En bedøvelses-, kirurgisk og høstmetode for evaluering av transpedikulære skruer ved hjelp av en<em> In vivo</em> Porcine Lumbar Spine Model
Summary
Her presenterer vi en metode for å evaluere transpedikulære skruer ved hjelp av en in vivo porcine lumbale ryggradsmodell.
Abstract
Pedicle skruefiksering er gullstandarden for behandling av ryggsykdommer. Imidlertid har mange studier rapportert problemet med å løsne pedicle skruer etter spinal kirurgi, noe som er en alvorlig bekymring. For å løse dette problemet har forskjellige typer pedicle skruer blitt undersøkt for å identifisere de med god fikseringsstyrke og osseointegrasjon i ryggradsbenet. Den svære ryggraden er et godt alternativ for den menneskelige ryggraden i vurderingen av pedicle skruer på grunn av den anatomiske størrelsen, mekaniske egenskaper og kostnader. Selv om flere studier har rapportert at pedicle skruer er effektive i svinemodellen, har ingen studier beskrevet detaljerte protokoller for evaluering av en pedicle skrue ved hjelp av svinemodellen. Her beskriver vi en detaljert metode for evaluering av transpedikulære skruer ved hjelp av en in vivo porcine lumbale ryggradsmodell. De tekniske detaljer for anestesi, ryggraden kirurgi og høst gitt her vil legge til rette for evalueringen av tRanspedikulær skruefikseringsmodell.
Introduction
Transpedicular screw fixation is a gold-standard treatment for degenerative lumbar spine and bursting fracture because it involves three columns of the spine and achieves stabilization1,2. However, most patients who undergo such surgery also have osteoporosis3,4. Many studies have evaluated the fixation strength and the osseointegration status of transpedicular screws, because the loosening of pedicle screws currently in use has been reported in patients with osteoporosis5,6.
The porcine spine is similar to the human spine in terms of size. It is less expensive compared to a primate model7. Furthermore, an in vivo mechanical study has demonstrated that the quadruped porcine spine is essentially loaded in the same way as that of the human spine8, which is why many researchers use porcine spines for studies on the prevention of pedicle screw loosening. However, it takes several months to study pedicle screws in the porcine spine because identifying the long-term stability of pedicle screws takes times. In order to compare different types of screws in the vertebral body, it is necessary to insert the screws in similar positions. Therefore, researchers should be well-acquainted with proper anesthesia techniques, standardized surgical protocols, and harvest procedures before performing any experiments. Here, we describe a detailed method for anesthesia, surgery, and harvest for the evaluation of pedicle screw fixation using a porcine spine model, including ex vivo imaging, histology, and strength testing.
Protocol
Representative Results
Discussion
Evalueringen av transpedikulære skruer i svinhinnen krever mye tid og krefter. For det første er miniatyrgrisen et stort dyr. For dyrepleie og anestesi trenger forskeren en spesialisert protokol. For det andre bør kirurgi opprettholde et miljø som ligner på human kirurgi. Formålet med å evaluere pedicle skruer i svin ryggraden er å utvikle en effektiv skrue som kan brukes på mennesker. For det tredje, evaluering av langsiktig stabilitet av transpedikulære skruer krever omtrent tre måneder etter ryggraden. Der…
Disclosures
The authors have nothing to disclose.
Acknowledgements
Denne studien ble støttet av et tilskudd (CNUH-BRI-2012-02-005) finansiert av Biomedical Research Institute of Chonbuk National University Hospital (CNUH-BRI), Republikken Korea.
Materials
| Miniature pig | OrientBio | ||
| Atropine | Jeil pharmaceutical | A04900241 | Anesthesia |
| Over-the needle plastic catheter | BD | REF382412 | Maintenance of IV line |
| Ketamine | Yuhan | A04502441 | Anesthesia |
| Xylazine | Bayer Korea | A00800071 | Anesthesia |
| Laryngoscope | Karl storz | Intubation | |
| Endotracheal tube | Covidien | Intubation | |
| Isoflurane | JW pharmaceutical Co | A02104781 | Anesthesia |
| Eye ointment | Hanlim pharma | A37851721 | Protection of pig's eye |
| Cefazolin | Donga pharma | A01503951 | Antibiotics |
| Saline | JW pharmaceutical Co | A02151392 | Maintenance of fluid homeostasis |
| Fentanyl | Hana pharm | C03200032 | Pain control |
| Enrofloxacin | Bayer | 93106-60-6 | Antibiotics |
| Morphine | Myungmoon pharma | C03700091 | Pain control |
| Meloxicam | Boehringer Ingelheim | A07600711 | Antibiotics |
| Povidone-iodine | Hyundai pharma | Wound dressing | |
| Scalpel blade size 15 | Braun | I1 BB515 | Skin incision |
| Cobb elevator | Codman | 65-2546 | Dissection of muscle |
| Burr | Medtronic | Making of starting point of screw | |
| Rongeur | Aesculap | FO515R | Making of starting point of screw |
| Guide pin (K-wire) | CE | 01067803 | Guidance of screw trajectory |
| C-arm | GE | OEC 9800 plus | Guidance of screw trajectory |
| Portable X-ray | Siemens | Mobile XP hybrid | Guidance of screw trajectory |
| Pedicle probe | OtisBiotech | SPI-02-01 | Guidance of screw trajectory |
| Pedicle sounding device | OtisBiotech | SPI-03-01 | Guidance of screw trajectory |
| Pedicle screw | OtisBiotech | MS-40025 | |
| Posterior fixator systems | OtisBiotech | ||
| Rod | OtisBiotech | ROD-60140 | Rigid fixation between screws |
| Universal handle | OtisBiotech | SPI-08-01 | To fix the screws to the rod |
| Straight socket wrench | OtisBiotech | SPI-06-01 | To fix the screws to the rod |
| counter torque wrench | OtisBiotech | SPI-07-01 | To fix the screws to the rod |
| Bulb irrigation syringe | Hyupsug medical | HS-IR-140 | Irrigation |
| Silicone drain | Sewon medical | 2205-006 | To drain the fluid at the surgical site |
| 3.0 metric absorbable suture | Ethicon | BA1673H | Muscle suture |
| 2.0 metric nonabsorbable nylon suture | Ethicon | W1626T | Skin suture |
| Gauze | Kingphar Korea | KP120-06 | |
| Pentobarbital | Hanlim pharma | 645301221 | Euthanasia |
| Oscillating saw | Zimmer | Harvest spine | |
| Tower forceps | Aesculap | BF461R | Harvest spine |
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