Direct pedicle screw insertion pullout strength / Resistência ao arrancamento do parafuso pedicular de inserção direta

ABSTRACT Objective: Study the in vitro pullout strength of SpineGuard/Zavation Dynamic Surgical Guidance Z-Direct Screw (DSG Screw), a screw pedicle designed to be inserted using a direct insertion technique. Methods: DSG Screws of 5.5 mm and 6.5 mm were introduced into polyurethane blocks with a density of 10 PCF (0,16 g/cm3). According to the experimental group, screws were inserted without pilot hole, with pilot without tapping, undertapping and line-to-line tapping. Screw pullout tests were performed using a universal test machine after screw insertion into polyurethane blocks. Results: Screws inserted directly into the polyurethane blocks without pilot hole and tapping showed a statistically higher pullout strength. Insertion of the screw without tapping or with undertapping increases the pullout screw strength compared to line-to-line tapping. Conclusion: DSG Screw showed the highest pullout strength after its insertion without pilot hole and tapping. Level of Evidence V, Expert Opinion.

RESUMO Objetivo: Estudar a resistência ao arrancamento in vitro do parafuso de inserção direta da SpineGuard/Zavation (parafuso DSG), um parafuso pedicular projetado para ser inserido usando a técnica de inserção direta. Métodos: Parafusos DSG de 5,5 mm e 6,5 mm foram introduzidos em blocos de poliuretano com densidade de 10 PCF (0,16 g/cm3). De acordo com o grupo experimental, os parafusos foram inseridos sem orifício piloto, com orifício e sem macheamento e macheamento diâmetro inferior com mesma geometria. Os testes de resistência dos parafusos foram realizados usando uma máquina de teste universal após a inserção dos parafusos nos blocos de poliuretano. Resultados: Os parafusos inseridos diretamente nos blocos de poliuretano sem orifício piloto e sem macheamento apresentaram uma resistência de arrancamento com significância estatística maior. A inserção do parafuso sem macheamento ou com macheamento com diâmetro inferior apresenta maior resistência ao arrancamento em comparação com o macheamento do mesmo diâmetro. Conclusão: O parafuso DSG apresentou a maior resistência ao arrancamento após sua inserção sem orifício piloto e sem macheamento. Nível de Evidência V, Opinião do Especialista.

Bone callus formation is highly disrupted by dietary restriction in growing rats sustaining a femoral fracture

Abstract Purpose: To evaluate the effects of food restriction on fracture healing in growing rats. Methods: Sixty-eight male Wistar rats were assigned to two groups: (1) Control and (2) Dietary restriction. After weaning the dietary restricted animals were fed ad libitum for 42 days with 50% of the standard chow ingested by the control group. Subsequently, the animals underwent bone fracture at the diaphysis of the right femur, followed by surgical stabilization of bone fragments. On days 14 and 28 post-fracture, the rats were euthanized, and the fractured femurs were dissected, the callus was analyzed by dual-energy X-ray absorptiometry, micro-computed tomography, histomorphometry, mechanical tests, and gene expression. Results: Dietary restriction decreased body mass gain and resulted in several phenotypic changes at the bone callus (a delay in cell proliferation and differentiation, lower rate of newly formed bone and collagen deposition, reductions in bone callus density and size, decrease in tridimensional callus volume, deterioration in microstructure, and reduction in bone callus strength), together with the downregulated expression of osteoblast-related genes. Conclusion: Dietary restriction had detrimental effects on osseous healing, with a healing delay and a lower quality of bone callus formation.

Undernutrition impairs the quality of growth plate and trabecular and cortical bones in growing rats

Abstract Purpose: To investigate the effects of dietary restriction on the growth plate and long bone tissue in growing rats. Methods: Sixty male Wistar rats were randomly assigned to two groups: Control (Con) and Diet-restricted (Res). After weaning, the Res rats were offered 50% of the chow ingested by the control (ad libitum food intake). The animals were subdivided into two subgroups with follow-ups up to 56 or 70 days. After euthanasia, the growth plate of tibias was analyzed by histomorphometry, micro-computed tomography, and mechanical test. The trabecular and compact bones were evaluated by histomorphometry, dual-energy X-ray absorptiometry, and micro-computed tomography (μCT). Real-time PCR was used to analyze gene expression. Results: Although dietary restriction did not alter gene expression, several phenotypic changes were seen in the growth plate; i.e., decrease in volume, reduction in total area and height, decrease in the area ossified zones, mechanical weakening, reduction in mass of trabecular and cortical bone, lower bone density, deterioration of the trabecular and cortical microarchitecture, and trabeculae with lower collagen deposition. Conclusion: Dietary restriction had severe detrimental effects on the growth plate and trabecular and cortical bone.

