Application of a new anatomic hook-rod-pedicle screw system in young patients with lumbar spondylolysis:A pilot study

BACKGROUND The pedicle screw-laminar hook system has strong fixation and is conducive to bone graft fusion for lumbar spondylolysis.However,the current pedicle screwlaminar hook fixation system is not specifically designed for lumbar spondylolysis.AIM To investigate the clinical effects of a new anatomical hook-rod-pedicle screw system in the treatment of lumbar spondylolysis in young adults.METHODS We designed a new anatomic hook-rod-pedicle screw system for young patients with lumbar spondylolysis.The isthmus and the corresponding pedicle screw entry point were exposed through the intermuscular approach.Autogenous iliac bone graft was obtained to bridge the isthmus defect,and then the anatomic hook-rod-pedicle screw system was used to fix the isthmus in 15 young patients.RESULTS At 24 mo follow-up,the visual analogue scale score of low back pain decreased from 6.73±0.88 to 0.73±0.59,and the Oswestry disability index score decreased from 58.20±8.99 to 7.87±4.97.Computed tomography showed bilateral isthmic bone healing in 14 cases and unilateral isthmic bone healing in 1 case.Magnetic resonance imaging showed that the lumbar disc signal of diseased segment and adjacent segments had no change compared with that before surgery.The pain visual analogue scale score of the donor site was 0.20±0.41 at the last follow-up.According to the Modified Macnab score,the excellent and good rate was 100%.CONCLUSION The application of this new anatomical hook-rod-pedicle screw system to treat young patients with lumbar spondylolysis has the advantages of less trauma,a simple operation and satisfactory clinical effects.

Atlantoaxial pedicle screw system for treatment of unstable atlantoaxial dislocation post traction

Objective To explore the technique and clinical outcome of the atlantoaxial pedicle screw system in the treatment of the unstable altantoaxial dislocation post traction.

Additive manufactured osseointegrated screws with hierarchical design

Bone screws are devices used to fix implants or bones to bones.However,conventional screws are mechanically fixed with thread and often face long-term failure due to poor osseointegration.To improve osseointegration,screws are evolving from solid and smooth to porous and rough.Additive manufacturing(AM)offers a high degree of manufacturing freedom,enabling the preparation of predesigned screws that are porous and rough.This paper provides an overview of the problems currently faced by bone screws:long-term loosening and screw breakage.Next,advances in osseointegrated screws are summarized hierarchically(sub-micro,micro,and macro).At the sub-microscale level,we describe surface-modification techniques for enhancing osseointegration.At the micro level,we summarize the micro-design parameters that affect the mechanical and biological properties of porous osseointegrated screws,including porosity,pore size,and pore shape.In addition,we highlight three promising pore shapes:triply periodic minimal surface,auxetic structure with negative Poisson ratio,and the Voronoi structure.At the macro level,we outline the strategies of graded design,gradient design,and topology optimization design to improve the mechanical strength of porous osseointegrated screws.Simultaneously,this paper outlines advances in AM technology for enhancing the mechanical properties of porous osseointegrated screws.AM osseointegrated screws with hierarchical design are expected to provide excellent long-term fixation and the required mechanical strength.

Biomechanical effects of posterior lumbar interbody fusion with vertical placement of pedicle screws compared to traditional placement

BACKGROUND The pedicle screw technique is widely employed for vertebral body fixation in the treatment of spinal disorders.However,traditional screw placement methods require the dissection of paraspinal muscles and the insertion of pedicle screws at specific transverse section angles(TSA).Larger TSA angles require more force to pull the muscle tissue,which can increase the risk of surgical trauma and ischemic injury to the lumbar muscles.AIM To study the feasibility of zero-degree TSA vertical pedicle screw technique in the lumbosacral segment.METHODS Finite element models of vertebral bodies and pedicle screw-rod systems were established for the L4-S1 spinal segments.A standard axial load of 500 N and a rotational torque of 10 N/m were applied.Simulated screw pull-out experiment was conducted to observe pedicle screw resistance to pull-out,maximum stress,load-displacement ratio,maximum stress in vertebral bodies,load-displacement ratio in vertebral bodies,and the stress distribution in pedicle screws and vertebral bodies.Differences between the 0-degree and 17-degree TSA were compared.RESULTS At 0-degree TSA,the screw pull-out force decreased by 11.35%compared to that at 17-degree TSA(P<0.05).At 0-degree and 17-degree TSA,the stress range in the screw-rod system was 335.1-657.5 MPa and 242.8-648.5 MPa,separately,which were below the fracture threshold for the screw-rod system(924 MPa).At 0-degree and 17-degree TSA,the stress range in the vertebral bodies was 68.45-78.91 MPa and 39.08-72.73 MPa,separately,which were below the typical bone yield stress range for vertebral bodies(110-125 MPa).At 0-degree TSA,the load-displacement ratio for the vertebral bodies and pedicle screws was slightly lower compared to that at 17-degree TSA,indicating slightly lower stability(P<0.05).CONCLUSION The safety and stability of 0-degree TSA are slightly lower,but the risks of screw-rod system fracture,vertebral body fracture,and rupture are within acceptable limits.

