Object: We investigated whether -intermittent hyperbaric oxygen (HBO) therapy can mitigate the adverse effects of cigarette smoking on the bone healing of tibial lengthening by using a previously validated rabbit model.
Methods: Eighteen male rabbits were randomly divided into three groups of six animals each. Group 1 (smoking plus HBO) went through intermittent cigarette smoke inhalation and hyperbaric oxygen therapy, group 2 (control) did not go through intermittent cigarette smoke inhalation or hyperbaric oxygen therapy and group 3 (smoking) went through intermittent cigarette smoke inhalation. Each animal’s right tibia was lengthened 5 mm by using an uniplanar lengthening device. Bone mineral density (BMD) study was performed for all the animals at 1 day before operation and 3, 4, 5, and 6 weeks after operation. All of the animals were killed at 6 weeks postoperatively for biomechanical testing.
Results: By using the preoperative BMD as an internal control, we found that the BMD of group 1 (smoking plus HBO)and group 2 (control) was superior to that of group 3 (smoking). The mean %BMD at 3, 4, 5, and 6 weeks were 58.6%, 66.6%, 73.7%, and 83.8%, respectively, in group 1, whereas the mean %BMD were 52.0%, 64.3%, 70.1%, and 76.2%, respectively, in group 2, and the mean %BMD were 46.2%, 54.0%, 64.9%, and 69.4%, respectively, in group 3 (two-tailed t test, p> 0.05, p> 0.05, p> 0.05, and p< 0.05 at 3, 4, 5, and 6 week respectively between group 1 and group 2, p< 0.01, p< 0.01, p< 0.01, and p< 0.01 at 3, 4, 5, and 6 week, respectively, between group 1 and group 3 and p< 0.05, p< 0.05, p< 0.05, and p< 0.05 at 3, 4, 5, and 6 week respectively between group 2 and group 3). By using the contralateral nonoperated tibia as an internal control, we found that the torsional strength of group 1 (smoking plus HBO) and group 2 (control) was superior to that of group 3 (smoking). The mean percentage of maximum torque was 80.9% in group 1 (smoking plus HBO) and was 78.0% in group 2 (control), whereas the mean percentage of maximum torque was 59.6% in group 3 (smoking) (two-tailed t test, p< 0.05 between groups 1and 3 and between groups 2 and 3, whereas p> 0.05 between groups 1 and 2).
Conclusion: This study suggests that smoke inhalation delays the bone healing in tibial lengthening; however, HBO mitigates the delayed healing effect of smoke inhalation and, thus, helps the smoking animal in achieving an expeditious bone healing in tibial lengthening.
From the Department of Orthopaedic Surgery (S.W.-N.U., S.-S.Le, S.-S.Li, C.-L.T., C.-H.S.), and Hyperbaric Oxygen Therapy Center (S.W.-N.U., S.-S.Le), and Department of Radiology (C.R.W.) of Chang Gung Memorial Hospital and Department of Mechanical Engineering of Chang Gung University, Taiwan, Republic of China.
Address for reprints: Steve Wen-Neng Ueng, MD, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No 222, Mai-Chin Road, Keelung 204, Taiwan, R.O.C.
This work was funded by National Science Council of Republic of China (Taiwan).
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
