Grisez Brian T, Hanselman Andrew E, Boukhemis Karim W, Lalli Trapper A J, Lindsey Brock A
Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV 26506-9196, USA.
Adv Orthop. 2018 Sep 13;2018:4625967. doi: 10.1155/2018/4625967. eCollection 2018.
Traditional above-the-knee amputation prosthetics utilize a stump-socket interface that is well-known for skin/socket problems, sitting difficulty, disuse osteopenia, and increased work of ambulation. As a result, we evaluated a novel osseointegrated transcutaneous implant in a large animal. The implant was designed to promote osseointegration at the bone-implant interface and minimize complications. As proof of concept, four Dorset sheep underwent a two-stage surgery for forelimb placement of an osseointegrated transcutaneous implant utilizing Compress® technology (Biomet, Inc., Warsaw, IN). Two sheep received a long anchor plug (90 mm long x 9 mm in diameter) and two received a short anchor plug (46 mm long x 9 mm in diameter). Sixteen weeks after the initial surgery, the operative limbs, along with the attached implant, underwent radiographic and histological analysis for osseointegration. Periprosthetic fractures occurred in the two animals that received the longer internal prosthesis; one healed with splinting and the other animal underwent a second surgical procedure to advance the amputation site more proximal. No fractures occurred in the shorter internal prosthesis group. There was no histological evidence of infection and none of the transcutaneous adapters failed. Bone-implant osseointegration was demonstrated in two of three limbs that underwent histological analysis. This unique implant demonstrated osseointegration without transcutaneous adapter failure, all while displaying minimal infection risk from the outside environment. Although it involved short-term follow-up in a limited number of animals, this pilot study provides a platform for further investigation into the valid concept of using Compress® technology as an endo-exo device.
传统的膝上截肢假肢采用的残肢-接受腔界面因皮肤/接受腔问题、坐姿困难、废用性骨质减少和步行工作量增加而闻名。因此，我们在大型动物身上评估了一种新型的骨整合经皮植入物。该植入物旨在促进骨-植入物界面的骨整合并将并发症降至最低。作为概念验证，四只多塞特羊接受了两阶段手术，使用Compress®技术（Biomet公司，印第安纳州华沙）在前肢植入骨整合经皮植入物。两只羊接受了长锚固栓（90毫米长×9毫米直径），两只接受了短锚固栓（46毫米长×9毫米直径）。初次手术后16周，对手术肢体及其附着的植入物进行了影像学和组织学分析以评估骨整合情况。接受较长内部假体的两只动物发生了假体周围骨折；一只通过夹板固定愈合，另一只动物接受了第二次手术，将截肢部位向近端推进。较短内部假体组未发生骨折。没有感染的组织学证据，且所有经皮适配器均未失效。在接受组织学分析的三个肢体中的两个中证实了骨-植入物骨整合。这种独特的植入物显示出骨整合且经皮适配器未失效，同时对外界环境的感染风险最小。尽管该研究对数量有限的动物进行了短期随访，但这项初步研究为进一步研究将Compress®技术用作内外结合装置的有效概念提供了一个平台。
