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Li X, Xiao Y, Shu H, Sun X, Nie M. Risk Factors and Corresponding Management for Suture Anchor Pullout during Arthroscopic Rotator Cuff Repair. J Clin Med 2022; 11:jcm11226870. [PMID: 36431347 PMCID: PMC9699024 DOI: 10.3390/jcm11226870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Due to the aging of the population, the incidence of rotator cuff tears is growing. For rotator cuff repair, arthroscopic suture-anchor repair has gradually replaced open transosseous repair, so suture anchors are now considered increasingly important in rotator cuff tear reconstruction. There are some but limited studies of suture anchor pullout after arthroscopic rotator cuff repair. However, there is no body of knowledge in this area, which makes it difficult for clinicians to predict the risk of anchor pullout comprehensively and manage it accordingly. METHODS The literature search included rotator cuff repair as well as anchor pullout strength. A review of the literature was performed including all articles published in PubMed until September 2021. Articles of all in vitro biomechanical and clinical trial levels in English were included. After assessing all abstracts (n = 275), the full text and the bibliographies of the relevant articles were analyzed for the questions posed (n = 80). Articles including outcomes without the area of interest were excluded (n = 22). The final literature research revealed 58 relevant articles. Narrative synthesis was undertaken to bring together the findings from studies included in this review. RESULT Based on the presented studies, the overall incidence of anchor pullout is not low, and the incidence of intraoperative anchor pullout is slightly higher than in the early postoperative period. The risk factors for anchor pullout are mainly related to bone quality, insertion depth, insertion angle, size of rotator cuff tear, preoperative corticosteroid injections, anchor design, the materials used to produce anchors, etc. In response to the above issues, we have introduced and evaluated management techniques. They include changing the implant site of anchors, cement augmentation for suture anchors, increasing the number of suture limbs, using all-suture anchors, using an arthroscopic transosseous knotless anchor, the Buddy anchor technique, Steinmann pin anchoring, and transosseous suture repair technology. DISCUSSION However, not many of the management techniques have been widely used in clinical practice. Most of them come from in vitro biomechanical studies, so in vivo randomized controlled trials with larger sample sizes are needed to see if they can help patients in the long run.
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Han Z, Wang B, Ren B, Liu Y, Zhang N, Wang Z, Liu J, Mao K. Characterization and Biomechanical Study of a Novel Magnesium Potassium Phosphate Cement. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070997. [PMID: 35888086 PMCID: PMC9320010 DOI: 10.3390/life12070997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Abstract
Magnesium potassium phosphate cement (MKPC) has attracted considerable attention as a bone regeneration material. However, there are only a few reports on its biomechanical properties. To evaluate the biomechanical properties of MKPC, we compared the mechanical parameters of pedicle screws enhanced with either MKPC or polymethyl methacrylate (PMMA) bone cement. The results show that the maximum pull-out force of the pedicle screws was 417.86 ± 55.57 and 444.43 ± 19.89 N after MKPC cement setting for 30 min and 12 h, respectively, which was better than that of the PMMA cement. In fatigue tests, the maximum pull-out force of the MKPC cement group was 435.20 ± 7.96 N, whereas that of the PMMA cement in the control group was 346.80 ± 7.66 N. Furthermore, the structural characterization analysis of the MKPC cement revealed that its microstructure after solidification was an irregular tightly packed crystal, which improved the mechanical strength of the cement. The maximum exothermic temperature of the MKPC reaction was 45.55 ± 1.35 °C, the coagulation time was 7.89 ± 0.37 min, and the compressive strength was 48.29 ± 4.76 MPa, all of which meet the requirements of clinical application. In addition, the MKPC cement did not significantly inhibit cell proliferation or increase apoptosis, thus indicating good biocompatibility. In summary, MKPC exhibited good biomechanical properties, high initial strength, good biocompatibility, and low exothermic reaction temperature, demonstrating an excellent application potential in the field of orthopedics.
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Affiliation(s)
- Zhenchuan Han
- Chinese PLA Medical School, Beijing 100853, China; (Z.H.); (B.R.)
