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Hu Y, Chen X, Chu Z, Luo L, Gan Z, Zhong J, Yuan Z, Zhu B, Dong W. Biomechanical Properties of Novel Porous Scaffold Core and Hollow Lateral Hole Pedicle Screws: A Comparative Study in Bama Pigs. Orthop Surg 2024; 16:1718-1725. [PMID: 38766934 PMCID: PMC11216838 DOI: 10.1111/os.14091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE Screw loosening is a common complication of internal fixation of pedicle screw. Therefore, the development of a pedicle screw with low loosening rate and high biosafety is of great clinical significance. This study aimed to investigate whether the application of a porous scaffold structure can improve the stability of pedicle screws by comparing the biomechanical properties of novel porous scaffold core pedicle screws (PSCPSs) with those of hollow lateral hole pedicle screws (HLHPSs) in a porcine lumbar spine. METHODS Thirty-two pedicle screws of both types were implanted bilaterally into the L1-4 vertebrae of four Bama pigs, with our newly designed PSCPSs on the right and HLHPSs on the left. All the Bama pigs were sacrificed 16 weeks postoperatively, and the lumbar spine was freed into individual vertebrae. Biomechanical properties of both the pedicle screws were evaluated using pull-out tests, as well as cyclic bending and pull-out tests, while the mechanical properties were assessed using three-point bending tests. The data generated were statistically analyzed using paired-sample t-tests and two independent sample t-tests. RESULTS We found that the maximal pull-out forces before and after cyclic bending of the PSCPSs (1161.50 ± 337.98 N and 1075.25 ± 223.33 N) were significantly higher than those of the HLHPSs (948.38 ± 194.32 N and 807.13 ± 242.75 N) (p < 0.05, p < 0.05). In 800 cycles of the bending tests, neither PSCPS nor HLHPS showed loosening or visible detachment, but their maximal pull-out forces after cyclic bending tests decreased compared to those in cycles without cyclic bending tests (7.43% and 14.89%, respectively), with no statistical significance (p > 0.05 and p > 0.05, respectively). Additionally, both screws buckled rather than broke in the three-point bending tests, with no statistically significant differences between the maximal bending load and modulus of elasticity of the two screws (p > 0.05 and p > 0.05, respectively). CONCLUSIONS Compared with the HLHPSs, the PSCPSs have greater pull-out resistance and better fatigue tolerance with appropriate mechanical properties. Therefore, PSCPSs theoretically have significant potential for clinical applications in reducing the incidence of loosening after pedicle screw implantation.
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Affiliation(s)
- Yong Hu
- Department of Spine SurgeryNingbo No. 6 HospitalNingboChina
| | - Xijiong Chen
- Health Science CenterNingbo UniversityNingboChina
| | - Zhentao Chu
- Health Science CenterNingbo UniversityNingboChina
| | - Linwei Luo
- Health Science CenterNingbo UniversityNingboChina
| | - Zhiwei Gan
- Health Science CenterNingbo UniversityNingboChina
| | - Jianbin Zhong
- Department of Spine SurgeryNingbo No. 6 HospitalNingboChina
| | - Zhenshan Yuan
- Department of Spine SurgeryNingbo No. 6 HospitalNingboChina
| | - Bingke Zhu
- Department of Spine SurgeryNingbo No. 6 HospitalNingboChina
| | - Weixin Dong
- Department of Spine SurgeryNingbo No. 6 HospitalNingboChina
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Seo J, Kim H, Min J, Kim Y, Jeon IH, D'Lima D, Koh KH. Development of in vitro osteoporosis model in minipig proximal humerus and femur: validation in histological and biomechanical study. J Orthop Surg Res 2023; 18:615. [PMID: 37608307 PMCID: PMC10463625 DOI: 10.1186/s13018-023-04102-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The minipig has been used for research in various fields of medicine, even in orthopedics. Though previous studies have already suggested other methods to create osteoporotic bone, those methods had some disadvantages for taking time and efforts. Therefore, we aimed to generate osteoporotic proximal humerus and proximal femur of minipig using EDTA solution and validate their properties through dual