Nandrolone decanoate appears to increase bone callus formation in young adult rats after a complete femoral fracture

Abstract Purpose: To evaluate the influence of nandrolone decanoate on fracture healing and bone quality in normal rats. Methods: Male rats were assigned to four groups (n=28/group): Control group consisting of animals without any intervention, Nandrolone decanoate (DN) group consisting of animals that received intramuscular injection of nandrolone decanoate, Fracture group consisting of animals with a fracture at the mid-diaphysis of the femur, and Fracture and nandrolone decanoate group consisting of animals with a femur fracture and treatment with nandrolone decanoate. Fractures were created at the mid-diaphysis of the right femur by a blunt trauma and internally fixed using an intramedullary steel wire. The DN was injected intramuscularly twice per week (10 mg/kg of body mass). The femurs were measured and evaluated by densitometry and mechanical resistance after animal euthanasia. The newly formed bone and collagen type I levels were quantified in the callus. Results: The treated animals had longer femurs after 28 days. The quality of the intact bone was not significantly different between groups. The bone callus did show a larger mass in the treated rats. Conclusion: The administration of nandrolone decanoate did not affect the quality of the intact bone, but might have enhanced the bone callus formation.

Hepatic Osteodystrophy: The Mechanism of Bone Loss in Hepatocellular Disease and the Effects of Pamidronate Treatment

OBJECTIVES: The present study was designed to evaluate the bone phenotypes and mechanisms involved in bone disorders associated with hepatic osteodystrophy. Hepatocellular disease was induced by carbon tetrachloride (CCl4). In addition, the effects of disodium pamidronate on bone tissue were evaluated. METHODS: The study included 4 groups of 15 mice: a) C = mice subjected to vehicle injections; b) C+P = mice subjected to vehicle and pamidronate injections; c) CCl4+V = mice subjected to CCl4 and vehicle injections; and d) CCl4+P = mice subjected to CCl4 and pamidronate injections. CCl4 or vehicle was administered for 8 weeks, while pamidronate or vehicle was injected at the end of the fourth week. Bone histomorphometry and biomechanical analysis were performed in tibiae, while femora were used for micro-computed tomography and gene expression. RESULTS: CCl4 mice exhibited decreased bone volume/trabecular volume and trabecular numbers, as well as increased trabecular separation, as determined by bone histomorphometry and micro-computed tomography, but these changes were not detected in the group treated with pamidronate. CCl4 mice showed increased numbers of osteoclasts and resorption surface. High serum levels of receptor activator of nuclear factor-κB ligand and the increased expression of tartrate-resistant acid phosphatase in the bones of CCl4 mice supported the enhancement of bone resorption in these mice. CONCLUSION: Taken together, these results suggest that bone resorption is the main mechanism of bone loss in chronic hepatocellular disease in mice.

Whole-body vibration improves fracture healing and bone quality in rats with ovariectomy-induced osteoporosis

PURPOSE: To investigate the effect of vibration therapy on the bone callus of fractured femurs and the bone quality of intact femurs in ovariectomized rats. METHODS: Fifty-six rats aged seven weeks were divided into four groups: control with femoral fracture (CON, n=14), ovariectomized with femoral fracture (OVX, n=14), control with femoral fracture plus vibration therapy (CON+VT, n=14), and ovariectomized with femoral fracture plus vibration therapy (OVX+VT, n=14). Three months after ovariectomy or sham surgery, a complete fracture was produced at the femoral mid-diaphysis and stabilized with a 1-mm-diameter intramedullary Kirschner wire. X-rays confirmed the fracture alignment and fixation. Three days later, the VT groups underwent vibration therapy (1 mm, 60 Hz for 20 minutes, three times per week for 14 or 28 days). The bone and callus quality were assessed by densitometry, three-dimensional microstructure, and mechanical test. RESULTS : Ovariectomized rats exhibited a substantial loss of bone mass and severe impairment in bone microarchitecture, both in the non-fractured femur and the bone callus. Whole-body vibration therapy exerted an important role in ameliorating the bone and fracture callus parameters in the osteoporotic bone. CONCLUSION: Vibration therapy improved bone quality and the quality of the fracture bone callus in ovariectomized rats.

