Een verdovings-, chirurgie- en oogstmethode voor de evaluatie van transpediculaire schroeven met behulp van een<em> In Vivo</em> Porcine Lumbar Spine Model
Summary
Hier introduceren we een methode om transpediculaire schroeven te evalueren door gebruik te maken van een in vivo porcine lumbale ruggengraat model.
Abstract
Pedicle screw fixatie is de gouden standaard voor de behandeling van ruggengraatziekten. Echter, veel studies hebben gemeld het probleem van losse pedicle schroeven na spinale operatie, dat is een ernstige zorg. Om dit probleem aan te pakken, zijn diverse soorten schroeven van de pedicle onderzocht om die met goede fixatie sterkte en osseointegratie in ruggengraat te identificeren. De varkenswervelkolom is een goed alternatief voor de menselijke wervelkolom bij de evaluatie van pedicelschroeven door de anatomische grootte, mechanische eigenschappen en kosten. Hoewel verschillende studies hebben aangetoond dat pedicle schroeven efficiënt zijn in het porcine model, heeft geen studie gedetailleerde protocollen beschreven voor de evaluatie van een pedicle screw met behulp van het porcine model. Hier beschrijven we een gedetailleerde methode voor het evalueren van transpediculaire schroeven met behulp van een in vivo porcine lumbale ruggengraat model. De technische details voor anesthesie, ruggengraatchirurgie en oogst die hier worden verstrekt, zullen bij de evaluatie van de t vergemakkelijkt wordenRanspedicular schroef fixatie model.
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
De evaluatie van transpediculaire schroeven in de varkenswortel vereist veel tijd en moeite. Ten eerste is het miniatuur varken een groot dier. Voor dierenzorg en verdoving heeft de onderzoeker een gespecialiseerd protocol nodig. Ten tweede dient de operatie een omgeving te houden die vergelijkbaar is met die van de menselijke operatie. Het doel van het evalueren van pedicle schroeven in de varkenswervelkolom is het ontwikkelen van een efficiënte schroef die op mensen kan worden toegepast. Ten derde, de evaluatie van d…
Disclosures
The authors have nothing to disclose.
Acknowledgements
Deze studie werd ondersteund door een subsidie (CNUH-BRI-2012-02-005), gefinancierd door het Biomedisch Onderzoeksinstituut van Chonbuk National University Hospital (CNUH-BRI), Republiek 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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