energy X-ray absorptiometry (DEXA), micro-CT study, histological and biomechanical ways. METHODS Six minipigs were used. Out of a total of 12 proximal humerus (PH) and 12 proximal femurs (PF), 6 PH and 6 PF were used as the decalcified group and the opposite side as the non-decalcified group. In vitro decalcification with Ca-chelating agents (0.5 M EDTA solution, pH 7.4) was used. Area BMD (aBMD) was measured using DEXA, Volumetric BMD (vBMD), and microstructure were measured using micro-CT. Universal testing machine was used to measure ultimate load to failure (ULTF). Each group was compared using two types of suture anchors (all-suture anchor, ASA, and conventional screw type anchor, CA). RESULTS There was a significant difference in aBMD and cortical thickness (aBMD: decalcified, 0.433 ± 0.073 g/cm2, undecalcified, 0.962 ± 0.123 g/cm2, p < 0.001; cortical thickness: decalcified, 0.33 ± 0.34 mm, undecalcified, 1.61 ± 0.45 mm, p < 0.001). In the case of ASA, the ULTF was significantly lower in the decalcified group (decalcified: 176.6 ± 74.2 N, non-decalcified: 307.7 ± 116.5 N, p = 0.003). In the case of CA, there was no significant difference (decalcified: 265.1 ± 96.0 N, undecalcified: 289.4 ± 114.5 N, p = 0.578). CONCLUSION We demonstrated that decalcification with EDTA solution significantly decreased aBMD, vBMD, and cortical thickness. Decalcified minipig bone using EDTA resulted in similar biomechanical properties as osteoporotic human bone with respect to anchor pull-out.
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Affiliation(s)
- Jeonghyeon Seo
- Department of Orthopedic Surgery, Areumcheil Hospital, Seoul, Republic of Korea
| | - Hyojune Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Joongkee Min
- Asan Medical Center, Convergence Medicine Research Center, Computerized Tomography Core, Seoul, Republic of Korea
| | - Yongwoo Kim
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Darry D'Lima
- Department of Molecular Medicine, Scripps Research, La Jolla, CA, USA
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Health, San Diego, CA, USA
| | - Kyoung Hwan Koh
- Department of Molecular Medicine, Scripps Research, La Jolla, CA, USA.
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Health, San Diego, CA, USA.
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, Republic of Korea.
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van Oirschot B, van den Beucken JJ, Mikos AG, Jansen JA. Lateral Bone Augmentation Using a Three-Dimensional-Printed Polymeric Chamber to Compare Biomaterials. Tissue Eng Part C Methods 2023; 29:287-297. [PMID: 37082957 PMCID: PMC10402696 DOI: 10.1089/ten.tec.2023.0025] [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: 02/28/2023] [Accepted: 04/18/2023] [Indexed: 04/22/2023] Open
Abstract
The aim of this study was to test the suitability of calcium phosphate cement mixed with poly(lactic-co-glycolic acid) (CPC-PLGA) microparticles into a ring-shaped polymeric space-maintaining device as bone graft material for lateral bone augmentation. Therefore, the bone chambers were installed on the lateral portion of the anterior region of the mandibular body of mini-pigs. Chambers were filled with either CPC-PLGA or BioOss® particles for comparison and left for 4 and 12 weeks. Histology and histomorphometry were used to obtain temporal insight in material degradation and bone formation. Results indicated that between 4 and 12 weeks of implantation, a significant degradation of the CPC-PLGA (from 75.1% to 23.1%), as well as BioOss material, occurred (from 40.6% to 14.4%). Degradation of both materials was associated with the presence of macrophage-like and osteoclast-like cells. Furthermore, a significant increase in bone formation occurred between 4 and 12 weeks for the CPC-PLGA (from 0.1% to 7.2%), as well as BioOss material (from 8.3% to 23.3%). Statistical analysis showed that bone formation had progressed significantly better using BioOss compared to CPC-PLGA (p < 0.05). In conclusion, this mini-pig study showed that CPC-PLGA does not stimulate lateral bone augmentation using a bone chamber device. Both treatments failed to achieve "clinically" meaningful alveolar ridge augmentation.