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
- Department of Orthopedics, Chinese PLA Rocket Force Characteristic Medical Center, Beijing 100088, China;
| | - Bo Wang
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China;
| | - Bowen Ren
- Chinese PLA Medical School, Beijing 100853, China; (Z.H.); (B.R.)
| | - Yihao Liu
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
| | - Nan Zhang
- Department of Orthopedics, Chinese PLA Rocket Force Characteristic Medical Center, Beijing 100088, China;
| | - Zheng Wang
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
| | - Jianheng Liu
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
- Correspondence: (J.L.); (K.M.)
| | - Keya Mao
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
- Correspondence: (J.L.); (K.M.)
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Chevalier Y, Matsuura M, Krüger S, Traxler H, Fleege C, Rauschmann M, Schilling C. The effect of cement augmentation on pedicle screw fixation under various load cases : results from a combined experimental, micro-CT, and micro-finite element analysis. Bone Joint Res 2021; 10:797-806. [PMID: 34894754 PMCID: PMC8696523 DOI: 10.1302/2046-3758.1012.bjr-2020-0533.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims Anchorage of pedicle screw rod instrumentation in the elderly spine with poor bone quality remains challenging. Our study aims to evaluate how the screw bone anchorage is affected by screw design, bone quality, loading conditions, and cementing techniques. Methods Micro-finite element (µFE) models were created from micro-CT (μCT) scans of vertebrae implanted with two types of pedicle screws (L: Ennovate and R: S4). Simulations were conducted for a 10 mm radius region of interest (ROI) around each screw and for a full vertebra (FV) where different cementing scenarios were simulated around the screw tips. Stiffness was calculated in pull-out and anterior bending loads. Results Experimental pull-out strengths were excellently correlated to the µFE pull-out stiffness of the ROI (R2 > 0.87) and FV (R2 > 0.84) models. No significant difference due to screw design was observed. Cement augmentation increased pull-out stiffness by up to 94% and 48% for L and R screws, respectively, but only increased bending stiffness by up to 6.9% and 1.5%, respectively. Cementing involving only one screw tip resulted in lower stiffness increases in all tested screw designs and loading cases. The stiffening effect of cement augmentation on pull-out and bending stiffness was strongly and negatively correlated to local bone density around the screw (correlation coefficient (R) = -0.95). Conclusion This combined experimental, µCT and µFE study showed that regional analyses may be sufficient to predict fixation strength in pull-out and that full analyses could show that cement augmentation around pedicle screws increased fixation stiffness in both pull-out and bending, especially for low-density bone. Cite this article: Bone Joint Res 2021;10(12):797–806.
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Affiliation(s)
- Yan Chevalier
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Maiko Matsuura
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Hannes Traxler
- Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | | | - Michael Rauschmann
- Department of Spine and Reconstructive Surgery, Sana Klinik Offenbach, Academic University Hospital, Offenbach, Germany
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汪 振. A Brief Discussion on Ecology Geological Survey. INTERNATIONAL JOURNAL OF ECOLOGY 2020. [DOI: 10.12677/ije.2020.94047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1661-1669. [DOI: 10.1007/s00586-019-05985-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/12/2019] [Accepted: 04/19/2019] [Indexed: 12/14/2022]
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Rong Z, Zhang F, Xiao J, Wang Z, Luo F, Zhang Z, Xu J, Dai F. Application of Cement-Injectable Cannulated Pedicle Screw in Treatment of Osteoporotic Thoracolumbar Vertebral Compression Fracture (AO Type A): A Retrospective Study of 28 Cases. World Neurosurg 2018; 120:e247-e258. [PMID: 30149154 DOI: 10.1016/j.wneu.2018.08.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate safety and effectiveness of the novel polymethyl methacrylate-augmented bone cement-injectable cannulated pedicle screw (CICPS) in patients with thoracolumbar vertebral compression fractures (AO type A) associated with osteoporosis. METHODS We conducted a retrospective cohort study of 28 patients treated for osteoporosis-related thoracolumbar vertebral body compression fracture at our facility between 2011 and 2015. Treatment involved posterior thoracolumbar fusion or lumbar fusion using CICPS. Treatment effectiveness was evaluated using visual analog scale and Oswestry Disability Index scores, degree of fracture reduction, and correction of kyphosis. The safety of CICPS was mainly assessed in terms of intraoperative and postoperative complications. Radiography, computed tomography, and magnetic resonance imaging outcomes were also assessed. RESULTS All 28 patients had severe osteoporosis. The visual analog scale score at final follow-up (0.50 ± 0.69) was significantly (P < 0.001) lower compared with before surgery (4.93 ± 1.30). The Oswestry Disability Index score had also decreased from 57.39% ± 14.46% to 6.83% ± 15.38% at final follow-up (P < 0.001). Radiologic evaluation of vertebral height and Cobb angle showed good fracture reduction and satisfactory correction of kyphosis (preoperative vs. final follow-up, P < 0.001). There were no instances of screw loosening or symptomatic complications except for a few cases of cement leakage from CICPS (10.3%; cement leakage most common in AO type A3.3). CONCLUSIONS The use of CICPS and polymethyl methacrylate is an effective and safe surgical technique for management of osteoporosis-related vertebral fractures (AO type A), with good clinical outcomes and low complications rates.
