Osteogenesis of surface-decalcified bone matrix gelation in the repair of segmental bone defects / 中国组织工程研究

BACKGROUND: Repair of segmental bone defects is one of the difficult problems in orthopaedics. Although the therapeutic effect on bone autograft is the best, the source is limited and there is lack of suitable substitutive materials for autologous bone.OBJECTIVE: To probe into the therapeutic effects of surface-decalcified bone matrix gelation(SDBMG) and the substitutive possibility of autologous bone on repair of segmental bone defects.DESIGN: The research was designed as completely randomized controlled experiment. The clinical research was designed as pre- and post-controlled study on the basis of diagnosis.SEETING: Department of Orthopaedics, Wuhan General Hospital of Guangzhou Military Area Command.MATERLALS and PARTICIPANTS: The experiment was accomplished in Laboratory of Wuhan General Hospital of Guangzhou Military Area Command, and Testing Center of Wuhan University of Technology. Thirty-two local healthy adult male rabbits were employed as the materials in the experiment, 2.5 kg in body mass, bought from Hubei Academy of Medical Sciences. The clinical subjects were 31 patients(male 25 and female 6, a meanage of 9 years old) with segmental bone defects hospitalized in the Department of Orthopaedics, Wuhan General Hospital of Guangzhou Military Area Command during January 1991 to May 2001.METHODS: The 32 rabbits were randomized into group A and group B. The bilateral radial bones were prepared into 1-cm bone defect in both groups. In both groups, SDBMG was grafted on the left side; in Group A, wholly-decalcffied bone matrix gelatin(WDBMG) was grafted on the right side;and in Group B, the autologous bone was grafted on the right side. Human SDBMG was provided to treat 31 cases of segmental bone defects.MAIN OUTCOME MEASURES: ① Regular X-ray and histological examinations after operation in animals(Group A) and biomechanical deterruination (Group B ). ② Regular X-ray examinations after operation.RESULTS: SDBMG induced osteogenesis process "gradually" from exterior to interior. The bone repair with SDBMG was similar to that with autologous bone, and there was no significant difference in compressive strength compared with autologous bone. After clinical follow-up, except failure in 1 case due to improper selection of indication, the other 30 cases were all cured.CONCLUSION: SDBMG provides satisfactory osteogenesis and reliable mechanical property. It can be taken as the suitable substitutive material for autologons bone in the repair of segmental bone defects. But it is cautious for the application of SDBMG to infective bone defect in the active phase.

Amputation or Salvage-the Medical and Ethical Reflection on the Children with Lower Limbs Severe Injury / 中国医学伦理学

We often have to choosea between amputation and salvage after severe injuries in lower limbs of children.We have established the score scale and discriminatory equation in judging the severity of low limb injury in children.Through medical ethical analysis,the author makes a conclusion that the score scale and the discriminatory equation is valuable in determining severity of lower limbs injury in children.