BIOMECHANICAL STUDY ON EFFECTS OF BONE MINERAL DENSITY ON FIXATION STRENGTH OF EXPANSIVE PEDICLE SCREW_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GAO Mingxuan ¹ , LI Xusheng ¹ , ZHEN Ping ¹ , WU Zhigang ¹ , ZHOU Shenghu ¹ , TIAN Qi ¹ , LEI Wei ²

1Department of Orthopedics, Orthopedic Office of Research of Chinese PLA, Lanzhou General Hospital of Lanzhou Military Command, Lanzhou Gansu, 730050, P.R.China;;
2Department of Orthopedics, Orthopedic Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University. Corresponding author: LI Xusheng, E-mail: lixush1968@sina.com;;
LEI Wei, E-mail: weileifmmu@yahoo.cn;

Corresponding author：

Keywords：

Expansive pedicle screw; Osteoporosis; Pullout test; Biomechanics

DOI：

10.7507/1002-1892.20130211

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Objective To evaluate the fixation strength of expansive pedicle screw (EPS) at different bone mineral density (BMD) levels, further to provide theoretical evidence for the clinical application of the EPS in patients with osteoporosis. Methods Fresh human cadaver spines (T12-L5 spines) were divided into 4 levels: normal BMD, osteopenia, osteoporosis, and severe osteoporosis according to the value of BMD, 12 vertebra in each level. Conventional pedicle screw (CPS) or EPS was implanted into the bilateral vertebra in CPS group and EPS group, respectively, 12 screws in each group per BMD level. Screw pullout tests were conducted. The maximum pullout strength, stiffness, and energy absorption were determined by an AG-IS material testing machine with constant rate of loading in a speed of 5 mm/ min. Results With the decline of BMD from normal to severe osteoporosis level, the maximum pullout strength and the stiffness correspondingly declined (P lt; 0.05). In CPS group, the energy absorption gradually decreased (P lt; 0.05); in EPS group, significant difference was found between other different BMD levels (P lt; 0.05) except between normal BMD and osteopenia and between osteoporosis and severe osteoporosis (P gt; 0.05). At the same BMD level, the maximum pullout strength of EPS group was significantly larger than that of CPS group (P lt; 0.05); the stiffness of EPS group was significantly higher than that of CPS group (P lt; 0.05) except one at normal BMD level; and no significant difference was found in the energy absorption between 2 groups (P gt; 0.05) except one at osteopenia level. No significant difference was found in maximum pullout strength, stiffness, and energy absorption between EPS group at osteoporosis level and CPS group at osteopenia level (P gt; 0.05); however, the maximum pullout strength, stiffness, and energy absorption of EPS group at severe osteoporosis level were significantly lower than those of CPS group at osteopenia level (P lt; 0.05). Conclusion Compared with CPS, the EPS can significantly improve the fixation strength, especially in patients with osteopenia or osteoporosis.

Citation： GAO Mingxuan,LI Xusheng,ZHEN Ping,WU Zhigang,ZHOU Shenghu,TIAN Qi,LEI Wei. BIOMECHANICAL STUDY ON EFFECTS OF BONE MINERAL DENSITY ON FIXATION STRENGTH OF EXPANSIVE PEDICLE SCREW. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(8): 969-973. doi: 10.7507/1002-1892.20130211 Copy

