Recent Progress in Animal Studies of the Skin- and Bone-integrated Pylon With Deep Porosity for Bone-Anchored Limb Prosthetics With and Without Neural Interface.
Recent Progress in Animal Studies of the Skin- and Bone-integrated Pylon With Deep Porosity for Bone-Anchored Limb Prosthetics With and Without Neural Interface.
复制标题
用于具有和不具有神经接口的骨锚式肢体假肢的具有深孔隙的皮肤和骨整合塔的动物研究的最新进展。
DOI：
10.1093/milmed/usaa445
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发表时间：
2021
影响因子：
1.2
通讯作者：
Prilutsky,BorisI
中科院分区：
文献类型：
--
作者：
Pitkin,Mark;Cassidy,Charles;Shevtsov,MaximA;Jarrell,JoshuaR;Park,Hangue;Farrell,BradJ;Dalton,JohnF;Childers,WLee;Kistenberg,RobertS;Oh,Kyunggeune;Klishko,AlexanderN;Prilutsky,BorisI
骨锚定假肢的三个主要未解决的问题是皮肤与经皮骨植入物的稳定、无感染的整合，植入物与宿主骨之间的坚固的骨骼固定，以及感觉神经和肌肉与假肢的安全界面，用于直观的双向假肢控制。在这里，我们回顾我们完成的工作和报告的结果最近progress.Materials和MethodsEight女性成年猫皮肤和骨集成pylon（SBIP）和8名男性成年猫接受SBIP外周神经接口（PNI）pylon到右胫骨远端。后一个塔架提供PNI，用于连接动力传感经胫骨假体与残余比目鱼肌和残余胫神经远端的电极。如果植入后28-70天没有感染迹象，猫开始佩戴被动假体。我们记录和分析了五只猫的水平和斜坡运动的全身力学被动假肢和一只猫的动力传感假肢。我们还对9只猫的组织与植入物的整合进行了组织学分析。4只猪的左后肢接受了SBIP，2只猪的左前肢接受了SBIP。我们记录了截肢前和骨整合后的垂直地面反作用力。我们还进行了拔出死后测试植入塔。一只猪在背部接受修改SBIP与不银coating.ResultsSix猫SBIP组植入70天。1只猫发生感染，未植入假体。5只猫的pylon持续了148至183天，在运动过程中显示出假体的大量负载（低于术前对照组的40.4%），并显示皮肤和骨组织深长入SBIP（超过60%）。SBIP-PNI组8只猫中有7只表现出pylon整合不良，无感染临床体征。1只猫植入假体824天（27个月）。该动物在水平行走过程中使用双向控制假肢显示出垂直载荷增加到接近正常值，尽管推进力显著降低。从对猪的研究中发现，在运动过程中，完整肢体和假肢之间的载荷对称性为80 ± 5.5%。皮肤-植入物界面无感染，但形成了一个造口，可能是因为猪大腿中皮肤和软组织的高流动性。背植入导致无感染的皮肤深ingrowth到SBIP implants.ConclusionsCats SBIP（n = 5）和SBIP-PNI（n = 1）pylons开发了一个健全的接口与残留的皮肤和骨骼，并表现出大量的负载假肢在运动过程中。1只SBIP动物发生感染，7只SBIP-PNI猫表现出骨整合不良，无感染体征。SBIP-PNI的未来研究应侧重于与残差积分的可靠性。正在进行的猪研究需要减少皮肤和软组织的额外活动性，直到SBIP植入物内形成皮肤密封。
IntroductionThe three major unresolved problems in bone-anchored limb prosthetics are stable, infection-free integration of skin with a percutaneous bone implant, robust skeletal fixation between the implant and host bone, and a secure interface of sensory nerves and muscles with a prosthesis for the intuitive bidirectional prosthetic control. Here we review results of our completed work and report on recent progress.Materials and MethodsEight female adult cats received skin- and bone-integrated pylon (SBIP) and eight male adult cats received SBIP-peripheral neural interface (PNI) pylon into the right distal tibia. The latter pylons provided PNI for connection between a powered sensing transtibial prosthesis and electrodes in residual soleus muscle and on residual distal tibial nerve. If signs of infection were absent 28-70 days after implantation, cats started wearing a passive prosthesis. We recorded and analyzed full-body mechanics of level and slope locomotion in five cats with passive prostheses and in one cat with a powered sensing prosthesis. We also performed histological analyses of tissue integration with the implants in nine cats.Four pigs received SBIPs into the left hindlimb and two pigs—into the left forelimb. We recorded vertical ground reaction forces before amputation and following osseointegration. We also conducted pullout postmortem tests on the implanted pylons. One pig received in dorsum the modified SBIPs with and without silver coating.ResultsSix cats from the SBIP groups had implant for 70 days. One cat developed infection and did not receive prosthesis. Five cats had pylon for 148 to 183 days, showed substantial loading of the prosthesis during locomotion (40.4% below presurgery control), and demonstrated deep ingrowth of skin and bone tissue into SBIP (over 60%). Seven of eight cats from the SBIP-PNI group demonstrated poor pylon integration without clinical signs of infection. One cat had prosthesis for 824 days (27 months). The use of the bidirectionally controlled prosthesis by this animal during level walking demonstrated increased vertical loading to nearly normal values, although the propulsion force was significantly reduced.From the study on pigs, it was found that symmetry in loading between the intact and prosthetic limbs during locomotion was 80 ± 5.5%. Skin-implant interface was infection-free, but developed a stoma, probably because of the high mobility of the skin and soft tissues in the pig’s thigh. Dorsal implantation resulted in the infection-free deep ingrowth of skin into the SBIP implants.ConclusionsCats with SBIP (n = 5) and SBIP-PNI (n = 1) pylons developed a sound interface with the residuum skin and bone and demonstrated substantial loading of prosthetic limb during locomotion. One animal with SBIP developed infection and seven cats with SBIP-PNI demonstrated poor bone integration without signs of infection. Future studies of the SBIP-PNI should focus on reliability of integration with the residuum. Ongoing study with pigs requires decreasing the extra mobility of skin and soft tissues until the skin seal is developed within the SBIP implant.