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Affiliation(s)
- Bart van Oirschot
- Regenerative Biomaterials, Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - John A. Jansen
- Regenerative Biomaterials, Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
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Kato G, Baba S, Kawaguchi K, Watanabe T, Mae T, Tomari S. Perpendicular probing and screwing technique: A simple method for accurate pedicle screw placement based on the human internal reference frame for angle estimation. PLoS One 2022; 17:e0277229. [PMID: 36441680 PMCID: PMC9704603 DOI: 10.1371/journal.pone.0277229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/22/2022] [Indexed: 11/29/2022] Open
Abstract
The pedicle screw (PS) is widely used for spinal fixation surgery. However, PS malpositioning can cause critical complications; thus, the accuracy of ascertaining PS trajectory is paramount. This study aimed to demonstrate the accuracy and safety of a simple and cost-effective PS placement technique using a human internal reference frame for angle estimation. Ex vivo lumbar porcine spine samples were fixed to a wooden board with rostrocaudal and mediolateral rotational angles adjusted by two angle vises. PS entry points (EPs) were identified using clear anatomical vertebral landmarks. PS placement was performed on one side using the perpendicular probing and screwing technique (PPST), wherein the attitude angle of the sample was adjusted such that the longitudinal axis of the target pedicle was perpendicular to the ground. The pedicle probe and PS driver were manually maintained perpendicular to the ground during probing and PS placement. PS placement on the contralateral side was performed freehand as a control. Offsets between the preoperatively planned and implanted PS rotational angles measured using computed tomography for PPST and freehand method were analyzed. Pedicle wall penetration was also evaluated. The mean ± standard error of the medial rotational offsets was 5.83° ± 0.57° in the freehand group versus 2.89° ± 0.31° in the PPST group (p <0.001), and the rostrocaudal rotational offsets were 4.81° ± 0.65° in the freehand group versus 2.92° ± 0.45° in the PPST group (p = 0.01). The mean pedicle wall penetration distance was significantly reduced by PPST (0.28 ± 0.12 mm vs 0.80 ± 0.17 mm in the freehand group, p = 0.0071). Thus, PPST improved PS positioning accuracy, resulting in reduced pedicle wall penetration and increased PS placement safety. This simple technique is also potentially cost-effective for institutions without computer-assisted surgical systems.
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Affiliation(s)
- Go Kato
- Department of Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
- Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan
- * E-mail:
| | - Satoshi Baba
- Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan
| | - Kenichi Kawaguchi
- Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takeshi Watanabe
- Department of Orthopedic Surgery, Watanabe Orthopedic Hospital, Fukuoka, Japan
| | - Takao Mae
- Department of Orthopedic Surgery, Saga Medical Center, Koseikan, Saga, Japan
| | - Shinji Tomari
- Department of Orthopedic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
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Selection of animal bone surrogate samples for orthopaedic screw testing based on human radius CT-derived bone morphology. Med Eng Phys 2022; 103:103786. [DOI: 10.1016/j.medengphy.2022.103786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/26/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022]
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Ienello L, Kennedy M, Wendt-Hornickle E, Baldo C, Moshnikova V, Guedes A. Ultrasound-guided rectus sheath block injections in miniature swine cadavers: technique description and distribution of two injectate volumes. Vet Anaesth Analg 2022; 49:210-218. [DOI: 10.1016/j.vaa.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
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Zhang Z, Gan Y, Guo Y, Lu X, Li X. Animal models of vertical bone augmentation (Review). Exp Ther Med 2021; 22:919. [PMID: 34335880 PMCID: PMC8290405 DOI: 10.3892/etm.2021.10351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022] Open
Abstract
Vertical bone augmentation is an important challenge in dental implantology. Existing vertical bone augmentation techniques, along with bone grafting materials, have achieved certain clinical progress but continue to have numerous limitations. In order to evaluate the possibility of using biomaterials to develop bone substitutes, medical devices and/or new bone grafting techniques for vertical bone augmentation, it is essential to establish clinically relevant animal models to investigate their biocompatibility, mechanical properties, applicability and safety. The present review discusses recent animal experiments related to vertical bone augmentation. In addition, surgical protocols for establishing relevant preclinical models with various animal species were reviewed. The present study aims to provide guidance for selecting experimental animal models of vertical bone augmentation.
