Top screw pullout is a significant problem in anterior scoliosis correction, with rates of 5-15% reported in the literature. The Mater Misericordiae Hospital in Brisbane currently has a series of 125 patients with scoliosis treated by thoracoscopic anterior fusion, instrumentation and correction between April 2000 and August 2007. In this series 11 top screws are known to have pulled out (a rate of 8.8%), with six occurring in the first week, and all within 6 weeks, suggesting that the problem is one of excessive static force rather than fatigue. This thesis describes a biomechanical investigation into the mechanics of vertebral body screw pullout in anterior scoliosis surgical constructs. Previous biomechanical studies of vertebral body screws have evaluated their resistance to either straight pullout or cephalo-caudad compression forces, however the aim of this study was to assess screw resistance to more realistic loading conditions, namely pullout of initially angled screws, and pullout where the motion path is an arc rather than a straight axial pullout, as would be expected in a single rod anterior construct. The first series of experiments involved straight and angled pullout tests using synthetic bone. In the angled tests, both locked and free-to-pivot configurations were tested. The second series of experiments tested the effect of cephalo-caudad pre-compression (the actual deformity correction step performed during surgery) on subsequent axial pullout strength. A third series of experiments performed arc pullouts using synthetic bone, and the final series of experiments tested the pullout resistance of a newly proposed screw position configuration against the standard screw positioning using ovine lumbar vertebrae. Synthetic bone testing revealed that for initially angled pullout, resistance is greatest as the screw angle approaches 0 (ie a direct axial pullout). Cephalo-caudad pre-compression reduced subsequent pullout strength for cases where a staple was not used under the screw head, but if a staple was used the pre-compression did not decrease pullout force significantly. Arc pullout resistance was greatest when the screw was angled at 10 cephalad, and the mean pullout strength for the proposed screw configuration using ovine lumbar vertebrae (1864N) was almost double that of the standard screw positioning (993N). The clinical implication of this study is that top screw pullout resistance can be maximised by placing the top screw as close as possible to the top endplate and the bottom screw as close as possible to the bottom endplate, although this will have detrimental effects on the pullout of the second screw should the top screw pull out. Screw angulation is a less important factor but any angulation should be in a cephalad direction and around 10º in magnitude. The experimental results also suggest that the use of a staple may play a role in preventing cephalo-caudad pre-compression forces from reducing screw resistance to subsequent pullout forces.

Trabecular bone forms the internal scaffolding of most bones, and consists of a microscopic lattice-like structure of interconnected bony struts. Experimental work has demonstrated that trabecular bone adapts its structural rigidity and orientation in response to the strains placed upon the skeleton during life, a concept popularly known as “Wolff’s Law” or “bone functional adaptation”. Anthropological work has focused on correlating variation in primate trabecular bone to locomotor and masticatory function, to provide a context for the interpretation of fossil morphology. However, intraspecies variation and its underlying mechanisms are still poorly understood. In this thesis, variation in trabecular bone structure is examined in the human foot in four archaeological populations. The aim is to tease apart the factors underlying variation in human trabecular microstructure to determine whether it may be a suitable proxy for inferring terrestrial mobility in past populations. μCT scanning is used to image the three-dimensional trabecular structure of the talus, calcaneus, and first metatarsal in samples from four archaeological populations. Trabecular structure is quantified in seventeen volumes of interest placed throughout the foot. Trabecular bone is influenced by a variety of factors including body mass, age, diet, temperature, genetics, sex, and mechanical loading. Before trabecular structure can be used to infer habitual behaviour, the effects of these factors need to be understood and ideally statistically accounted for. Therefore, the effects of variation in bone size and shape, body mass, age, and sex on human trabecular structure are examined in four populations. Significant effects of body mass and age are reported, but little sexual dimorphism was found within populations. Taking these results into account, variation in trabecular structure is compared between archaeological populations that were divided into high and low mobility categories. Results demonstrate that the four populations show similar patterns of trabecular variation throughout the foot, with a signal of terrestrial mobility level superimposed upon it. Terrestrial mobility is associated with greater bone volume fraction and thicker, more widely spaced, and less interconnected trabeculae. Ontogeny of trabecular bone in the human calcaneus is investigated in two archaeological populations in the final chapter of the thesis. Results indicate that calcaneal trabecular bone adapts predictably to changes in loading associated with phases of gait maturation and increases in body mass. This opens the possibility of using trabecular structure to serve as a proxy of neuromuscular development in juvenile hominins. This work demonstrates that trabecular bone may serve as a useful proxy of habitual behaviour in hominin fossils and past populations when all contributing factors are carefully considered and ideally statistically controlled for.

