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.	张智海, 张智若, 刘忠厚, 等. 中国大陆地区以-2.0SD 为诊断标准的骨质疏松症发病率回顾性研究. 中国骨质疏松杂志, 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.	万世勇, 雷伟, 吴子祥, 等. 膨胀式椎弓根螺钉在骨螺钉界面的显微 CT 评价及组织学分析. 中华外科杂志, 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.	刘瑶瑶, 代飞, 孙东, 等. 不同量骨水泥强化新型空心椎弓根螺钉的体外生物力学研究. 第三军医大学学报, 2012, 34(16): 1626-1629.0.
8.	刘欣春, 朱悦. 椎弓根钉骨水泥强化技术应用进展. 中国修复重建外科杂志, 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.	潘显明, 谭映军, 张波, 等. 椎弓根螺钉的螺纹形状与拔钉生物力学. 第四军医大学学报, 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. 张智海, 张智若, 刘忠厚, 等. 中国大陆地区以-2.0SD 为诊断标准的骨质疏松症发病率回顾性研究. 中国骨质疏松杂志, 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. 万世勇, 雷伟, 吴子祥, 等. 膨胀式椎弓根螺钉在骨螺钉界面的显微 CT 评价及组织学分析. 中华外科杂志, 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. 刘瑶瑶, 代飞, 孙东, 等. 不同量骨水泥强化新型空心椎弓根螺钉的体外生物力学研究. 第三军医大学学报, 2012, 34(16): 1626-1629.0.
8. 刘欣春, 朱悦. 椎弓根钉骨水泥强化技术应用进展. 中国修复重建外科杂志, 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. 潘显明, 谭映军, 张波, 等. 椎弓根螺钉的螺纹形状与拔钉生物力学. 第四军医大学学报, 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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