Department of Chemical and Biomedical Engineering, Cleveland State University, 2121 Euclid Ave, Cleveland, OH, 44115, USA.
Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Skeletal Radiol. 2020 Mar;49(3):375-382. doi: 10.1007/s00256-019-03288-9. Epub 2019 Aug 4.
While percutaneous osteoplasty is common for the treatment of vertebral fractures, low strength of fixation remains a major challenge for use in metastatic weight-bearing bones. With stent, wire, and cement augmentation, this study explores the feasibility of percutaneous reinforced osteoplasty for use in correcting long bone fractures.
Fifteen explanted swine femora were randomly assigned into three groups. Group 1 (n = 5) was native (intact) bones without any intervention (control), group 2 (n = 5) received cementoplasty, and group 3 (n = 5) received stent and wire scaffolding ("rebar") in addition to cementoplasty. All treatment procedures were performed under fluoroscopic guidance. Mechanical strength of fracture fixation was quantified by peak load to failure, stiffness, work done to fracture, and fatigue testing with four-point bend test.
Percutaneous osteoplasty with or without reinforcement was successfully achieved in all specimens. The respective peak load at failure, flexural stiffness, and work done to fracture (mean ± SEM) for group 1 was 2245 ± 168 N, 14.77 ± 1.3 Nm/degree, and 4854 ± 541 Nmm; group 2 was 468 ± 81 N, 3.9 ± 0.5 Nm/degree, and 401 ± 56 Nmm; and group 3 was 594 ± 90 N, 4.42 ± 0.4 Nm/degree, and 522 ± 54 Nmm. The mean cyclic displacement for groups 1, 2, and 3 were 0.15, 0.58, and 0.48 mm, respectively, at 220-240 N loading.
While percutaneous reinforced osteoplasty with stent, wire, and cement augmentation resulted in improved mechanical strength in restored bones, it did not differ significantly from specimens that underwent exclusive cementoplasty. With the improvement of fracture strength, the concept may be applicable for prevention or treatment of pathological fractures.
虽然经皮骨成形术常用于治疗椎体骨折，但固定强度低仍然是在转移性承重骨中应用的主要挑战。本研究通过支架、钢丝和水泥增强，探讨经皮强化骨成形术用于矫正长骨骨折的可行性。
15 根取出的猪股骨随机分为三组。第 1 组（n=5）为未干预的天然（完整）骨（对照），第 2 组（n=5）接受骨水泥成形术，第 3 组（n=5）除骨水泥成形术外，还接受支架和钢丝支架（“钢筋”）。所有治疗程序均在透视引导下进行。通过四点弯曲试验的失效峰值负荷、刚性、断裂功和疲劳试验来量化骨折固定的机械强度。
所有标本均成功完成经皮骨成形术，或不进行强化。第 1 组的失效峰值负荷、弯曲刚度和断裂功（平均值±SEM）分别为 2245±168 N、14.77±1.3 Nm/度和 4854±541 Nmm；第 2 组分别为 468±81 N、3.9±0.5 Nm/度和 401±56 Nmm；第 3 组分别为 594±90 N、4.42±0.4 Nm/度和 522±54 Nmm。第 1、2 和 3 组的平均循环位移分别为 0.15、0.58 和 0.48mm，在 220-240N 加载下。
虽然支架、钢丝和水泥增强的经皮强化骨成形术可改善修复骨的机械强度，但与仅接受骨水泥成形术的标本相比，差异无统计学意义。随着骨折强度的提高，该概念可能适用于病理性骨折的预防或治疗。