No description available.

Submitted by Claudinei Pracidelli (cpracide@ipen.br) on 2016-11-11T17:46:50Z No. of bitstreams: 0 / Made available in DSpace on 2016-11-11T17:46:50Z (GMT). No. of bitstreams: 0 / A movimentação dentária induzida é um processo biológico complexo mediado por estímulos mecânicos, levando a um subsequente processo de remodelação óssea, podendo haver reabsorção indesejada da raiz dentária provocada pelo excesso de força. Uma vez que a movimentação ortodôntica se baseia em um processo inflamatório localizado, o propósito deste estudo foi avaliar os efeitos do laser de baixa potência no processo de remodelação óssea e reabsorção radicular, buscando correlacionar as mudanças metabólicas observadas a nível celular ocorridas nos dias iniciais da movimentação dentária às alterações teciduais observadas microscopicamente e à arquitetura e morfologia do trabeculado e cortical ósseo. Primeiros molares de sessenta e oito ratos machos Wistar foram submetidos à movimentação induzida, divididos em 3 grupos: controle negativo (nenhuma movimentação), não irradiado (movimentação sem irradiação) e laser (movimentação e irradiação com laser de baixa potência de comprimento de onda de 810 nm, potência de 100 mW, área de 0,02cm2 e energia de 1,5 J/ponto) e eutanasiados nos dias 3, 6, 9, 14 e 21. Mensurações da movimentação dentária e análises histomorfométricas foram realizadas em todos os dias estudados. Análise imunoistoquímica dos marcadores RANKL, OPG e TRAP e avaliações por microscopia eletrônica de varredura (MEV) foram feitas nos dias 3, 6 e 9 e o ensaio Western Blotting para proteínas RANKL e SOFAT e imagens de microtomografia computadorizada (MicroCT) nos dias 14 e 21. Os resultados deste estudo mostraram que a movimentação dentária foi significantemente maior no grupo Laser (aumento em média de 40%) em todos os dias avaliados. O lado de compressão mostrou maior expressão de RANKL e osteoclastos TRAP-positivos nos dias 3, 6 e 9 (p<0,05), promovendo significativa redução na área de osso alveolar presente no lado de compressão nos dias 6, 9 e 14 (p<0,05), e alterações microestruturais, como menor fração de volume ósseo/volume total, menor densidade óssea mineral aos 14 dias. A irradiação com laser também aumentou a expressão de RANKL e a citocina SOFAT no dia 14. No lado de tensão, houve maior expressão de OPG especialmente aos 9 dias (p<0,001) e significativo aumento na área de osso alveolar presente nos dias 14 (p<0,01) e 21 (p<0,05) histomorfometricamente e maior densidade óssea mineral e espessura das trabéculas aos 21 dias (p<0,01). Com relação às áreas de hialinização presentes, os resultados mostraram áreas significantemente reduzidas nos dias 3, 6 e 9 nos grupos irradiados, o que explica o menor número de odontoclastos na superfície radicular nestes dias e a redução significante das áreas de reabsorção radicular observadas nas lâminas histológicas nos dias 9, 14 e 21 e nas imagens de MEV nos dias 3 e 9. Os grupos irradiados também mostraram menor volume das lacunas de reabsorção radicular medidas no MicroCT nos dias 14 e 21, especialmente nos lados de compressão. O estudo concluiu que o laser de baixa potência influenciou a remodelação óssea, aumentou a atividade dos osteoclastos no lado da compressão, e estimulou a formação óssea no de tensão, acelerando significativamente o movimento dentário e potencialmente reduzindo as áreas de necrose no ligamento periodontal e, consequentemente, a reabsorção radicular. / Tese (Doutorado em Tecnologia Nuclear) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Avaliação da \"qualidade\" da microarquitetura óssea contribui na prevenção e risco de fraturas associado a osteoporose. Amostras de ossos trabeculares de corpos vertebrais da região T12, L1 e L4 de 30 de indivíduos (cadáveres humanos), classificados pela técnica de ultrassonometria de calcâneo como normais, osteopênicos e osteoporóticos foram utilizadas. Os parâmetros histomorfométricos, físicos e mecânicos da microarquitetura analisados pela técnica de microtomografia de raios-X, ensaios mecânicos de compressão axial e nanoindentação. Baseado nestes parâmetros, constantes elásticas efetivas globais foram obtidas pela técnica homogeneização assintótica para estrutura tipo-placa. Teste ANOVA apresentou diferenças, muito e extremamente significativas para densidade linear estrutural (p = 0,017), grau de anisotropia (p = 0,042), auto valor (p = 0,045), número de Euler (p = 0,016), idade (p = 0,009), separação trabecular (p = 0,009), densidade de conectividade (p = 0,006), módulo de elasticidade (p = 0,001), tensão máxima no limite de resistência a fratura (0,001), índice de qualidade óssea do calcâneo (p = 0,0001), fração de volume ósseo (p = 0,0001), espessura trabecular (p = 0,0002), dimensão fractal (p = 0,0002), momento de inércia polar médio (p = 0,00005), excentricidade (p = 0,0002), fração de porosidade (p = 0,0001) e densidade mineral óssea aparente (p = 0,00005) entre os grupos. O teste de Spearman identificou correlação moderada, alta e muito alta dos valores da tensão máxima no limite de resistência a fratura com os parâmetros de idade (r = -0,684), fração de volume ósseo (r = 0,762), fator de forma trabecular (r = -0,754), espessura trabecular (r = 0,675), densidade linear trabecular (r = 0,622), autos valores (r = -0,615), dimensão fractal (r = 0,855), momento de inércia polar médio (r = 0,816), excentricidade (r = -0,569) e fração de porosidade (r = -0,762). Estes parâmetros são indicadores da qualidade da microarquitetura óssea trabecular e risco de fratura associado a osteoporose. / Evaluation of the \"quality\" of bone microarchitecture can contribute to the prevention and risk of fractures associated with osteoporosis. Samples of trabecular bone from the vertebral regions T12, L1 and L4 from the bodies of 30 individuals (human cadavers), classified by ultrasonometry technique calcaneus as normal, osteopenic and osteoporotic were used. The histomorphometric, physical and mechanical parameters of the microarchitecture were analyzed by X-ray microtomography technique, mechanical tests of axial compression and nanoindentation. Based on these parameters, globally effective elastic constants were obtained by asymptotic homogenization technique for type-plate structure. ANOVA test showed differences that were very and extremely significant for the following: structural linear density (p = 0.017) anisotropy (p = 0.042), auto value (p = 0.045), Euler number (p = 0.016), age (p = 0.009), trabecular separation (p = 0.009), connectivity density (p = 0.006), elastic modulus (p = 0.001), maximum stress fracture strength limit (0.001), bone quality score of the calcaneus (p = 0.0001), bone volume fraction (p = 0.0001), trabecular thickness (p = 0.0002), fractal dimension (p = 0.0002), mean polar moment of inertia (p = 0.00005), eccentricity (p = 0.0002), porosity fraction (p = 0.0001) and apparent bone mineral density (p = 0.00005) between groups. The Spearman test identified moderate correlation, high and very high values of maximum stress fracture resistance limit for the following parameters: age (r = -0.684), bone volume fraction (r = 0.762), trabecular bone pattern factor (r = -0.754), trabecular thickness (r = 0.675), trabecular linear density (r = 0.622), auto value (r = -0.615), fractal dimension (r = 0.855), mean polar moment of inertia (r = 0.816), eccentricity (r = -0.569) and porosity fraction (r = -0.762). These parameters are quality indicators of the microarchitecture of trabecular bone and fracture risk associated with osteoporosis.

