Automating skeletal expansion: An implant for distraction osteogenesis of the mandible.
Automating skeletal expansion: An implant for distraction osteogenesis of the mandible.
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自动骨骼扩张：用于下颌骨牵引成骨的植入物。
DOI：
10.1115/1.3071969
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发表时间：
2009
期刊：
影响因子：
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通讯作者：
Troulis,MariaJ
中科院分区：
文献类型：
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作者：
Magill,JohnC;Byl,MartenF;Goldwaser,Batya;Papadaki,Maria;Kromann,Roger;Yates,Brent;Morency,JosephR;Kaban,LeonardB;Troulis,MariaJ
牵张成骨是一种利用人体自然愈合能力延长骨骼的技术。一个截骨器被创造出来，一个坚硬的牵张装置被固定在骨头上。在一段潜伏期之后，该设备每天被激活两到四次，总共1毫米/天的骨骼延长。这项技术用于矫正各种先天和后天畸形的下颌骨、面中部和长骨。为了缩短治疗周期并消除患者启动该装置的并发症，自动连续牵张装置将是可取的。据报道，持续的牵张可以产生足够的骨骼，以每天2毫米的速度延长，从而缩短治疗时间。我们在这里描述的装置使用微型高压液压、位置反馈和数字控制器来实现对分心过程的闭环控制。植入的致动器可以在直线轨迹和弯曲的牵引力路径上产生高达40N的牵引力。在这篇文章中，我们详细介绍了弹簧动力液压储油器、控制器和用户界面。在猪头和生猪身上进行了测试新装置设计的实验。在身体头部，该装置进行了11天/11 mm的牵张，其均方根位置误差为0.09 mm。该设备在五只活着的动物中每一只都工作了几天，尽管出现了一些部件故障，导致了设计修订。测试系列表明，该系统的新颖设计提供了自动牵张下颌骨所需的能力。进一步的开发将集中在使植入的位置传感器更加坚固，然后进行临床试验。
Distraction osteogenesis is a technique of bone lengthening that makes use of the body’s natural healing capacity. An osteotomy is created, and a rigid distraction device is attached to the bone. After a latency period, the device is activated two to four times per day for a total of 1 mm/day of bone lengthening. This technique is used to correct a variety of congenital and acquired deformities of the mandible, midface, and long bones. To shorten the treatment period and to eliminate the complications of patient activation of the device, an automated continuous distraction device would be desirable. It has been reported that continuous distraction generates adequate bone with lengthening at a rate of 2 mm/day, thereby reducing the treatment time. The device we describe here uses miniature high-pressure hydraulics, position feedback, and a digital controller to achieve closed-loop control of the distraction process. The implanted actuator can produce up to 40 N of distraction force on linear trajectories as well as curved distraction paths. In this paper we detail the spring-powered hydraulic reservoir, controller, and user interface. Experiments to test the new device design were performed in a porcine cadaver head and in live pigs. In the cadaver head, the device performed an 11 day/11 mm distraction with a root-mean-squared position error of 0.09 mm. The device functioned for periods of several days in each of five live animals, though some component failures occurred, leading to design revisions. The test series showed that the novel design of this system provides the capabilities necessary to automate distraction of the mandible. Further developments will focus on making the implanted position sensor more robust and then on carrying out clinical trials.