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Affiliation(s)
- Zhigang Rong
- Department of Orthopaedics, National and Regional United Engineering Laboratory, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Fei Zhang
- Department of Orthopaedics, General Hospital of Xin Jiang Military Region, Xinjiang, China
| | - Jun Xiao
- Department of Orthopaedics, National and Regional United Engineering Laboratory, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zhengdong Wang
- Department of Orthopaedics, National and Regional United Engineering Laboratory, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Fei Luo
- Department of Orthopaedics, National and Regional United Engineering Laboratory, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zehua Zhang
- Department of Orthopaedics, National and Regional United Engineering Laboratory, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jianzhong Xu
- Department of Orthopaedics, National and Regional United Engineering Laboratory, Southwest Hospital, Third Military Medical University, Chongqing, China.
| | - Fei Dai
- Department of Orthopaedics, National and Regional United Engineering Laboratory, Southwest Hospital, Third Military Medical University, Chongqing, China.
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Chevalier Y, Matsuura M, Krüger S, Fleege C, Rickert M, Rauschmann M, Schilling C. Micro-CT and micro-FE analysis of pedicle screw fixation under different loading conditions. J Biomech 2017; 70:204-211. [PMID: 29336820 DOI: 10.1016/j.jbiomech.2017.12.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
Abstract
Anchorage of pedicle screw instrumentation in the elderly spine with poor bone quality remains challenging. In this study, micro finite element (µFE) models were used to assess the specific influence of screw design and the relative contribution of local bone density to fixation mechanics. These were created from micro computer tomography (µCT) scans of vertebras implanted with two types of pedicle screws, including a full region-or-interest of 10 mm radius around each screw, as well as submodels for the pedicle and inner trabecular bone of the vertebral body. The local bone volume fraction (BV/TV) calculated from the µCT scans around different regions of the screw (pedicle, inner trabecular region of the vertebral body) were then related to the predicted stiffness in simulated pull-out tests as well as to the experimental pull-out and torsional fixation properties mechanically measured on the corresponding specimens. Results show that predicted stiffness correlated excellently with experimental pull-out strength (R2 > 0.92, p < .043), better than regional BV/TV alone (R2 = 0.79, p = .003). They also show that correlations between fixation properties and BV/TV were increased when accounting only for the pedicle zone (R2 = 0.66-0.94, p ≤ .032), but with weaker correlations for torsional loads (R2 < 0.10). Our analyses highlight the role of local density in the pedicle zone on the fixation stiffness and strength of pedicle screws when pull-out loads are involved, but that local apparent bone density alone may not be sufficient to explain resistance in torsion.