Un os long est composé de tissus osseux cortical et spongieux. Ces tissus ont des structures et des caractéristiques physiques différentes mais ont tous deux la capacité de se régénérer de façon naturelle suite à une lésion. Cette régénération ou réparation implique une séquence bien caractérisée d’événements contrôlés par l’interaction étroite entre des facteurs de croissance, des cellules, l’environnement chimique et dynamique, ainsi que par la matrice extracellulaire. L’ostéopontine (OPN) et la sialoprotéine osseuse (BSP) sont des protéines de la matrice extracellulaire exerçant des fonctions importantes dans le tissu osseux. Le but de ce travail a été d’étudier le rôle de l’OPN et de la BSP dans la réparation osseuse par génétique expérimentale. Les modèles utilisés dans cette études consistent en des lésions, l’un diaphysaire et purement cortical, l’autre région épi-métaphysaire mêlant destruction de l’os cortical, trabéculaire et de la plaque de croissance. La réparation de ces lésions a été analysée par microtomographie haute résolution aux rayons X et par histomorphométrie. Dans un premier temps, la réparation d’une perforation épi-métaphysaire dans le fémur chez la souris, a été caractérisée et comparée à celle de même diamètre réalisée dans la diaphyse. Dans cette étude comparative, des profils distincts de réparation ont été mis en évidence bien que tous deux mettent en place un mécanisme d’ossification intramembranaire. Ainsi, le défect cortical diaphysaire est comblé par une formation osseuse centripète restreinte à la zone corticale. Dans le modèle épi-métaphysaire, la formation osseuse est initiée au fond du défect et se propager vers le cortex. Ce processus aboutit à une restauration des travées mais à une réparation incompléte du cortex. Ainsi, le premier modèle apparaît comme pertinent pour l’étude de la réparation corticale alors que le modèle épi-métaphysaire se présente plus adapté à l’étude de la réparation de l’os trabéculaire. L’OPN et la BSP n’ont pas de fonctions redondantes dans la réparation de ces lésions. En effet, l’OPN intervient principalement dans la réparation de l’os trabéculaire, son absence entraîne un retard lié à un défaut de progression de l’os au sein de la cavité. L’absence de BSP quant à elle, semble intervenir uniquement dans le processus de réparation de l’os cortical diaphysaire, provoquant un retard de réparation dû à un défaut de minéralisation de l’ostéoïde. Les travaux réalisés au cours de cette thèse ont permis de caractériser des modèles de lésions osseuses pertinents pour l’étude de la réparation de l’os cortical et spongieux. L’utilisation de ces modèles a permis d’améliorer la compréhension du rôle de deux protéines de la matrice extracellulaire osseuse dans la réparation de cortical et trabéculaire grâce aux modèles de génétique expérimentale. / Long bones consist of cortical and spongious bone tissue, which have different structures and physiological characteristics. Both can heal spontaneously. Bone healing is a complex multi-step process which depends on cells, soluble factors, mechanical environment and bone matrix. Osteopontin (OPN) and Bone Sialoportein (BSP) are extracellular matrix proteins, which have been shown to exert important functions in bone. The aim of this study is to address the role of OPN and BSP in bone repair using experimental genetic strategies. Injured bone models are drilled-hole defects performed in diaphyseal cortical bone or in the epi-metaphyseal region. Bone healing was analyzed by micro-tomography and histomorphometry. Epi-metaphyseal defect healing was characterized and compared to cortical bone repair. In this comparative study, distinct patterns of bone repair have been shown while in both models repair occurs through intramembranous ossification. Diaphyseal defect was rapidly filled with newly bone formed in a centripetal manner within the cortical gap. In contrast, bone formation within the epi-metaphyseal defect was initiated from the depth of the cavity and spread towards the cortical edges, regenerating cancellous bone and albeit not completely cortical wall. Therefore, diaphyseal drill defects appear pertinent for the study of spontaneous cortical healing whereas epi-metaphyseal drill defects appear as appropriate models to investigate spongy bone regeneration. OPN and BSP do not show redundancy in the bone repair process of these two models. Indeed, OPN is mainly involved in trabecular bone repair; its deficiency induced a delay due to impaired bone progression within the epi-metaphyseal cavity. The lack of BSP only delayed cortical bone repair due to an impaired mineralization of the bone matrix. This study permits to characterize pertinent models of cortical and trabecular bone repair. Application of these models added new insights on the involvement of matrix proteins in cortical defect healing and trabecular bone repair using experimental genetic models.

This diploma thesis describes the design of filling element with trabecular structure for revision implant of total knee arthroplasty. Design of the filling element is created by the digital data of the patient tissue. Production of a functional sample is performed using additive technology Selective Laser Melting. This work also include analyze of the accuracy of this technology for the production of titanium alloy Ti6Al4V.