1.	Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone, 2004, 35(2): 375-382.
2.	高明暄, 周胜虎, 邓晓文, 等. 骨质疏松对椎弓根螺钉稳定性影响的实验研究. 中国骨质疏松杂志, 2013, 19(1): 39-42.
3.	Scarvell JM, Van Twest MS, Stanton SF, et al. Prevalence of undisclosed osteoporosis in patients with minimal trauma fractures: A prospective cohort study. Phys Sportsmed, 2013, 41(2): 44-49.
4.	杨亚军, 崔燎. FoxO/Wnt通路在氧化应激介导的骨质疏松中的调控机制. 中国药理学通报, 2013, 29(1): 27-30.
5.	刘瑶瑶, 孙东, 张泽华, 等. 用于骨质疏松椎体固定的椎弓根螺钉进展. 中国矫形外科杂志, 2011, 19(23): 1982-1986.
6.	Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg (Am), 2000, 82-A(10): 1458-1476.
7.	Lei W, Wu Z. Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J, 2006, 15(3): 321-326.
8.	吴子祥, 雷伟, 孙明林, 等. 膨胀式椎弓根螺钉脊柱后路内固定的生物力学测试. 医用生物力学, 2004, 19(2): 98-102.
9.	张伟, 雷伟, 吴子祥. 膨胀式椎弓根螺钉的强度测试. 科学技术与工程, 2008, 8(16): 4635-4637, 4653.
10.	石磊, 王陵, 雷伟, 等. 低弹性模量膨胀螺钉在骨质疏松绵羊的体内研究. 中国骨质疏松杂志, 2011, 17(9): 761-765.
11.	Liu Z, Piao J, Pang L, et al. The diagnostic criteria for primary osteoporosis and the incidence of osteoporosis in China. J Bone Miner Metab, 2002, 20(4): 181-189.
12.	廖二元. 骨质疏松诊断方法综述. 药品评价, 2012, 9(7): 14-20.
13.	Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res, 1986, (203): 7-17.
14.	Roy-Camille R, Benazet JP, Desauge JP, et al. Lumbosacral fusion with pedicular screw plating instrumentation. A 10-year follow-up. Acta Orthop Scand Suppl, 1993, 251: 100-104.
15.	Ying SH, Kao HC, Chang MC, et al. Fixation strength of PMMA-augmented pedicle screws after depth adjustment in a synthetic bone model of osteoporosis. Orthopedics, 2012, 35(10): e1511-e1516.
16.	Higashino K, Kim JH, Horton WC, et al. A biomechanical study of two different pedicle screw methods for fixation in osteoporotic and nonosteoporotic vertebrae. J Surg Orthop Adv, 2012, 21(4): 198-203.
17.	Cook SD, Barbera J, Rubi M, et al. Lumbosacral fixation using expandable pedicle screws. An alternative in reoperation and osteoporosis. Spine J, 2001, 1(2): 109-114.
18.	李宏伟, 马远征, 鲍达, 等. 膨胀与普通椎弓根钉治疗脊柱胸腰段骨折合并骨质疏松的对比研究. 中国骨质疏松杂志, 2006, 12(1): 13-16.
19.	王祥善, 孙保国, 刘建民, 等. 膨胀式椎弓根螺钉在骨质疏松椎体的生物力学研究. 实用诊断与治疗杂志, 2005, 19(8): 552-557.
20.	Cook SD, Salkeld SL, Stanley T, et al. Biomechanical study of pedicle screw fixation in severely osteoporotic bone. Spine J, 2004, 4(4): 402-408.
21.	Wu ZX, Gao MX, Sang HX, et al. Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation: a biomechanical study and a 2-year follow-up of 20 patients. J Surg Res, 2012, 173(1): 91-98.
22.	高明暄, 刘兴炎, 甄平, 等. 膨胀式椎弓根螺钉联合椎间融合器治疗腰椎滑脱症. 中国修复重建外科杂志, 2009, 23(8): 904-908.
23.	Koller H, Zenner J, Hitzl W, et al. The impact of a distal expansion mechanism added to a standard pedicle screw on pullout resistance. A biomechanical study. Spine J, 2013, 13(5): 532-541.
24.	Kocak T, Däxle M, Reichel H, et al. Alternative technique of cement augmentation of loosened pedicle screws—technical note and presentation of two cases. Acta Chir Orthop Traumatol Cech, 2013, 80(1): 89-91.
25.	Li Y, Cheng H, Liu ZC, et al. In vivo study of pedicle screw augmentation using bioactive glass in osteoporosis sheep. J Spinal Disord Tech, 2013, 26(4): E118-E123.
26.	Jonvaux J, Hoc T, Budyn E. Analysis of micro fracture in human Haversian cortical bone under compression. Int J Numer Method Biomed Eng, 2012, 28(9): 974-998.
27.	高石军, 魏景超, 陆博, 等. 微骨折结合未培养的兔自体骨髓单个核细胞修复全层关节软骨缺损的实验观察. 中华医学杂志, 2012, 92(35): 2463-2467.

1. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone, 2004, 35(2): 375-382.
2. 高明暄, 周胜虎, 邓晓文, 等. 骨质疏松对椎弓根螺钉稳定性影响的实验研究. 中国骨质疏松杂志, 2013, 19(1): 39-42.
3. Scarvell JM, Van Twest MS, Stanton SF, et al. Prevalence of undisclosed osteoporosis in patients with minimal trauma fractures: A prospective cohort study. Phys Sportsmed, 2013, 41(2): 44-49.
4. 杨亚军, 崔燎. FoxO/Wnt通路在氧化应激介导的骨质疏松中的调控机制. 中国药理学通报, 2013, 29(1): 27-30.
5. 刘瑶瑶, 孙东, 张泽华, 等. 用于骨质疏松椎体固定的椎弓根螺钉进展. 中国矫形外科杂志, 2011, 19(23): 1982-1986.
6. Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg (Am), 2000, 82-A(10): 1458-1476.
7. Lei W, Wu Z. Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J, 2006, 15(3): 321-326.
8. 吴子祥, 雷伟, 孙明林, 等. 膨胀式椎弓根螺钉脊柱后路内固定的生物力学测试. 医用生物力学, 2004, 19(2): 98-102.
9. 张伟, 雷伟, 吴子祥. 膨胀式椎弓根螺钉的强度测试. 科学技术与工程, 2008, 8(16): 4635-4637, 4653.
10. 石磊, 王陵, 雷伟, 等. 低弹性模量膨胀螺钉在骨质疏松绵羊的体内研究. 中国骨质疏松杂志, 2011, 17(9): 761-765.
11. Liu Z, Piao J, Pang L, et al. The diagnostic criteria for primary osteoporosis and the incidence of osteoporosis in China. J Bone Miner Metab, 2002, 20(4): 181-189.
12. 廖二元. 骨质疏松诊断方法综述. 药品评价, 2012, 9(7): 14-20.
13. Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res, 1986, (203): 7-17.
14. Roy-Camille R, Benazet JP, Desauge JP, et al. Lumbosacral fusion with pedicular screw plating instrumentation. A 10-year follow-up. Acta Orthop Scand Suppl, 1993, 251: 100-104.
15. Ying SH, Kao HC, Chang MC, et al. Fixation strength of PMMA-augmented pedicle screws after depth adjustment in a synthetic bone model of osteoporosis. Orthopedics, 2012, 35(10): e1511-e1516.
16. Higashino K, Kim JH, Horton WC, et al. A biomechanical study of two different pedicle screw methods for fixation in osteoporotic and nonosteoporotic vertebrae. J Surg Orthop Adv, 2012, 21(4): 198-203.
17. Cook SD, Barbera J, Rubi M, et al. Lumbosacral fixation using expandable pedicle screws. An alternative in reoperation and osteoporosis. Spine J, 2001, 1(2): 109-114.
18. 李宏伟, 马远征, 鲍达, 等. 膨胀与普通椎弓根钉治疗脊柱胸腰段骨折合并骨质疏松的对比研究. 中国骨质疏松杂志, 2006, 12(1): 13-16.
19. 王祥善, 孙保国, 刘建民, 等. 膨胀式椎弓根螺钉在骨质疏松椎体的生物力学研究. 实用诊断与治疗杂志, 2005, 19(8): 552-557.
20. Cook SD, Salkeld SL, Stanley T, et al. Biomechanical study of pedicle screw fixation in severely osteoporotic bone. Spine J, 2004, 4(4): 402-408.
21. Wu ZX, Gao MX, Sang HX, et al. Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation: a biomechanical study and a 2-year follow-up of 20 patients. J Surg Res, 2012, 173(1): 91-98.
22. 高明暄, 刘兴炎, 甄平, 等. 膨胀式椎弓根螺钉联合椎间融合器治疗腰椎滑脱症. 中国修复重建外科杂志, 2009, 23(8): 904-908.
23. Koller H, Zenner J, Hitzl W, et al. The impact of a distal expansion mechanism added to a standard pedicle screw on pullout resistance. A biomechanical study. Spine J, 2013, 13(5): 532-541.
24. Kocak T, Däxle M, Reichel H, et al. Alternative technique of cement augmentation of loosened pedicle screws—technical note and presentation of two cases. Acta Chir Orthop Traumatol Cech, 2013, 80(1): 89-91.
25. Li Y, Cheng H, Liu ZC, et al. In vivo study of pedicle screw augmentation using bioactive glass in osteoporosis sheep. J Spinal Disord Tech, 2013, 26(4): E118-E123.
26. Jonvaux J, Hoc T, Budyn E. Analysis of micro fracture in human Haversian cortical bone under compression. Int J Numer Method Biomed Eng, 2012, 28(9): 974-998.
27. 高石军, 魏景超, 陆博, 等. 微骨折结合未培养的兔自体骨髓单个核细胞修复全层关节软骨缺损的实验观察. 中华医学杂志, 2012, 92(35): 2463-2467.

Chinese Journal of Reparative and Reconstructive Surgery

BIOMECHANICAL STUDY ON EFFECTS OF BONE MINERAL DENSITY ON FIXATION STRENGTH OF EXPANSIVE PEDICLE SCREW

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