Comparative efficacy of proximal femoral nail vs dynamic condylar screw in treating unstable intertrochanteric fractures

BACKGROUND Among the most frequent hip fractures are trochanteric fractures,which usually occur from low-energy trauma like minor falls,especially in older people with osteoporotic bones.AIM To evaluate the treatment efficacy of dynamic condylar screws(DCS)and proximal femoral nails(PFN)for unstable intertrochanteric fractures.METHODS To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures,a thorough search was carried out.For research studies published between January 1996 and April 2024,PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar were all searched.The complete texts of the papers were retrieved,vetted,and independently examined by two investigators.Disputes were settled by consensus,and any disagreements that persisted were arbitrated by a third author.RESULTS This study included six articles,comprising a total of 173 patients.Compared to the DCS,the PFN had a shorter operation time[mean difference(MD):-41.7 min,95%confidence interval(95%CI):-63.04 to-20.35,P=0.0001],higher success rates with closed reduction techniques[risk ratio(RR):34.05,95%CI:11.12-104.31,P<0.00001],and required less intraoperative blood transfusion(MD:-1.4 units,95%CI:-1.80 to-1.00,P<0.00001).Additionally,the PFN showed shorter fracture union time(MD:-6.92 wk,95%CI:-10.27 to-3.57,P<0.0001)and a lower incidence of reoperation(RR:0.37,95%CI:0.17-0.82,P=0.01).However,there was no discernible variation regarding hospital stay,implant-related complications,and infections.CONCLUSION Compared to DCS,PFN offers shorter operative times,reduces the blood transfusions requirements,achieves higher closed reduction success,enables faster fracture healing,and lowers reoperation incidence.

Roller Screw and Threaded Chain Speed Reducer: An Experimental Evaluation

We are developing a speed reducer that can be considered a transformation of a worm gear reducer: the worm is replaced by an inverted roller screw, and the gear is replaced by a threaded chain drive. This configuration lessens wear, increases load capacity, and improves efficiency. The threaded chain consists of nut-shaped links. This paper presents the results of tests carried out on a prototype with a reduction ratio of 46.

Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.

Metallurgical analysis of a failed maraging steel shear screw used in the band separation system of a satellite launch vehicle

Maraging steels have excellent combination of strength and toughness and are extensively used for a variety of aerospace applications. In one such critical application, this steel was used to fabricate shear screws of a stage separation system in a satellite launch vehicle. During assembly preparations, one of the shear screws which connected the separation band and band end block has failed at the first thread. Microstructural analysis revealed that the crack originated from the root of the thread and propagated in an intergranular mode. The failure is attributed to combined effect of stress and corrosion leading to stress corrosion cracking.