Análise fotoelástica da região inferior do corpo vertebral L4 / Photoelastic analisys in the lower region of vertebral body L4

OBJETIVO: Analisar as tensões geradas no corpo vertebral L4 quando submetida à força de compressão, utilizando a técnica da fotoelasticidade de transmissão. MÉTODOS: Doze modelos fotoelásticos foram utilizados e divididos em três grupos, sendo cada grupo formado por quatro modelos, de acordo com a localização do corte sagital nas vértebras L4-L5 (cortes A, B e C). A simulação foi realizada utilizando uma força compressão de 15 N e as ordens de franjas foram avaliadas no corpo vertebral L4 utilizando o método de compensação de Tardy. RESULTADOS: A análise fotoelástica mostrou que em geral, as tensões se distribuíram de forma homogênea nos corpos vertebrais. As tensões no corte C foram maiores que no B, que por sua vez foram maiores que no corte A. CONCLUSÃO: A região posterior do corpo vertebral L4, principalmente no corte C, apresentou maiores concentrações de tensões, sendo assim, é a área mais susceptível à fratura vertebral e à espondilolistese. Análises econômicas e de decisão. Desenvolvimento de modelo econômico ou de decisão, Nível de evidência I.

OBJECTIVE: to analyze the shear forces on the vertebral body L4 when submitted to a compression force by means of transmission photoelasticity. METHODS: Twelve photoelastic models were divided into three groups, with four models per group, according to the positioning of the sagittal section vertebrae L4-L5 (sections A, B and C). The simulation was performed using a 15N compression force, and the fringe orders were evaluated in the vertebral body L4 by the Tardy compensation method. RESULTS: Photoelastic analysis showed, in general, a homogeneous distribution in the vertebral bodies. The shear forces were higher in section C than B, and higher in B than A. CONCLUSION: The posterior area of L4, mainly in section C, showed higher shear concentrations, corresponding to a more susceptible area for bone fracture and spondylolisthesis. Economic and Decision Analyses - Development of an Economic or Decision Model. Level I.

Análise biomecânica e histológica de músculos gastrocnêmios de ratas submetidas à lesão muscular e tratados com laserterapia de baixa intensidade / Biomechanical and histological analysis of the gastrocnemius in rats subjected to muscle injury and treatment with low-level laser therapy

OBJETIVO: Avaliar, mecânica e histologicamente, a aplicação do laser terapêutico de baixa potência, no processo reparativo de lesões provocadas por impacto em músculos gastrocnêmios de ratas. MÉTODOS: 45 ratas Wistar foram divididas em três grupos (n=15/grupo): C (controle, sem lesão), LM (lesão muscular) e LM-L (lesão muscular e laserterapia). A lesão muscular experimental foi produzida pela queda de uma carga de 250 g, de uma altura de 30cm, diretamente sobre o músculo. Os animais do grupo LM-L foram submetidos à aplicação de laser 960nm, 2J/cm², durante três dias, duas aplicações por dia, no local da lesão. Foi realizado ensaio mecânico na máquina universal de ensaio Emic®. RESULTADOS: As médias dos valores de força máxima foram: (35,70 ± 2,69) N no grupo C, (31,77 ± 2,59) N no grupo LM e (34,36 ± 3,63) N no grupo LM-L, com diferença estatística significativa nos grupos C e LM (p < 0,05). As médias dos valores de rigidez relativa foram (3,75 ± 0,98) N/mm no grupo C, (3,84 ± 0,32) N/mm no grupo LM e (4,43 ± 0,68) N/mm no grupo LM-L, sem diferença estatística (p > 0,05). A análise histológica evidenciou presença de vasos sanguíneos no grupo LM-L e hematomas em processo de reparação. CONCLUSÃO: A laserterapia influencia de forma positiva no processo de regeneração da lesão muscular.

OBJETIVE: To evaluate, by means of biomechanical and histological analysis, the effect of low-level laser therapy on the gastrocnemius of rats subjected to muscle lesion by impact. METHODS: 45 female Wistar rats, weighing 250g, were divided into 3 groups (n=15/group): C (control), ML (animals submitted to muscle lesion) and ML-L (animals submitted to muscle lesion and laser therapy). The animals from groups ML and ML-L were subjected to an experimental muscle lesion by means of an impact of a 250g load, released from a height of 30 cm, directly on the gastrocnemius. The animals from group ML-L were submitted to a treatment with a 960 Nm laser, 2 J/cm², for 3 days, twice a day. RESULTS: The mechanical tests were performed on the Universal Testing Machine. The average values of maximum force were: 35.70 (± 2.69) N in group C, 31.77 (± 2.59) N in group ML and 34.36 (± 3.63) N in group ML-L, with a statistically significant difference between groups C and ML (p < 0.05). The average values of stiffness were: 3.75 (± 0.98) N/mm in group C, 3.84 (± 0.32) N/mm in group ML and 4.43 (± 0.68) N/mm in group ML-L, with no statistically significant differences (p>0.05). Histological analysis showed a presence of blood vessels in group ML-L and a hematoma in the healing stage. CONCLUSION: Treatment with low-level laser had a positive effect in the healing process of muscle injury.