Indiana University-Purdue University Indianapolis (IUPUI) / Pyk2: Potential Regulator of Post-Menopausal Bone Loss H.W. LARGURA1,2*, P. ELENISTE2, S. HUANG2, S. LIU1, M. ALLEN3, A. BRUZZANITI2. 1Indiana University School of Dentistry Department Orthodontics and Oral Facial Development, 2Indiana University School of Dentistry Department of Oral Biology, 3Indiana University School of Medicine Department of Anatomy and Cell Biology, Indianapolis, Indiana, USA Osteoporosis is a pathologic condition of bone, commonly found in post-menopausal women, which occurs from an imbalance between bone formation and resorption. Following menopause, the bone resorbing activity of osteoclasts exceeds bone formation by osteoblasts, resulting in decreased trabecular and cortical bone and a subsequent decrease in bone mass. Reduced bone mass increases the risk of pathologic fracture of bones. Due to adverse effects associated with current treatment protocols for bone loss, alternative treatment modalities with reduced adverse effects are needed. Estrogen plays a role in maintaining balance in the bone remodeling cycle by controlling remodeling activation, osteoblast and osteoclast numbers, and their respective effectiveness in formation and resorption. With declining estrogen levels, this elegantly balanced interaction is altered and bone resorption exceeds bone formation, resulting in bone loss and increased bone fragility. Pyk2 is a protein tyrosine kinase that plays an important role in regulating bone resorption by osteoclasts, as well as osteoblast proliferation and differentiation. Deletion of the Pyk2 gene in mice leads to an increase in bone mass, in part due to dysfunctional osteoclast and osteoblast activity. In this study, we examined the role of Pyk2 in the effects of estrogen on bone mass. We used wild type (WT) and Pyk2 knock-out (KO) mice that had been ovariectomized (OVX) and treated with or without estrogen (E2)-releasing pellets. Control mice included sham OVX surgery receiving placebo pellet. We found that deletion of Pyk2 conferred increased bone mass in sham, OVX and OVX+E2 mice. In addition, Pyk2 KO mice supplemented with 17estradiol exhibited a marked increase in bone volume/trabecular volume, trabecular number, and trabecular thickness, but not cortical bone parameters compared to WT mice. Results of this study provide evidence for the role of Pyk2 in the effects of estrogen on bone mass. Understanding the role of Pyk2 in bone could lead to the development of new pharmaceutical targets for the treatment of bone loss associated with osteoporosis.

No description available.

<p> This thesis focuses on an examination of cortical and trabecular bone density and geometry at the radius and tibia in postmenopausal women, primarily women with history of breast carcinoma, while also assessing musculoskeletal changes in postmenopausal breast cancer patients after treatment with the Aromatase Inhibitor, Anastrozole. The first sub-study is an investigation of the reproducibility of the pQCT measurement parameters at the radius and tibia in healthy pre-and postmenopausal women. Results indicated that the reproducibility was good at the radius and even better at the tibia for all parameters measured. The second study is an appraisal of the level of osteoporosis knowledge in a cohort of postmenopausal women. The participants were assessed via the Facts on Osteoporosis Quiz, a well validated questionnaire, and the data revealed significantly lower test scores among the breast cancer subjects in comparison with healthy postmenopausal women. In the remaining group of studies, pQCT technology was utilized to describe trabecular and cortical bone at the radius and tibia in postmenopausal women and women with a history of breast carcinoma whom had been prescribed Anastrozole. The following measurement sites were significantly lower in the breast cancer subjects: TOT_DEN and TOT_CNT at the 4% radius; CRT_DEN, TOT_CNT, and CRT_CNT at the 20% radius; TOT_DEN at the 4% tibia; and CRT_DEN at the 38% tibia. With respect to time on Anastrozole, TOT_CNT at the 4% radius (r=-0.36); TOT_CNT (r=-0.33), CRT_CNT (r=-0.34) and CRT_DEN (r=-0.44) at the 20% radius; and CRT_DEN (r=-0.39) and CRT_CNT (r=-0.27) at the 38% tibia were significantly negatively correlated with days on Anastrozole. Furthermore, after two years of Anastrozole treatment in a small cohort of breast cancer subjects, there was a significant decrease in CRT_DEN (p=0.025) at the 20% diaphyseal radius and also at the 38% diaphyseal tibia (p=0.051). Together, the sub-studies that comprise this thesis demonstrate that there are noteworthy deficiencies in osteoporosis knowledge among postmenopausal women, particularly those with a history of breast carcinoma, and yet, these are the same women that have an increased need to understand the preventative and treatment options regarding this disease as they demonstrate reduced bone density at all measurement sites. It also appears that time on Anastrozole primarily affects cortical bone density in these women. In summary, this thesis provides novel details regarding cortical bone in breast cancer subjects and emphasizes the need for a normative database of bone quality parameters at different skeletal sites in order to gain a better understanding of the utility of each skeletal site with regard to fracture risk prediction. </p> / Thesis / Doctor of Philosophy (PhD)