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Affiliation(s)
- Y Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany.
| | - M Matsuura
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - S Krüger
- Aesculap AG, Research & Development, Tuttlingen, Germany
| | - C Fleege
- Orthopädische Universitätsklinik Friedrichsheim gGmbH, Wirbelsäulenorthopädie, Frankfurt a.M., Germany
| | - M Rickert
- Orthopädische Universitätsklinik Friedrichsheim gGmbH, Wirbelsäulenorthopädie, Frankfurt a.M., Germany
| | - M Rauschmann
- Orthopädische Universitätsklinik Friedrichsheim gGmbH, Wirbelsäulenorthopädie, Frankfurt a.M., Germany
| | - C Schilling
- Aesculap AG, Research & Development, Tuttlingen, Germany
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Postl LK, Ahrens P, Beirer M, Crönlein M, Imhoff AB, Foehr P, Burgkart R, Braun C, Kirchhoff C. Pull-out stability of anchors for rotator cuff repair is also increased by bio-absorbable augmentation: a cadaver study. Arch Orthop Trauma Surg 2016; 136:1153-8. [PMID: 27290655 DOI: 10.1007/s00402-016-2484-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Osteoporosis is a highly focused issue in current scientific research and clinical treatment. Especially in rotator cuff repair, the low bone quality of patients suffering from osteoporosis is an important issue. In this context, non-biological solutions using PMMA for anchor augmentation have been developed in the recent past. The aim of this study was to evaluate whether augmentation of suture anchors using bio-absorbable osteoconductive fiber-reinforced calcium phosphate results in improved failure load of suture anchors as well. MATERIALS AND METHODS Altogether 24 suture anchors (Corkscrew FT 1 Suture Anchors, Arthrex, Naples, FL, USA) were evaluated by applying traction until pullout in 12 paired fresh frozen human cadaver humeri using a servo-hydraulic testing machine. Inclusion criteria were an age of more than 64 years, a macroscopically intact RC and an intact bone. The anchors were evaluated at the anterolateral and posteromedial aspect of the greater tuberosity. 12 suture anchors were augmented and 12 suture anchors were conventionally inserted. RESULTS The failure load was significantly enhanced by 66.8 % by the augmentation method. The fiber-reinforced calcium phosphate could be easily injected and applied. CONCLUSION The bio-absorbable cement in this study could be a promising augmentation material for RC reconstructions, but further research is necessary-the material has to be evaluated in vivo.
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Affiliation(s)
- L K Postl
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany
| | - P Ahrens
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany
| | - M Beirer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany
| | - M Crönlein
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany
| | - A B Imhoff
- Department of Orthopedics and Sportorthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany
| | - P Foehr
- Department of Orthopedics and Sportorthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany
| | - R Burgkart
- Department of Orthopedics and Sportorthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany
| | - C Braun
- Department of Forensic Medicine, Ludwig-Maximilians-Universitaet, Campus Innenstadt, Nussbaumstrasse 26, 80336, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany.
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Mueller JU, Baldauf J, Marx S, Kirsch M, Schroeder HWS, Pillich DT. Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws. J Neurosurg Spine 2016; 25:103-9. [PMID: 26943258 DOI: 10.3171/2015.10.spine15511] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Loosening and pullout of pedicle screws are well-known problems in pedicle screw fixation surgery. Augmentation of pedicle screws with bone cement, first described as early as 1975, increases the pedicle-screw interface and pullout force in osteoporotic vertebrae. The aim of the present study was to identify cement leakage and pulmonary embolism rates in a large prospective single-center series of pedicle screw augmentations. METHODS All patients who underwent cement-augmented pedicle screw placement between May 2006 and October 2010 at the authors' institution were included in this prospective cohort study. Perivertebral cement leakage and pulmonary cement embolism were evaluated with a CT scan of the area of operation and with a radiograph of the chest, respectively. RESULTS A total of 98 patients underwent placement of cement-augmented pedicle screws; 474 augmented screws were inserted in 237 vertebrae. No symptomatic perivertebral cement leakage or symptomatic pulmonary cement embolism was observed, but asymptomatic perivertebral cement leakage was seen in 88 patients (93.6%) and in 165 augmented vertebrae (73.3%). Cement leakage most often occurred in the perivertebral venous system. Clinically asymptomatic pulmonary cement embolism was found in 4 patients (4.1%). CONCLUSIONS Perivertebral cement leakage often occurs in pedicle screw augmentation, but in most cases, it is clinically asymptomatic. Cement augmentation should be performed under continuous fluoroscopy to avoid high-volume leakage. Alternative strategies, such as use of expandable screws, should be examined in more detail for patients at high risk of screw loosening.
