Biomechanical study of a newly-designed Y type pedicle screw in osteoporotic synthetic bone_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Tengyu , CHEN Jiajun , ZHOU Xin , CAO Chunfeng ,  WANG Qunbo

Department of Orthopedics, Yongchuan Hospital, Chongqing Medical University, Yongchuan Chongqing, 402160, P.R.China;

Corresponding?author：

WANG Qunbo, Email: wqb631113@163.com

Keywords：

Osteoporotic synthetic bone; Y type pedicle screw; biomechanical stability

DOI：

10.7507/1002-1892.201705069

Video：

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Objective To evaluate the biomechanical stability of a newly-designed Y type pedicle screw (YPS) in osteoporotic synthetic bone. Methods The osteoporotic synthetic bone were randomly divided into 3 groups (n=20). A pilot hole, 3.0 mm in diameter and 30.0 mm in deep, was prepared in these bones with the same method. The YPS, expansive pedicle screw (EPS), and bone cement-injectable cannulated pedicle screw (CICPS) were inserted into these synthetic bone through the pilot hole prepared. X-ray film examination was performed after 12 hours; the biomechanical stability of YPS, EPS, and CICPS groups was tested by the universal testing machine (E10000). The test items included the maximum axial pullout force, the maximum running torque, and the maximum periodical anti-bending. Results X-ray examination showed that in YPS group, the main screw and the core pin were wrapped around the polyurethane material, the core pin was formed from the lower 1/3 of the main screw and formed an angle of 15° with the main screw, and the lowest point of the inserted middle core pin was positioned at the same level with the main screw; in EPS group, the tip of EPS expanded markedly and formed a claw-like structure; in CICPS group, the bone cement was mainly distributed in the front of the screw and was dispersed in the trabecular bone to form a stable screw-bone cement-trabecular complex. The maximum axial pullout force of YPS, EPS, and CICPS groups was (98.43±8.26), (77.41±11.41), and (186.43±23.23) N, respectively; the maximum running torque was (1.42±0.33), (0.96±0.37), and (2.27±0.39) N/m, respectively; and the maximum periodical anti-bending was (67.49±3.02), (66.03±2.88), and (143.48±4.73) N, respectively. The above indexes in CICPS group were significantly higher than those in YPS group and EPS group (P<0.05); the maximum axial pullout force and the maximum running torque in YPS group were significantly higher than those in EPS group (P<0.05), but there was no significant difference in the maximum periodical anti-bending between YPS group and EPS group (P>0.05). Conclusion Compared with EPS, YPS can effectively enhance the maximum axial pullout force and maximum rotation force in the module, which provides a new idea for the design of screws and the choice of different fixation methods under the condition of osteoporosis.

Citation： WANG Tengyu, CHEN Jiajun, ZHOU Xin, CAO Chunfeng, WANG Qunbo. Biomechanical study of a newly-designed Y type pedicle screw in osteoporotic synthetic bone. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(10): 1231-1235. doi: 10.7507/1002-1892.201705069 Copy

1.	張智海, 張智若, 劉忠厚, 等. 中國大陸地區以-2.0SD 為診斷標準的骨質疏松癥發病率回顧性研究. 中國骨質疏松雜志, 2016, 22(1): 1-8.0.
2.	Ponnusamy KE, Iyer S, Gupta G, et al. Instrumentation of the osteoporotic spine: biomechanical and clinical considerations. Spine J, 2011, 11(1): 54-63.
3.	Lei W, Wu Z. Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J, 2006, 15(3): 321-326.
4.	萬世勇, 雷偉, 吳子祥, 等. 膨脹式椎弓根螺釘在骨螺釘界面的顯微 CT 評價及組織學分析. 中華外科雜志, 2007, 45(18): 1271-1273.0.
5.	Wu ZX, Gong FT, Liu L, et al. A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws. Arch Orthop Trauma Surg, 2012, 132(4): 471-476.
6.	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.
7.	劉瑤瑤, 代飛, 孫東, 等. 不同量骨水泥強化新型空心椎弓根螺釘的體外生物力學研究. 第三軍醫大學學報, 2012, 34(16): 1626-1629.0.
8.	劉欣春, 朱悅. 椎弓根釘骨水泥強化技術應用進展. 中國修復重建外科雜志, 2013, 27(10): 1267-1272.0.
9.	Schatlo B, Molliqaj G, Cuvinciuc V, et al. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. J Neurosurg Spine, 2014, 20(6): 636-643.
10.	Yilmaz G, Hwang S, Oto M, et al. Surgical treatment of scoliosis in osteogenesis imperfecta with cement-augmented pedicle screw instrumentation. J Spinal Disord Tech, 2014, 27(3): 174-180.
11.	Kiner DW, Wybo CD, Sterba W, et al. Biomechanical analysis of different techniques in revision spinal instrumentation: larger diameter screws versus cement augmentation. Spine (Phila Pa 1976), 2008, 33(24): 2618-2622.
12.	Brantley AG, Mayfield JK, Koeneman JB, et al. The effects of pedicle screw fit. An in vitro study. Spine (Phila Pa 1976), 1994, 19(15): 1752-1758.
13.	潘顯明, 譚映軍, 張波, 等. 椎弓根螺釘的螺紋形狀與拔釘生物力學. 第四軍醫大學學報, 2002, 23(5): 447-450.0.
14.	Bostan B, Esenkaya I, Gunes T, et al. A biomechanical comparison of polymethylmethacrylate-reinforced and expansive pedicle screws in pedicle-screw revisions. Acta Orthop Traumatol Turc, 2009, 43(3): 272-276.
15.	Liu D, Zhang XJ, Liao DF, et al. Biomechanical Comparison of Pedicle Screw Augmented with Different Volumes of Polymethylmethacrylate in Osteoporotic and Severely Osteoporotic Synthetic Bone Blocks in Primary Implantation: An Experimental Study. Biomed Res Int, 2016, 2016: 9627504.
16.	Chen LH, Tai CL, Lai PL, et al. Pullout strength for cannulated pedicle screws with bone cement augmentation in severely osteoporotic bone: influences of radial hole and pilot hole tapping. Clin Biomech (Bristol, Avon), 2009, 24(8): 613-618.
17.	Chen LH, Tai CL, Lee DM, et al. Pullout strength of pedicle screws with cement augmentation in severe osteoporosis: a comparative study between cannulated screws with cement injection and solid screws with cement pre-filling. BMC Musculoskelet Disord, 2011, 12: 33.