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Affiliation(s)
- Zepeng Zhang
- Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, P.R. China
| | - Yaxin Gan
- Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, P.R. China
| | - Yarong Guo
- Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, P.R. China
| | - Xuguang Lu
- Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, P.R. China
| | - Xianqi Li
- Department of Oral and Maxillofacial Surgery, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, P.R. China.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Matsumoto Dental University, Shiojiri, Nagano 399-0781, Japan
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Baba S, Kawaguchi K, Itamoto K, Watanabe T, Hayashida M, Mae T, Nakashima Y, Kato G. Use of an inertial measurement unit sensor in pedicle screw placement improves trajectory accuracy. PLoS One 2020; 15:e0242512. [PMID: 33196657 PMCID: PMC7668595 DOI: 10.1371/journal.pone.0242512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/03/2020] [Indexed: 12/02/2022] Open
Abstract
Ascertaining the accuracy of the pedicle screw (PS) trajectories is important as PS malpositioning can cause critical complications. We aimed to determine the angle range over which estimation is unreliable; build a low-cost PS placement support system that uses an inertial measurement unit (IMU) to enable the monitoring of surgical tools and PS trajectories, and determine the situations where IMU support would be most beneficial. In PS insertion experiments, we used cadaver samples that included lumbar porcine spines. Computed tomography images obtained before and after PS insertion were viewed. Offsets between the planned and implanted PS trajectories in the freehand and IMU-assisted groups were analyzed. The PS cortical bone breaches were classified according to the Gertzbein and Robbins criteria (GRC). Added head-down tilted sample experiments were repeated wherein we expected a decreased rostro-caudal rotational accuracy of the PS according to the angle estimation ability results. Evaluation of the PS trajectory accuracy revealed no significant advantage of IMU-assisted rostro-caudal rotational accuracy versus freehand accuracy. According to the GRC, IMU assistance significantly increased the rate of clinically acceptable PS positions (RoCA) than the freehand technique. In the head-down tilted sample experiments, IMU assist provided increased accuracies with both rostro-caudal and medial rotational techniques when compared with the freehand technique. In the freehand group, RoCA was significantly decreased in samples with rostral tilting relative to that in the samples without. However, In the IMU-assisted group, no significant difference in RoCA between the samples with and without head-down tilting was observed. Even when the planned PS medial and/or rostro-caudal rotational angle was relatively large and difficult to reproduce manually, IMU-support helped maintain the PS trajectory accuracy and positioning safety. IMU assist in PS placement was more beneficial, especially for larger rostro-caudal and/or medial rotational pedicle angles.
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Affiliation(s)
- Satoshi Baba
- Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan
- Trauma Center, Saga Medical Center, Koseikan, Saga, Japan
- Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kenichi Kawaguchi
- Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kazuhito Itamoto
- Department of Small Animal Clinical Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Takeshi Watanabe
- Department of Orthopedic Surgery, Watanabe Orthopedic Hospital, Itoshima, Fukuoka, Japan
| | - Mitsumasa Hayashida
- Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan
- Trauma Center, Saga Medical Center, Koseikan, Saga, Japan
- Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takao Mae
- Trauma Center, Saga Medical Center, Koseikan, Saga, Japan
- Department of Orthopedic Surgery, Saga Medical Center, Koseikan, Saga, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Go Kato
- Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan
- Trauma Center, Saga Medical Center, Koseikan, Saga, Japan
- Department of Orthopedic Surgery, Fukuoka Red Cross Hospital, Fukuoka, Japan
- * E-mail:
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