Posterior fixation and fusion with atlas pedicle screw system for upper cervical diseases

Objective： To evaluate the feasibility, safety and efficacy of atlas pedicle screws system fixation and fusion for the treatment of upper cervical diseases. Methods： Twenty-three consecutive patients with upper cervical disorders requiring stabilization, including 19 cases of atlantoaxial dislocation （4 congenital odontoid disconnections, 6 old odontoid fractures, 4 fresh odontoid fractures of Aderson Ⅱ C, 3 ruptures of the C1 transverse ligament, and 2 fractures of C1）, 2 cases of C2 tumor （instability after the resection of the tumors）, and 2 giant neurilemomas of C2-C3（instability after resection of the tumors）, were treated by posterior fixation and fusion with the atlas pedicle screw system, in which the screws were inserted through the posterior arch of C1. The operative time, bleeding volume and complications were reported. All patients were immobilized without external fixation or with rigid cervical collars for 1-3 months. All patients were followed up and evaluated with radiographs and CT. Results： In the 23 patients, 46 C1 pedicle screws, 42 C2 pedicle screws and 6 lower cervical lateral mass screws and 2 lower cervical pedicle screws were placed. The mean operative time and bleeding volume was 2.7 hours and 490 ml respectively. No intraoperative complications were directly related to surgical technique. No neurological, vascular or infective complications were encountered. All patients were followed up for 3-36 months （average 15 months）. Firm bony fusion was documented in all patients after 3-6 months. One patient with atlas fracture showed anterior occipitocervical fusion. There was no implant failure. Conclusions： Posterior fixation and fusion of the atlas pedicle screw system is feasible and safe for the treatment of upper cervical diseases, and may be applicable to a larger number of patients.

Comparison of therapeutic effect between percutaneous kyphoplasty and pedicle screw system on vertebral compression fracture

Objective： To compare the clinical efficacy of percutaneous kyphoplasty （PKP） with pedicle screw system （PS） in the treatment of vertebral compression fracture （VCF） . Methods： Eighty-six patients with VCF were treated either by PKP （ Group A, n ffi 30） ） or PS （ Group B, n ffi 56）. The anterior, intermediate, and posterior heights of the vertebrae body , visual analogue pain scale （VAS） before and after operation, the duration of operation, and amount of blood loss between two groups were compared. Results ： No statistical difference was noted regarding the vertebral height between two groups. Significant difference was seen in VAS, duration of operation and amount of blood loss between the two groups （P 〈0. 01 ）. Conclusions： Percutaneous kyphoplasty has the similar therapeutic efficacy with pedicle screw system in treatment of VCF with a mininlal invasion, less operation time and blood loss. For those with posterior wall destruction, PS is deemed favorable.

Acceleration-Dependent Analysis of Vertical Ball Screw Feed System without Counterweight

The distinguishing feature of a vertical ball screw feed system without counterweight is that the spindle system weight directly acts on the kinematic joints.Research into the dynamic characteristics under acceleration and deceleration is an important step in improving the structural performance of vertical milling machines.The magnitude and direction of the inertial force change significantly when the spindle system accelerates and decelerates.Therefore,the kinematic joint contact stiffness changes under the action of the inertial force and the spindle system weight.Thus,the system transmission stiffness also varies and affects the dynamics.In this study,a variable-coefficient lumped parameter dynamic model that considers the changes in the spindle system weight and the magnitude and direction of the inertial force is established for a ball screw feed system without counterweight.In addition,a calculation method for the system stiffness is provided.Experiments on a vertical ball screw feed system under acceleration and deceleration with different accelerations are also performed to verify the proposed dynamic model.Finally,the influence of the spindle system position,the rated dynamic load of the screw-nut joint,and the screw tension force on the natural frequency of the vertical ball screw feed system under acceleration and deceleration are studied.The results show that the vertical ball screw feed system has obviously different variable dynamics under acceleration and deceleration.The influence of the rated dynamic load and the spindle system position on the natural frequency under acceleration and deceleration is much greater than that of the screw tension force.

How cross screw length influences the stiffness of intramedullary nail systems

Fractures of long bones are commonly treated with intramedullary (IM) nails and they have been shown to have a very high success rate. Recently we have concerns with the use of the newer IM nailing systems, that uses longer cross screws, which have been developed with variation in implant designs. We believe that the newer implants provide less fracture stability, due to decreased stiffness of the IM nailing system. The aim of this study was to biomechanically determine the influence of the length of cross screw on the stiffness of the IM nailing system, using a composite model. Our test results confirmed our suspicion that the newer IM nailing system using longer cross screw-length is less stiff than traditional nailing systems using shorter cross screw length, during axial loading.