Efeitos da aplicação do laser de baixa potência na regeneração do nervo isquiático de ratos / Effects of low-power laser on injured rat sciatic nerve regeneration

Os nervos periféricos sofrem constantes lesões de origem traumática, o que resulta em perdas funcionais. A terapia com laser de baixa potência vem sendo utilizada para minimizar os efeitos maléficos da inflamação e acelerar o processo de cicatrização dos tecidos lesados. Este estudo teve como objetivo verificar o efeito da irradiação do laser 830 nm no comportamento do nervo isquiático de ratos submetido a esmagamento. Foram utilizados 20 ratos, todos tendo tido o nervo isquiático esmagado, divididos em 4 grupos (n=5): P7 e P14, tratamento placebo por 7 e 14 dias; L7 e L14, tratamento por laser (dosagem de 4 J/cm²) por 7 e 14 dias. Os animais dos grupos P7 e P14 foram submetidos aos mesmos procedimentos, mas com o laser desligado. Os parâmetros analisados foram presença de infiltrado inflamatório e fibroblastos, destruição da bainha de mielina e degeneração axonal. Na análise estatística foi observada diferença estatística com relação a três parâmetros: os animais do grupo L14 apresentaram maior quantidade de fibroblastos (p=0,0001), menor degeneração da bainha de mielina (p=0,007) e menor quantidade de infiltrado inflamatório (p=0,001). A aplicação do laser de baixa potência contribuiu para a redução do processo inflamatório decorrente da lesão do nervo isquiático de ratos...

Peripheral nerves are commonly subject to traumatic injuries, leading to functional loss. Low-power laser therapy has been used in order to minimize harmful effects of inflammation and to accelerate healing of injured tissues. The purpose of this study was to assess the effect of 830 nm-laser irradiation on rat sciatic nerves submitted to crush. Twenty male Wistar rats had their sciatic nerve crushed and were divided into 4 groups (n=5): Sham7 and Sham14, placebo-treated for 7 and 14 days; L7 and L14, laser-treated (at 4 J/cm²) for 7 and 14 days. Sham group animals were submitted to the same procedures, but with the laser turned off. Assessed parameters were inflammatory infiltrates, fibroblasts, myelin sheath destruction, and axonal degeneration. The statistical analysis showed significant differences in three parameters: L14 animals showed more fibroblasts (p=0.0001), lesser myelin sheath degeneration (p=0.007), and lesser inflammatory infiltrates (p=0.001). Low-power laser therapy hence contributed to reduce the inflammatory process due to rat sciatic nerve injury...

Esteira com velocidade controlada para captação da marcha / Treadmill with controlled speed for recording gait

Métodos histológicos e eletrofisiológicos de avaliação da regeneração dos nervos periféricos não provêem dados sobre o real estado funcional do membro interessado, mesmo em condições experimentais controladas. Alguns métodos de avaliação funcional têm sido propostos, mas a correlação entre seus resultados e aqueles dos métodos histológicos e eletrofisiológicos ainda não está perfeitamente estabelecida, o que demanda maiores investigações. Estas, por outro lado, necessitam do aprimoramento dos métodos de captação, armazenamento e processamento dos dados obtidos. Neste trabalho foi desenvolvido uma esteira para caminhada de animais com velocidade controlada para captação das pegadas de ratos submetidos a diferentes tipos de lesão dos nervos ciático, peroneiro e tibial, obtidas numa trilha de marcha captada por uma webcam acoplada a esteira e a um microcomputador capaz de armazenar as marchas filmadas para posteriormente serem digitalizadas para avaliação funcional. A esteira desenvolvida possibilita a captação e filmagem das marchas tendo sido testado em estudos experimentais em andamento sobre lesões do nervo ciático do rato, submetido a diferentes formas de tratamento. Também permite ao pesquisador a captação da marcha com velocidade contínua controlada e pré-estabelecida pelo pesquisador anulando algumas variáveis que possam prejudicar os resultados da pesquisa, além de permitir a visualização imediata da marcha.

