate (0.5 mm/d vs. 0.25 mm/d) increased the overall time needed for complete bone regeneration, whereas increased distraction frequency (0.5 mm/12 h vs. 0.25 mm/6 h) stimulated faster bone regeneration, as found in experimental findings by others. Thus, the algorithm regulated by octahedral shear strain and fluid velocity was able to predict the bone regeneration patterns dependent on distraction rate and frequency during DO.
Collapse
Affiliation(s)
- Hanna Isaksson
- AO Research Institute, Clavadelerstrasse 8, 7270 Davos Platz, Switzerland
| | | | | | | | | | | | | |
Collapse
|