[Design and experimental study of internal fixator for the reconstruction of lumbar isthmus].
OBJECTIVE
To investigate the clinical applicability and value of internal fixator for the reconstruction of lumbar isthmus in the treatment of lumbar vertebral spondylolysis and to lay a foundation for its clinical application.


METHODS
Six teen healthy goats weighing 22.65-31.22 kg were selected to establish the models of vertebral spondylolysis at L5, which thereafter were randomized into two groups (n=8): bone graft group in which 0.8-1.1 g fresh autogenous bone was transplanted into the isthmus spondylolysis area, and internal fixation with bone graft group in which internal fixator was installed before transplanting 0.8-1.1 g fresh autogenous bone into the isthmus spondylolysis area. All animals were killed 8 weeks after operation to receive imaging, topographic anatomy and histology detection. Meanwhile, biomechanics test was performed by using 5 donated vertebral body specimens (4 males and 1 female aged 35-51 years old). The left isthmus of Ls vertebra was transected to serve as lumbar vertebral spondylolysis model. A mini-displacement sensor was put at the transected ends of the isthmus. Then loading was conducted with a constant velocity of 2 mm/min by electronic omnipotent tester simulating the direction of fixation force of the internal fixator, and the deformation value of the transected ends was collected by a dynamic data collector and analyzer. The loading was continued until the vertebra specimens were damaged. The deformation of displacement sensor and the closure of transected ends of the lumbar isthmus were observed.


RESULTS
All the goats behaved normally shortly after operation, and no nerve injury induced by operation and no wound infection occurred. Bilaterally oblique X-ray films of lumbar vertebra and topographic anatomy 8 weeks after operation showed the fusion rate of the internal fixation and bone graft group and the bone graft group was 100% and 62.5%, respectively, indicating there was a significant difference (P < 0.05). Histology observation showed 3 goats in the bone graft group presented empty bone trabecula, empty bone lacuna and the disappearance of osteocytes at the transected ends of lumbar isthmus; while in the internal fixation and bone graft group, the bone trabecula grew into cancellous structures with hematopoietic and fatty bone marrow tissue inside, and parts of the bone trabecula had various degrees of mosaic-like pattern. During the upload, the biomechanics test and data processing results showed when the external load was 40 N, the deformation of displacement sensor was identified and the gap between the transected ends of lumbar isthmus started to close; then with the increase of external load, the displacement sensor tended to ascend in a linearity manner; while when the external load was 212 N, the displacement sensor had no further deformation, the gap between the transected ends of lumbar isthmus was completely closed, and the pressor effect appeared.


CONCLUSIONS
The internal fixator for the reconstruction of lumbar isthmus has mechanical effects of stabilizing and elevating pressure with a high fusion rate.
Hao
Yonghong
Y
Department of Spine Surgery, Tianjin Hospital, Tianjin, PR China. haoyonghong168@yahoo.cn
Deng
Shucai
S
Zhao
Heyuan
H
Sun
Zhiming
Z
Li
Jianjiang
J
Zhou
Jing
J
Wang
Zhibin
Z
Xu
Jin
J
Yu
Shunlu
S
Wang
Linsen
L
Wang
Ruilin
R
D000818:Animals; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D005599:Fractures, Ununited / Q000601:surgery*; D006041:Goats; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D011474:Prosthesis Design; D016103:Spinal Fractures / Q000601:surgery*