Plating after tumor curettage in human femora does not efficiently improve torsional stability ex vivo

IF 3.3 2区 医学 Q2 ENGINEERING, BIOMEDICAL Journal of the Mechanical Behavior of Biomedical Materials Pub Date : 2024-11-03 DOI:10.1016/j.jmbbm.2024.106798
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Abstract

Background

Surgical treatments of benign primary bone tumors of the femur face the challenge of limiting tissue damage and contamination while providing sufficient stabilization to avoid fracture. While no clear treatment guidelines exist, surgical treatment commonly consists of femoral fenestration and curettage with optional filling and plating of the defect. Mono- or bicortical plating of distal femoral defects aim to reduce fracture risk and have been shown to increase axial stability. However, it remains unclear whether plating increases torsional stability of the affected femur.

Questions/purposes

This biomechanical study aimed to determine how much additional stability can be achieved by mono- or bicortical plating of femoral defects after fenestration. The following hypotheses were investigated: 1. Preventive plating of distal femur bone defects enhances torsional stability when compared to femoral fenestration alone. 2. A condition close to the intact (nonpathological) bone can be achieved by bone plating. 3. Defect shape influences torsional stability.

Patients and methods

Thiel embalmed human femora (n = 24) were left intact or subjected to the following surgical treatments (A) defect creation via fenestration, (B) defect with short monocortical plating, (C) defect with long bicortical plating. All femora were torsion tested in midstance position using pre-cycling and testing until failure. Quantitative computed tomography pre and post testing allowed bone mineral density calculation and crack path analysis. Finite element analysis provided insight into defect shape variations.

Results

Torsion experiments showed no relevant enhancement of torsional stability due to mono- or bicortical plating. There were no significant differences in maximum torque between unplated and plated femora with defect (defect: 35.38 ± 7.53 Nm, monocortical plating: 37.77 ± 9.82 Nm, bicortical plating: 50.27 ± 9.72 Nm, p > 0.05). Maximum torque for all treatment groups was significantly lower compared to intact femora (155–200 Nm, p < 0.001). Cracks originated predominantly from the proximal posterior corner of the defect and intersected with screw holes in plated femora. The influence of variations of the defect corner shapes had no significant influence on maximum torque and angle.

Conclusion

This biomechanical study shows that mono- or bicortical plating is not an effective preventive treatment against torsional failure of femora with distal defects as the resulting maximum torque was drastically reduced compared to intact femora. Thus, the initial hypotheses have to be rejected. As habitual loading of the femur includes a combination of axial and torsional loading, the observed lack of prevention against torsional failure might help to explain the occurrence of fractures despite plating. Future research towards ameliorating clinical outcome should address the role of defect filling with bone cement or bone grafts regarding the improvement of torsional stability after primary bone tumor treatment in the femur.

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人的股骨在肿瘤切除后进行钢板固定并不能有效改善体内的扭转稳定性。
背景:股骨良性原发性骨肿瘤的手术治疗面临着限制组织损伤和污染,同时提供足够的稳定性以避免骨折的挑战。虽然目前还没有明确的治疗指南,但手术治疗通常包括股骨开孔术和刮除术,并可选择对缺损部位进行填充和钢板固定。股骨远端缺损的单皮质或双皮质钢板旨在降低骨折风险,并已证明可增加轴向稳定性。然而,钢板是否能增加受影响股骨的扭转稳定性仍不清楚:这项生物力学研究旨在确定在股骨瓣膜置换术后,通过对股骨缺损进行单皮质或双皮质钢板置换能增加多少稳定性。研究提出了以下假设:1.与单纯股骨头瓣膜置换术相比,股骨远端骨缺损的预防性钢板置换术可增强扭转稳定性。2.2. 通过骨电镀可达到接近完整(非病理)骨的状态。3.缺损形状影响扭转稳定性:Thiel防腐处理后的人类股骨(n = 24)保持完好无损,或进行以下手术处理:(A)通过瘘管形成缺损;(B)缺损处采用短单层骨板;(C)缺损处采用长双层骨板。所有股骨均在站立中位进行扭转测试,采用预循环和测试直至失效。测试前后的定量计算机断层扫描可计算骨矿密度和分析裂纹路径。有限元分析有助于深入了解缺陷的形状变化:扭转实验结果表明,单皮质或双皮质电镀并没有增强扭转稳定性。未电镀股骨和带缺陷电镀股骨的最大扭矩没有明显差异(缺陷:35.38 ± 7.53 牛米,单皮质电镀:37.77 ± 9.82 牛米):37.77 ± 9.82 牛米,双皮质电镀:50.27 ± 9.72 牛米,P > 0.05)。与完好股骨相比,所有治疗组的最大扭矩都明显较低(155-200 牛米,P 结论:这一生物力学研究表明,单皮质钢板和双皮质钢板对股骨的损伤程度不同:这项生物力学研究表明,单骨盆或双骨盆钢板并不能有效预防股骨远端缺损的扭转失败,因为与完整股骨相比,单骨盆或双骨盆钢板所产生的最大扭矩大幅降低。因此,最初的假设必须被否定。由于股骨的习惯性负荷包括轴向负荷和扭转负荷的组合,因此观察到的对扭转失效的预防不足可能有助于解释为什么尽管进行了钢板固定,仍会发生骨折。为改善临床疗效,未来的研究应探讨在股骨原发性骨肿瘤治疗后,用骨水泥或骨移植填充缺损对改善扭转稳定性的作用。
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来源期刊
Journal of the Mechanical Behavior of Biomedical Materials
Journal of the Mechanical Behavior of Biomedical Materials 工程技术-材料科学:生物材料
CiteScore
7.20
自引率
7.70%
发文量
505
审稿时长
46 days
期刊介绍: The Journal of the Mechanical Behavior of Biomedical Materials is concerned with the mechanical deformation, damage and failure under applied forces, of biological material (at the tissue, cellular and molecular levels) and of biomaterials, i.e. those materials which are designed to mimic or replace biological materials. The primary focus of the journal is the synthesis of materials science, biology, and medical and dental science. Reports of fundamental scientific investigations are welcome, as are articles concerned with the practical application of materials in medical devices. Both experimental and theoretical work is of interest; theoretical papers will normally include comparison of predictions with experimental data, though we recognize that this may not always be appropriate. The journal also publishes technical notes concerned with emerging experimental or theoretical techniques, letters to the editor and, by invitation, review articles and papers describing existing techniques for the benefit of an interdisciplinary readership.
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