Abstract
Distraction osteogenesis (DO) is a mechanobiological process of producing new bone and overlying soft tissues through the gradual and controlled distraction of surgically separated bone segments. The process of bone regeneration during DO is largely affected by distraction parameters. In the present study, a distraction strategy with varying distraction rates (i.e., “rate-varying distraction”) is proposed, with the aim of shortening the distraction time and improving the efficiency of DO. We hypothesized that faster and better healing can be achieved with rate-varying distractions, as compared with constant-rate distractions. A computational model incorporating the viscoelastic behaviors of the callus tissues and the mechano-regulatory tissue differentiation laws was developed and validated to predict the bone regeneration process during DO. The effect of rate-varying distraction on the healing outcomes (bony bridging time and bone formation) was examined. Compared to the constant low-rate distraction, a low-to-high rate-varying distraction provided a favorable mechanical environment for angiogenesis and bone tissue differentiation, throughout the distraction and consolidation phase, leading to an improved healing outcome with a shortened healing time. These results suggest that a rate-varying clinical strategy could reduce the overall treatment time of DO and decrease the risk of complications related to the external fixator.
Highlights
Repair of large bone defects remains a challenge in orthopaedics
The interfragmentary movements (IFMs) decreased as healing progressed, reaching a stable value of around 0.02 mm, which was indicative of a complete bony union [20]
Our results showed that, compared with the constant low-rate distraction, a low-to-high rate-varying distraction (e.g., L11H2 or L7H4) provides a favorable mechanical environment for angiogenesis and bone tissue differentiation throughout the entire distraction and during the subsequent consolidation phase—leading to an improved healing outcome with a shortened treatment time
Summary
Numerous techniques are available as treatment options, including autogenous bone grafts, allografts, bone graft substitutes, and vascularized fibular bone grafts [1,2,3], distraction osteogenesis (DO)—an in vivo tissue engineering approach—remains the clinical gold standard for treating large bone defects [4,5]. DO is a mechanobiological process which involves producing new bone and overlying soft tissues through the gradual and controlled distraction of surgically separated bone segments [6,7,8]. The process of bone regeneration during DO is regulated by mechanical stimuli; the healing outcomes are largely affected by distraction parameters such as the distraction rate and frequency [6,9,10,11]. One important mechanical parameter is the distraction rate (i.e., the distance over which the bone is lengthened per day) [10,11].
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