Manon Julie, Englebert Alexandre, Evrard Robin, Schubert Thomas, Cornu Olivier
Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Bruxelles, Belgium.
Service de Chirurgie Orthopédique et Traumatologique, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
Front Bioeng Biotechnol. 2024 Oct 17;12:1478676. doi: 10.3389/fbioe.2024.1478676. eCollection 2024.
Critical-size bone defects (CSBDs) pose significant challenges in clinical orthopaedics and traumatology. Developing reliable preclinical models that accurately simulate human conditions is crucial for translational research. This study addresses the need for a reliable preclinical model by evaluating the design and efficacy of a custom-made 3D-printed intramedullary nail (IMN) specifically for CSBDs in minipigs. The study aims to answer the following questions: Can a custom-made 3D-printed IMN be designed for femoral osteosynthesis in minipigs? Does the use of the custom-made IMN result in consistent and reproducible surgical procedure, particularly in the creation and fixation of CSBDs? Can the custom-made IMN effectively treat and promote bone consolidation of CSBDs?
The custom-made 3D-printed IMN can be designed to effectively create, fix and treat CSBDs in minipigs, resulting in consistent surgical outcomes.
The IMN was designed based on CT scans of minipig femurs, considering factors such as femoral curvature, length, and medullary canal diameters. It was 3D-printed in titanium and evaluated through both and testing. Female Aachen minipigs underwent bilateral femoral surgeries to create and fix CSBDs using the custom-made IMN. Post-operative follow-up included X-rays and CT scans every 2 weeks, with manual examination of explanted femurs to assess consolidation and mechanical stability after 3 months.
The custom-made IMN effectively fitted the minipig femoral anatomy and facilitated reproducible surgical outcomes. Symmetric double osteotomies were successfully performed, and allografts showed minimal morphological discrepancies. However, proximal fixation faced challenges, leading to non-union in several cases, while most distal osteotomy sites achieved stable consolidation.
The custom-made 3D-printed IMN demonstrated potential in modelling and treating CSBDs in minipigs. While the design effectively supported distal bone healing, issues with proximal fixation highlight the need for further refinements. Potential improvements include better screw placement, additional mechanical support, and adaptations such as a reduction clamp or a cephalic screw to enhance stability and distribute forces more effectively.
临界尺寸骨缺损（CSBDs）在临床骨科和创伤学中构成了重大挑战。开发能够准确模拟人体状况的可靠临床前模型对于转化研究至关重要。本研究通过评估专门为小型猪CSBDs定制的3D打印髓内钉（IMN）的设计和功效，满足了对可靠临床前模型的需求。该研究旨在回答以下问题：能否设计一种定制的3D打印IMN用于小型猪的股骨接骨术？使用定制的IMN是否能带来一致且可重复的手术过程，特别是在CSBDs的创建和固定方面？定制的IMN能否有效治疗并促进CSBDs的骨愈合？
定制的3D打印IMN能够设计用于在小型猪中有效创建、固定和治疗CSBDs，从而产生一致的手术结果。
IMN基于小型猪股骨的CT扫描进行设计，考虑了股骨曲率、长度和髓腔直径等因素。它采用钛进行3D打印，并通过体外和体内测试进行评估。雌性亚琛小型猪接受双侧股骨手术，使用定制的IMN创建并固定CSBDs。术后随访包括每2周进行X射线和CT扫描，3个月后对取出的股骨进行手动检查以评估骨愈合和机械稳定性。
定制的IMN有效地适配了小型猪股骨解剖结构，并促进了可重复的手术结果。成功进行了对称双截骨术，同种异体移植物显示出最小的形态差异。然而，近端固定面临挑战，导致几例骨不连，而大多数远端截骨部位实现了稳定的骨愈合。
定制的3D打印IMN在小型猪CSBDs的建模和治疗中显示出潜力。虽然该设计有效地支持了远端骨愈合，但近端固定问题凸显了进一步改进的必要性。潜在的改进包括更好的螺钉放置、额外的机械支撑以及诸如复位夹或头端螺钉等调整，以增强稳定性并更有效地分散力量。