Histological and electrophysiological methods for evaluation of peripheral nerve regeneration do not faithfully reproduce the functional index of limbs, even in controlled experimental conditions. Some methods of functional evaluation have been proposed, but their correlation to histological and electrophysiological data is not completely established, requiring more investigations with improvement of collection, management and processing of obtained data. In this study we developed a treadmill with controlled speed for recording footprint of rats submitted to different kinds of sciatic, fibular and tibial nerve lesions. The footprints were obtained on a walking track by means of a webcam connected to the treadmill and a computer with capacity to record the gait that will be submitted to functional evaluation. The developed treadmill allows the collection and filming of gaits and it has been tested in current experimental studies in rats with sciatic nerve lesion submitted to different kinds of treatment. The treadmill also enables researchers to record gait with constant, controlled and pre-established speed, with the possibility of direct visualization through the treadmill wall. In this manner, some variables that could damage the results of the research are resolved.

Torque de inserção e resistência ao arrancamento dos parafusos vertebrais com alma cilíndrica e cônica / Insertion torque and pullout strength of vertebral screws with cylindrical and conic core

OBJETIVO: Avaliar o torque de inserção e a força de arrancamento de três diferentes parafusos utilizados para a fixação anterior da coluna vertebral, considerando a influência do diâmetro do orifício-piloto (DOP), a densidade dos corpos de prova (CDP) e o desenho da rosca dos parafusos. MÉTODOS: Foram utilizados CDP de poliuretana com duas densidades: 0,16 e 0,32g/cm³, e três tipos de parafusos (USS I, USS II posterior e USS II anterior). Na primeira etapa o orifício-piloto foi feito com sonda de 3,8mm para todos os parafusos; na segunda etapa, com sonda menor do que o diâmetro interno dos parafusos (3,5mm para os parafusos USS I; 3,4mm para os parafusos USS II posterior e 3,0mm para os parafusos USS II anterior). Foram formados 12 grupos experimentais com dez corpos de prova em cada grupo, de acordo com a densidade da poliuretana, DOP e tipo de parafuso utilizado. O torque foi mensurado durante a inserção dos parafusos e a força de arrancamento por meio de ensaio mecânico em máquina universal de teste. RESULTADOS: O torque máximo de inserção apresentou valores decrescentes nos corpos de prova de 0,16g/cm³ e 0,32g/cm³ e em todos os diâmetros do orifício-piloto. A força máxima de arrancamento, nos corpos de prova de 0,16g/cm³ e diâmetro da perfuração de 3,8mm, foi maior nos parafusos USS II posterior que nos parafusos USS I. Com o diâmetro da perfuração menor do que o diâmetro interno do parafuso, os parafusos USS II posterior e anterior apresentaram valores maiores que o parafuso USS I. Nos corpos de prova com 0,32g/cm³ de densidade e diâmetro de perfuração de 3,8mm, a força de arrancamento do parafuso USS II posterior e a do USS I foram maiores que a do parafuso USS II anterior. Com o diâmetro da perfuração menor que o diâmetro interno, os valores foram decrescentes entre o USS II posterior, USS II anterior e USS I. CONCLUSÕES: O torque de inserção e a força de arrancamento dos parafusos utilizados para fixação anterior da coluna vertebral ...

OBJECTIVE: To evaluate insertion torque and pullout strength of three different screws used in the anterior fixation of the spine, considering the influence of the diameter of the pilot hole (DOP), the test specimen density (CDP), and the screw thread design. METHODS: The authors used polyurethane test specimens with two densities: 0.16 and 0.32 g/cm³, and three types of screws (USS I, USS II posterior, and USS II anterior). In the first stage, the pilot hole was made with a 3.8 mm probe for all screws; in the second stage, with a probe smaller than the inner diameter of the screws (3.5 mm for screws USS I; 3.4 mm for USS II posterior screws, and 3.0 mm for USS II anterior screws). 12 experimental groups were formed with ten specimen tests in each group, according to the polyurethane density, DOP, and the type of screw used. Torque was measured during insertion of the screws and the pullout strength by a mechanical assay in a universal test machine. RESULTS: The maximum insertion torque presented a decreasing value in test specimens of 0.16 g/cm³ and 0.32 g/cm³ and in all pilot hole diameters. Maximum pullout strength in test specimens of 0.16 g/cm³ and 3.8 mm of perforation diameter was greater in USS II posterior screws than in USS I screws. With the perforation diameter smaller than the inner screw diameter, USS II posterior and anterior screws presented higher values than the USS I screw. In test specimens with 0.32 g/cm³ of density and perforation diameter of 3.8 mm, the pullout strength of USS II posterior and USS I screws was greater than that of USS II anterior screws. With the smaller perforation diameter than the inner diameter, the values were decreasing between the USS II posterior screw, then the USS II anterior screw, and then the USS I screw. CONCLUSION: Insertion torque and pullout strength of the screws used in the anterior fixation of the vertebral spine are influenced by the test specimen density, by the screw thread ...