Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah, United States of America.
Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, The University of Utah, Salt Lake City, Utah, United States of America.
PLoS One. 2019 Oct 25;14(10):e0221850. doi: 10.1371/journal.pone.0221850. eCollection 2019.
Percutaneous osseointegrated (OI) devices for amputees are metallic endoprostheses, that are surgically implanted into the residual stump bone and protrude through the skin, allowing attachment of an exoprosthetic limb. In contrast to standard socket suspension systems, these percutaneous OI devices provide superior attachment platforms for artificial limbs. However, bone adaptation, which includes atrophy and/or hypertrophy along the extent of the host bone-endoprosthetic interface, is seen clinically and depends upon where along the bone the device ultimately transfers loading forces to the skeletal system. The goal of this study was to determine if a percutaneous OI device, designed with a porous coated distal region and an end-loading collar, could promote and maintain stable bone attachment. A total of eight, 18 to 24-month old, mixed-breed sheep were surgically implanted with a percutaneous OI device. For 24-months, the animals were allowed to bear weight as tolerated and were monitored for signs of bone remodelling. At necropsy, the endoprosthesis and the surrounding tissues were harvested, radiographically imaged, and histomorphometrically analyzed to determine the periprosthetic bone adaptation in five animals. Bone growth into the porous coating was achieved in all five animals. Serial radiographic data showed stress-shielding related bone adaptation occurs based on the placement of the endoprosthetic stem. When collar placement and achieved end-bearing against the transected bone, distal bone conservation/hypertrophy was observed. The results supported the use of a distally loading and distally porous coated percutaneous OI device to achieve distal host bone maintenance.
对于截肢者，经皮骨整合（OI）装置是一种金属内假体，通过手术植入残肢骨内并穿过皮肤突出，从而连接外假体肢体。与标准的插座悬挂系统相比，这些经皮 OI 装置为假肢提供了更好的附着平台。然而，临床可见骨适应性，包括沿宿主骨-内假体界面的萎缩和/或肥大，这取决于设备最终将加载力转移到骨骼系统的骨骼位置。本研究的目的是确定一种经皮 OI 装置，其设计带有多孔涂层的远端区域和末端加载套环，是否可以促进和维持稳定的骨附着。总共对 8 只 18 至 24 个月大的杂种羊进行了经皮 OI 装置的手术植入。在 24 个月的时间里，允许动物根据耐受情况承重，并监测骨重塑的迹象。在尸检时，取出内假体和周围组织，进行放射影像学成像和组织形态计量学分析，以确定五只动物的假体周围骨适应性。所有五只动物的多孔涂层内均有骨生长。连续的放射学数据表明，根据内假体干的位置，发生了与应力屏蔽相关的骨适应性。当套环放置并实现对截断骨的末端承重时，观察到远端骨保存/肥大。结果支持使用远端加载和远端多孔涂层经皮 OI 装置来实现远端宿主骨的维持。