The Axial Nonlinear Vibration Analysis of Ball-screw about Machine Tool Feeding System

The forced state of the ball-screw of machine tool feeding system is analyzed. The ball-screw is simplified as Timoshenko beam and the differential equation of motion for the ball-screw is built. To obtain the axial vibration equation,the differential equation of motion is simplified using the assumed mode method. Axial vibration equation is in form of Duffing equation and has the characteristics of nonlinearity. The numerical simulation of Duffing equation is proceeded by MATLAB / Simulink. The effect of screw length,exciting force and damping coefficient are researched,and the axial vibration phase track diagram and Poincare section are obtained. The stability and period of the axial vibration are analyzed. The limit cycle of phase track diagram is enclosed. Axial vibration has two type-center singularity distributions on both sides of the origin. The singularity attracts vibration to reach a stable state,and Poincare section shows that axial vibration appears chaotic motion and quasi periodic motion or periodic motion. Singularity position changes with the vibration system parameters,while the distribution doesn’ t change. The period of the vibration is enhanced with increasing frequency and damping coefficient. Test of the feeding system ball-screw axial vibration exists chaos movement. This paper provides a certain theoretical basis for the dynamic characteristic analysis of machine feeding system ball-screw and optimization of structural parameters.

Distal clavicle fractures treated by anteroinferior plating with a single screw: Two case reports

BACKGROUND For the treatment of distal clavicle fractures,each treatment method has its own advantages and disadvantages,and there is no optimal surgical solution.CASE SUMMARY Based on this,we report 2 cases of distal clavicle fractures treated utilizing an anterior inferior plate with a single screw placed in the distal,in anticipation of providing a better surgical approach to distal clavicle fracture treatment.Two patients were admitted to the hospital after trauma with a diagnosis of distal clavicle fracture,and were admitted to the hospital for internal fixation of clavicle fracture by incision and reduction,with good postoperative functional recovery.CONCLUSION With solid postoperative fixation and satisfactory prognostic functional recovery,this technique has been shown to be simple,easy to perform and effective.

Error Analysis of Robotic Assembly System Based on Screw Theory

Assembly errors have great influence on assembly quality in robotic assembly systems. Error analysis is directed to the propagations and accumula-tions of various errors and their effect on assembly success.Using the screw coordinates, assembly errors are represented as 'error twist', the extremely compact expression. According to the law of screw composition, relative position and orientation errors of mating parts are computed and the necessary condition of assembly success is concluded. A new simple method for measuring assembly errors is also proposed based on the transformation law of a screw.Because of the compact representation of error, the model presented for error analysis can be applied to various part- mating types and especially useful for error analysis of complexity assembly.

Dynamic Characteristic Study of Ball Screw Feed Drive Systems Based on Multi-flexible Body Model

A new ball screw dynamic model was developed under the adequate consideration of the interaction in the screw-nut assembly (not only the mutual-coupling factors but also the self-coupling factors) . Based on this model,the multi-flexible body (MFB)dynamic model of ball screw feed drive system was then founded in order to take full account of the influencing factor of system flexibility and study the dynamic behaviors of the whole mechanical transmissions. Moreover,the MFB based state space modeling was proposed by modal state space method, which extraced the eigenmodes of more dominant modes and applied them into an MFB state space model,and realized the integrated model of servo drives and MFB mechanical transmissions more effectively and efficiently. In conclusion,the comparisons between simulations and experimental results show: the stiffness formulation of the ball screw assembly derived above is a suitable method for achieving accurate MFB models of ball screw mechanical transmission systems,this proposed MFB model is valid,and the integrated model of ball screw feed drive system is accurate and reliable. All these provide the important approaches and guidelines for dynamic characteristic study and selection of control parameters in the machine tool design period.

Distal locking in femoral intramedullary nailing system: Is one cross screw sufficient?

