微波消融猪生长板:微创骨骺成形术的概念验证

IF 4.2 2区 医学 Q1 ORTHOPEDICS Clinical Orthopaedics and Related Research® Pub Date : 2024-08-01 Epub Date: 2024-03-12 DOI:10.1097/CORR.0000000000003014
Samuel O Noonan, Kyle J Miller, Stephanie Goldstein, Ellen Leiferman, James White, Chris Brace, Kenneth J Noonan
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引用次数: 0

摘要

背景:针对肢体长度不一致(LLD)的腓骨外固定术,已有不同的手术方法。虽然这些方法效果不一,但都与发病率(疼痛和跛行)和潜在并发症有关。微波消融术是一种创伤较小的方法,可通过热能选择性地破坏生长板来阻止生长,从而治疗儿童肢体长度不一致:在这项使用猪体内模型进行的概念验证研究中,我们提出了以下问题:(1)通过 CT 扫描测量胫骨的长度和角度,胫骨生长板微波消融 2 到 4 个月后反应的持久性如何?为了制定体内微波消融方案,我们在 18 头 3 个月大的猪尸体后肢胫骨近端生长板附近放置了微波天线。为了确定合适的时间,我们在 65 瓦的功率设置下进行了 90 到 270 秒不等的消融。对胫骨进行切片后,我们目测了包括中央生长板在内的变色(意味着生长板受到破坏),但没有以破坏关节表面的方式侵入干骺端。利用这些信息,我们对三头活雌性猪(3.5 到 4 个月大)进行了微波消融,以评估生理变化和反应的持久性。术后进行了核磁共振成像,以确保干预导致的生长板空间改变与尸体中的类似。随后进行连续 CT 检查,以评估对局部骨骼和生长的潜在影响,直到手术后 2 到 4 个月动物安乐死为止。我们使用双胫骨的CT扫描分析了LLD、角度畸形和骨骼畸形。通过标准组织学染色将关节软骨的可见度与对侧胫骨的可见度进行比较,并通过荧光标记将胫骨近端生长板的生长速度进行比较:结果:18 具尸体标本的生长板上都出现了烧蚀区,但关节表面没有明显损伤。三头活猪在手术后没有表现出步态变化,也不需要明显的止痛药物。每只动物都表现出生长板破坏、预期肢体缩短(0.8、1.2 和 1.5 厘米)以及生长板周围骨腔化。与对照组胫骨相比,有轻微的骨外翻角度(4º、5º和12º)。通过与对侧胫骨的关节软骨厚度和细胞形态进行组织学比较,未发现可定性观察到的关节软骨损伤:结论:将微波天线放入猪的胫骨近端生长板中可减缓胫骨的生长速度,且无明显疼痛,也不会改变步态和功能:我们正在对动物模型进行进一步的研究和改进,包括缩短消融时间、比较动态消融(在消融过程中移动天线)以及从内侧和外侧入口对胫骨进行静态消融。这些改进以及计划中的与猪模型中标准机械生长停滞的比较可能会为 LLD 儿童消融生长板带来类似的方法。
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Microwave Ablation of the Pig Growth Plate: Proof of Concept for Minimally Invasive Epiphysiodesis.

Background: Different surgical methods for epiphysiodesis of limb length discrepancy (LLD) have been described. Although these methods are variably effective, they are associated with morbidity (pain and limp) and potential complications. Microwave ablation is a less-invasive opportunity to halt growth by selectively destroying the growth plate via thermal energy to treat LLD in children.

Questions/purposes: In this proof-of-concept study using an in vivo pig model, we asked: (1) What is the durability of response 2 to 4 months after microwave ablation of the tibial growth plate as measured by length and angulation of the tibia via a CT scan? (2) Was articular cartilage maintained as measured by standard histologic staining for articular cartilage viability?

Methods: To develop an in vivo protocol for microwave ablation, we placed microwave antennas adjacent to the proximal tibia growth plate in the cadaveric hindlimbs of 18 3-month-old pigs. To determine the suitable time, we varied ablation from 90 to 270 seconds at 65-W power settings. After sectioning the tibia, we visually assessed for discoloration (implying growth plate destruction) that included the central growth plate but did not encroach into the epiphysis in a manner that could disrupt the articular surface. Using this information, we then performed microwave ablation on three live female pigs (3.5 to 4 months old) to evaluate physiologic changes and durability of response. A postprocedure MRI was performed to ensure the intervention led to spatial growth plate alterations similar to that seen in cadavers. This was followed by serial CT, which was used to assess the potential effect on local bone and growth until the animals were euthanized 2 to 4 months after the procedure. We analyzed LLD, angular deformity, and bony deformity using CT scans of both tibias. The visibility of articular cartilage was compared with that of the contralateral tibia via standard histologic staining, and growth rates of the proximal tibial growth plate were compared via fluorochrome labeling.

Results: Eighteen cadaveric specimens showed ablation zones across the growth plate without visual damage to the articular surface. The three live pigs did not exhibit changes in gait or require notable pain medication after the procedure. Each animal demonstrated growth plate destruction, expected limb shortening (0.8, 1.2, and 1.5 cm), and bony cavitation around the growth plate. Slight valgus bone angulation (4º, 5º, and 12º) compared with the control tibia was noted. No qualitatively observable articular cartilage damage was encountered from the histologic comparison with the contralateral tibia for articular cartilage thickness and cellular morphology.

Conclusion: A microwave antenna placed into a pig's proximal tibia growth plate can slow the growth of the tibia without apparent pain and alteration of gait and function.

Clinical relevance: Further investigation and refinement of our animal model is ongoing and includes shorter ablation times and comparison of dynamic ablation (moving the antennae during the ablation) as well as static ablation of the tibia from a medial and lateral portal. These refinements and planned comparison with standard mechanical growth arrest in our pig model may lead to a similar approach to ablate growth plates in children with LLD.

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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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