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      Estudo da influência do torque de inserção na resistência ao arrancamento dos parafusos pediculares Translated title: The influence of insertion torque on pedicular screws' pullout resistance

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          Abstract

          Foram realizados ensaios mecânicos para avaliação do torque de inserção na resistência ao arrancamento dos parafusos pediculares. Foram utilizadas no estudo 30 vértebras de suínos da raça Landrace, nas quais parafusos de 5mm foram inseridos nos pedículos vertebrais. O orifício piloto foi realizado com brocas de 2,5mm, 3,8mm e 4,5mm. Foram realizados ensaios mecânicos de arrancamento dos implantes em máquina universal de testes. Foi observado aumento do torque de inserção dos parafusos com a perfuração do orifício piloto com diâmetro menor que o diâmetro interno do parafuso, e redução com o orifício piloto maior que o diâmetro interno do parafuso. Foi observada diferença estatística entre os valores do torque de inserção. A resistência ao arrancamento dos implantes aumentou com a perfuração do orifício piloto com valores menores que o diâmetro interno do parafuso e diminuiu com a perfuração com diâmetro maior que o diâmetro interno do parafuso. Foi observada diferença estatística dos valores da resistência ao arrancamento dos implantes apenas com a perfuração do orifício piloto com diâmetro maior que o diâmetro interno do parafuso.

          Translated abstract

          Mechanical assays were performed in order to evaluate the effect of the insertion torque on the pullout resistance of pedicular screws. Thirty vertebrae of Landrace pigs were used in the study, with 5-mm screws being inserted into the vertebral pedicles. The pilot hole was drilled with 1.5, 3.8 and 4.5 mm burrs. Mechanical assays of implant pullout resistance were performed with a universal testing machine. An increase in the insertion torque of the screws was observed when a pilot hole with a smaller diameter than the inner diameter of the screw was drilled, and a reduction was observed when the diameter of the pilot hole was larger than the inner diameter of the screw. A statistically significant difference in the insertion torque values was observed. The pullout resistance of the implants increased when the pilot hole had a smaller diameter than the inner diameter of the screw and decreased when the pilot hole had a larger diameter than the inner diameter of the screw. A statistically significant difference in implant pullout resistance was observed only when the diameter of the pilot hole was larger than the inner diameter of the screw.

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          Most cited references15

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          Increase of pullout strength of spinal pedicle screws with conical core: biomechanical tests and finite element analyses.

          Screw loosening can threaten pedicle screw fixation of the spine. Conical screws can improve the bending strength, but studies of their pullout strength as compared with that of cylindrical screws have shown wide variation. In the present study, polyurethane foam with two different densities (0.32 and 0.16 gm/cm3) was used to compare the pullout strength and stripping torque among three kinds of pedicle screws with different degrees of core tapering. Three-dimensional finite element models were also developed to compare the structural performance of these screws and to predict their pullout strength. In the mechanical tests, pullout strength was consistently higher in the higher density foam and was closely related to screw insertion torque (r=0.87 and 0.81 for the high and low density foam, respectively) and stripping torque (r=0.92 and 0.78, respectively). Conical core screws with effective foam compaction had significantly higher pullout strength and insertion torque than cylindrical core screws (p<0.05). The results of finite element analyses were closely related to those of the mechanical tests in both situations with or without foam compaction. This study led to three conclusions: polyurethane foam bone yielded consistent experimental results; screws with a conical core could significantly increase pullout strength and insertion torque over cylindrical; and finite element models could reliably reflect the results of mechanical tests.
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            Correlations between screw hole preparation, torque of insertion, and pullout strength for spinal screws.

            The bone-screw interface is critical in the use of spinal instrumentation. The purpose of these experiments described here was twofold. First, to determine whether a correlation existed between torque generated during screw insertion and the pullout strength. Second, to determine how differing surgical methods of screw hole preparation influenced torque of insertion and screw pullout strength. A series of experiments were carried out in which screws were inserted into synthetic bone (experiment 1) and into calf vertebrae (experiment 2). The method of screw hole preparation (i.e., diameter of entrance hole and pilot hole) was varied while the resulting torque of insertion and the pullout strength of the screw was measured in each case. A torque screwdriver was used to measure the torque of insertion of the screws. Screw pullout strength was measured using a materials testing machine. Two important results emerged from these experiments. First, a higher torque of insertion correlated with a higher screw pullout force. This correlation may be useful intraoperatively in evaluating fixation. Second, torque of insertion and pullout force were more influenced by cortex over-drill diameter than pilot hole diameter. These experiments show the importance of the dorsal cortex in pedicle screw fixation.
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              Insertional torque and pull-out strengths of conical and cylindrical pedicle screws in cadaveric bone.

              Insertion torque and pull-out strengths of conical and cylindrical pedicle screws were compared in human cadaveric vertebral bodies. To compare the performance of the conical design with the cylindrical design, and to determine whether insertional torque correlates with pull-out strength. A tapered pedicle screw design may lessen the likelihood of implant failure. Its effect on thread purchase is not known. Previous studies of cylindrical designs on the relation between insertion torque and pull-out strength have been conducted in bovine and synthetic bone. Seventy-eight pedicles were assigned randomly to one of the following pedicle screw: Texas Scottish Rite Hospital (Sofamor-Danek, Memphis, TN), Steffee VSP (Acromed, Cleveland, OH), Diapason (Dimso, Paris, France), AO Schanz (Synthes, Paoli, PA), or Synthes USS (Synthes, Paoli, PA). Pedicle screws were inserted with a torque screwdriver. Each screw was extracted axially from the pedicle at a rate of 1.0 mm/sec until failure using an MTS machine (Bionix 858, Minneapolis, MN). Force data were recorded. The conical design had the highest insertion torque. There were no significant differences in pull-out between any of the screw types. Correlation between insertional torque and pull-out strength was statistically significant only with the Texas Scottish Rite Hospital and Steffee VSP in L4 and AO Schanz in L5. A conical screw profile increases insertion torque, although insertional torque is not a reliable predictor of pull-out strength in cadaveric bone. Screw profile (with similar dimensions) has little effect on straight axial pull-out strengths in cadaveric bone.
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                Author and article information

                Journal
                aob
                Acta Ortopédica Brasileira
                Acta ortop. bras.
                ATHA EDITORA (São Paulo, SP, Brazil )
                1413-7852
                1809-4406
                2008
                : 16
                : 4
                : 214-216
                Affiliations
                [02] orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina de Ribeirão Preto
                [03] orgnameHospital Charitté orgdiv1Setor de Doenças do Aparelho Locomotor orgdiv2Departamento de Cirurgia da Coluna Vertebral
                [01] orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina de Ribeirão Preto orgdiv2Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor
                Article
                S1413-78522008000400005 S1413-7852(08)01600405
                1eca24bd-57c0-41f7-88fa-d65b22e3355f

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 19 October 2006
                : 22 August 2006
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 3
                Product

                SciELO Brazil

                Categories
                Artigo Original

                Parafusos ósseos,Spine,Bone screws,Biomechanics,Orthopedic fixation devices,Coluna vertebral,Biomecânica,Dispositivos de fixação ortopédica

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