Introduction: The indications for intramedullary nail fixation of fractures of the femoral shaft have been greatly expanded by techniques of interlocking nailing. However, distal locking screw fixation remains the most technically demanding and problematic portion of the procedure and maybe responsible for as much as one-half of the exposure of the surgeon’s hands to radiation during the procedure. Objective: This biomechanical study was undertaken to compare the stability of using one distal locking cross screw versus two cross screws in femoral fractures fixed with intramedullary nailing (IMN) system. Materials: A composite model made from a stainless steel IMN (12 mm × 1 mm) was connected to a load cell (Instron machine). Axial forces upto 2 kN (3 times body weight) was applied or until a maximum displacement of 1 mm was reached. The distal locking end of the intramedullary nail was secured with stainless steel cylinders of different dimensions 50 mm × 5 mm, 75 mm × 5 mm and 100 mm × 3 mm to represent the proximal femoral diaphysis, diaphyseo-metaphyseal junction and distal femoral metaphyseal respectively. The distal locking end of the intramedullary nail was attached to the cylinder with a dedicated single or two rods (5 mm diameter), made from stainless steel, to represent the distal locking cross screw. Results: In the 50 mm cylinder, the mean stiffness (±standard deviation) of the system using either single or two screws were similar i.e. 3298 ± 144 N/mm. But in the 75 mm and 100 mm cylinders, the mean stiffness of the fracture model with two distal locking cross screws fixation was 2.059 ± 96 N/mm and 0.816 ± 122 N/mm and with single distal locking cross screw fixation were 0.643 ± 142 N/mm and 0.289 ± 88 N/mm respectively. Conclusion: Single distal locking cross screw fixation provide poorer fracture stability compared to two distal locking cross screws when used to fix distal femoral metaphyseal fractures.

Gravity-Based Kinetostatic Modeling of Parallel Manipulators Using Screw Theory

The pose accuracy of parallel manipulators(PMs)is a key index to measure their performance.Establishing the grav-ity-based kinetostatic model of a parallel robot provides an important basis for its error composition and accuracy improvement.In this paper,a kinetostatic modeling approach that takes real gravity distribution into consideration is proposed to analyze the influence of gravity on the infinitesimal twist and actuator forces of PMs.First,the duality of the twist screw and constraint wrenches are used to derive the gravity-attached constraint wrenches independent of the external load and the limb stiffness matrix corresponding to the kinematics-based constraint wrenches.Sec-ond,the gravity model of the mechanism is established based on the screw theory and the principle of virtual work.Finally,the analytical formulas of the infinitesimal twist and the actuator force of PMs are obtained,and the influences of the external load,platform gravity,and rod gravity on the stiffness of the mechanism are decoupled.The non-overconstrained 3RPS and overconstrained 2PRU-UPR PMs are taken as examples to verify the proposed method.This research proposes a methodology to analyze the infinitesimal deformation of the mechanism under the influence of gravity.

Multitrack and multianchor point screw technique combined with the Wiltse approach for lesion debridement for lumbar tuberculosis

BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.METHODS The C-reactive protein(CRP)level,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)score,oswestry disability index(ODI)and American Spinal Injury Association(ASIA)grade were recorded and analysed pre-and postoperatively.RESULTS The CRP level and ESR returned to normal,and the VAS score and ODI were decreased at 3 mo postoperatively,with significant differences compared with the preoperative values(P<0.01).Neurological dysfunction was relieved,and the ASIA grade increased,with no adverse events.CONCLUSION The multitrack,multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.

Task-Oriented Topology System Synthesis of Reconfigurable Legged Mobile Lander Integrating Active and Passive Metamorphoses

To explore hostile extraterrestrial landforms and construct an engineering prototype,this paper presents the task-oriented topology system synthesis of reconfigurable legged mobile lander(ReLML)with three operation modes from adjusting,landing,to roving.Compared with our preceding works,the adjusting mode with three rotations(3R)provides a totally novel exploration approach to geometrically matching and securely arriving at complex terrains dangerous to visit currently;the landing mode is redefined by two rotations one translation(2R1T),identical with the tried-and-tested Apollo and Chang'E landers to enhance survivability via reasonable touchdown buffering motion;roving mode also utilizes 2R1T motion for good motion and force properties.The reconfigurable mechanism theory is first brought into synthesizing legged mobile lander integrating active and passive metamorphoses,composed of two types of metamorphic joints and metamorphic execution and transmission mechanisms.To reveal metamorphic principles with multiple finite motions,the finite screw theory is developed to present the procedure from unified mathematical representation,modes and source phase derivations,metamorphic joint and limb design,to final structure assembly.To identify the prototype topology,the 3D optimal selection matrix method is proposed considering three operation modes,five evaluation criteria,and two topological subsystems.Finally,simulation verifies the whole task implementation process to ensure the reasonability of design.