1. 張智海, 張智若, 劉忠厚, 等. 中國大陸地區以-2.0SD 為診斷標準的骨質疏松癥發病率回顧性研究. 中國骨質疏松雜志, 2016, 22(1): 1-8.0.
2. Ponnusamy KE, Iyer S, Gupta G, et al. Instrumentation of the osteoporotic spine: biomechanical and clinical considerations. Spine J, 2011, 11(1): 54-63.
3. Lei W, Wu Z. Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J, 2006, 15(3): 321-326.
4. 萬世勇, 雷偉, 吳子祥, 等. 膨脹式椎弓根螺釘在骨螺釘界面的顯微 CT 評價及組織學分析. 中華外科雜志, 2007, 45(18): 1271-1273.0.
5. Wu ZX, Gong FT, Liu L, et al. A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws. Arch Orthop Trauma Surg, 2012, 132(4): 471-476.
6. 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.
7. 劉瑤瑤, 代飛, 孫東, 等. 不同量骨水泥強化新型空心椎弓根螺釘的體外生物力學研究. 第三軍醫大學學報, 2012, 34(16): 1626-1629.0.
8. 劉欣春, 朱悅. 椎弓根釘骨水泥強化技術應用進展. 中國修復重建外科雜志, 2013, 27(10): 1267-1272.0.
9. Schatlo B, Molliqaj G, Cuvinciuc V, et al. Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison. J Neurosurg Spine, 2014, 20(6): 636-643.
10. Yilmaz G, Hwang S, Oto M, et al. Surgical treatment of scoliosis in osteogenesis imperfecta with cement-augmented pedicle screw instrumentation. J Spinal Disord Tech, 2014, 27(3): 174-180.
11. Kiner DW, Wybo CD, Sterba W, et al. Biomechanical analysis of different techniques in revision spinal instrumentation: larger diameter screws versus cement augmentation. Spine (Phila Pa 1976), 2008, 33(24): 2618-2622.
12. Brantley AG, Mayfield JK, Koeneman JB, et al. The effects of pedicle screw fit. An in vitro study. Spine (Phila Pa 1976), 1994, 19(15): 1752-1758.
13. 潘顯明, 譚映軍, 張波, 等. 椎弓根螺釘的螺紋形狀與拔釘生物力學. 第四軍醫大學學報, 2002, 23(5): 447-450.0.
14. Bostan B, Esenkaya I, Gunes T, et al. A biomechanical comparison of polymethylmethacrylate-reinforced and expansive pedicle screws in pedicle-screw revisions. Acta Orthop Traumatol Turc, 2009, 43(3): 272-276.
15. Liu D, Zhang XJ, Liao DF, et al. Biomechanical Comparison of Pedicle Screw Augmented with Different Volumes of Polymethylmethacrylate in Osteoporotic and Severely Osteoporotic Synthetic Bone Blocks in Primary Implantation: An Experimental Study. Biomed Res Int, 2016, 2016: 9627504.
16. Chen LH, Tai CL, Lai PL, et al. Pullout strength for cannulated pedicle screws with bone cement augmentation in severely osteoporotic bone: influences of radial hole and pilot hole tapping. Clin Biomech (Bristol, Avon), 2009, 24(8): 613-618.
17. Chen LH, Tai CL, Lee DM, et al. Pullout strength of pedicle screws with cement augmentation in severe osteoporosis: a comparative study between cannulated screws with cement injection and solid screws with cement pre-filling. BMC Musculoskelet Disord, 2011, 12: 33.

Chinese Journal of Reparative and Reconstructive Surgery

Biomechanical study of a newly-designed Y type pedicle screw in osteoporotic synthetic bone

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