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Affiliation(s)
- Jan U Mueller
- Department of Neurosurgery, University Medicine Greifswald
| | - Joerg Baldauf
- Department of Neurosurgery, University Medicine Greifswald
| | - Sascha Marx
- Department of Neurosurgery, University Medicine Greifswald
| | - Michael Kirsch
- Department of Radiology and Neuroradiology, University Medicine Greifswald, Germany
| | | | - Dirk T Pillich
- Department of Neurosurgery, University Medicine Greifswald
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El Saman A, Kelm A, Meier S, Sander AL, Eichler K, Marzi I, Laurer H. Intraoperative PEEP-ventilation during PMMA-injection for augmented pedicle screws: improvement of leakage rate in spinal surgery. Eur J Trauma Emerg Surg 2013; 39:461-8. [PMID: 26815441 DOI: 10.1007/s00068-013-0319-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Within the last two decades the use of polymethylmethacrylate (PMMA) in the treatment of osteoporotic vertebral fractures has been established widely. Several techniques of cement application in spinal surgery have been described. Besides classical vertebroplasty, kyphoplasty and related techniques that reinforce stability of the fractured vertebral body itself, augmentation of pedicle screws became an issue in the past 10 years. Aim of this technique is strengthening of the implant-bone-interface and the prevention of loosening and failure of posterior instrumentation in limited bone quality due to osteoporosis. PMMA use in spinal surgery always bears the risk of cement leakage and cement embolism. There are only few publications dealing with cement leakage in pedicle screw augmentation. We examined our cohort concerning incidence and type of leakage in comparison to the literature. In particular, we evaluated a possible role of intrathoracic pressure during cementation procedure. PATIENTS AND METHODS In this retrospective study 42 patients were included. Mean age was 74 (57-89) years. 311 fenestrated, augmented screws were analyzed postoperatively concerning leakage and subsequent pulmonary embolism of cement particles. Overall, there was a leakage rate of 38.3 %, and 28.6 % of patients showed pulmonary embolism of PMMA. During surgery, patients were in part ventilated with a positive end-expiratory pressure (PEEP) of 15 cmH2O during cement injection. These individuals showed significantly less leakage locally as well as less PMMA-emboli in the pulmonary circulation in contrast to patients ventilated without increased PEEP. CONCLUSION PEEP elevation during administration of PMMA via fenestrated pedicle screws is reducing the leakage rate in spinal surgery. These beneficial effects warrant further evaluation in prospective studies.
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Affiliation(s)
- A El Saman
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
| | - A Kelm
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - S Meier
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - A L Sander
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - K Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - I Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - H Laurer
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
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Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly. Eur J Trauma Emerg Surg 2013; 39:455-60. [DOI: 10.1007/s00068-013-0310-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
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Proschek D, Kafchitsas K, Kurth AA, Mattyasovszky SG, Betz S, Ludwig HR, Mack MG. The quality of applied bone cement depends on the chemical composition of the application system. Eur Surg Res 2011; 47:189-95. [PMID: 21986340 DOI: 10.1159/000330450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 06/15/2011] [Indexed: 11/19/2022]
Abstract
UNLABELLED The exothermal reaction of polymethylmethacrylate leads to an extensive interaction between bone cement and the synthetic material of the application system. This chemical reaction changes the structure of the cement and might generate air inclusions. METHODS AND MATERIALS Two application systems for bone cement made of polycarbonate (PC) and polypropylene (PP) were evaluated. The application systems were mounted in a testing unit. The testing device injects a defined amount of bone cement with a certain pressure. After the injection procedure a microscopic examination was carried out. RESULTS There were no differences in the size and the design of the used syringes. Forty procedures were carried out. The time frame for application of the cement was 5 min in the PC group and 9 min in the PP group. There was a remarkable interaction between the plastics and the cement with the appearance of numerous air inclusions in the PC group. Barely any interaction was found in the PP group. CONCLUSION Application systems made of PP enable a prolonged application time and a reduced number of air inclusions. Further research, especially on a molecular level as well as material tests on the quality of the applied bone cement, should be carried out.
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Affiliation(s)
- D Proschek
- Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, University Medical Center, Mainz, Germany. proschek @ arcor.de
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