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Objective:To observe the surgical method and clinical efficacy of applying calf tissue flap combined with artificial bone of antibiotics loaded calcium sulphate in treatment of tibia osteomyelitis.Methods:From July 2018 to January 2021, calf tissue flaps combined with artificial bone of antibiotics loaded calcium sulphate (or mixed with iliac bone) were applied to treat 16 cases with tibia osteomyelitis in the Department of Hand and Microsurgery of Baoji Third Hospital. There were 10 males and 6 females, aged 15 to 64 years old, with a mean age of 41 years old. For the 5 cases with acute osteomyelitis caused by wound infection, local dressing changes and drainage or VSD wound management were applied after debridement, together with primary systemic anti-infection treatment. After the acute infection period had been under control and stabilised, the wounds were then thoroughly exposed and cavities were filled and covered with the surgical reconstruction procedure with antibiotics-loaded artificial bone of calcium sulphate in combination with calf tissue flaps. For the 11 cases with chronic and hypotoxicity osteomyelitis, calf tissue flaps combined with antibiotics-blended artificial bone of calcium sulphate were applied to fill the cavity and cover the wound in phase I surgical reconstruction after thorough debridement. For the 7 cases with large bone defects or larger cavities after debridement, a mixed bone grafts of antibiotics-loaded artificial bone of calcium sulphate and autologous iliac bone were employed, with muscle flaps or myocutaneous flaps for an embedding repair. Sizes of the tissue flaps were 2.0 cm×3.5 cm to 12.0 cm×23.0 cm. Clinical outcomes were evaluated through follow-ups at outpatient clinic. The therapeutic effect was evaluated by the method described by McKee et al.Results:Except for 1 case of distal necrosis of tissue flap and survived after dressing change, the other tissue flap survived successfully. Postoperative follow-ups lasted for 12 to 40(mean 18) months. All the osteomyelitis were successfully cured, except 1 that had recurrence of osteomyelitis 1 year later, and treated with antibiotics-loaded artificial bone of calcium sulphate combined with autologous iliac bone implants after thorough debridement, and then healed well. The shape and texture of flaps were good. Protective sensations were restored to vary levels after 6 months. The calf regained weight-bearing and walking functions at 1 year after surgery. According to McKee et al., the therapeutic effect was evaluated: 11 cases were cured, 4 cases were improved, and 1 case relapsed, with an effective rate of 93.8%.Conclusion:Application of calf tissue flap combined with antibiotics-loaded artificial bone of calcium sulphate in the treatment of tibia osteomyelitis has a high cure rate and remarkable efficacy. It can significantly reduce the number of surgeries and shorten the course of disease.
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Objective:To compare the early clinical efficacy between reaming after distal tibia cortical fenestration combined with antibiotic-loaded calcium sulphate and trench grooving combined with polymethyl methacrylate (PMMA) for the treatment of chronic tibial osteomyelitis after intramedullary nail fixation.Methods:A retrospective analysis was conducted in the 20 patients who had been surgically treated for chronic tibial osteomyelitis after intramedullary nail fixation at Department of Trauma Orthopaedics, Honghui Hospital from January 2019 to January 2021. According to the surgical methods, they were divided into a reaming group and a grooving group. In the reaming group, there were 6 males and 3 females with an age of (47.6±11.4) years; in the grooving group, there were 9 males and 2 females with an age of (49.2±13.9) years. The 2 groups were compared in terms of duration of infection, operation time, intraoperative blood loss, bacterial culture results, total hospital stay, time for inflammatory indexes to return to normal, time for weight-bearing, complication rate, infection control rate, and good to excellent rate by Johner-Wruhs joint function scoring.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P > 0.05). All patients were followed up for 12 to 25 months after operation. There were no significant differences in the duration of infection, operation time, intraoperative blood loss, bacterial culture results, time for inflammatory indexes to return to normal, complication rate, infection control rate, or Johner-Wruhs scoring between the 2 groups ( P > 0.05). The total hospital stay [(11.7 ± 4.7) d] and weight-bearing time [(5.8 ± 1.6) weeks] for the reaming group were significantly shorter than those for the grooving group [(16.8 ± 4.6) d and (8.1 ± 2.9) weeks] ( P < 0.05). Conclusion:In the treatment of chronic tibial osteomyelitis after intramedullary nail fixation, compared with conventional trench grooving combined with PMMA, reaming after distal tibia cortical fenestration combined with antibiotic-loaded calcium sulphate can not only obtain satisfactory outcomes by infection control but also shorten the treatment cycle by allowing the patients to start early weight bearing.
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Background: Many studies have reported the role of Mesenchymal Stem Cells (MSC) in treating fractures. In case with bone defect, fracture healing needs not only osteogenic but also osteoconductive component (scaffold). Hydroxyapatite calcium sulphate (HA-CaSO4) being widely used as bone void filler, may serve as scaffold for MSC. However, the effect of this scaffold to the viability of MSC has not been evaluated before. Methods: MSC were isolated from the iliac marrow of a Giant Flamish rabbit, and expanded in DMEM using histogradient density. After one week, they were sub-cultured in a 25cc TC flask (passage 1) and have the medium replaced every 3 days. During the subculture, we embedded a HA-CaSO4 pellet into the flask. The cells were evaluated under inverted microscope at a weekly interval. Results: At the first week, MSC are difficult to be identified in microscope due to the large number of HA-CaSO4 crystals. By the third week however MSC have grown and the HA-CaSO4 crystals can readily be washed off by medium replacement. By the fourth weeks, MSC can be still seen on microscope. Conclusion: HA-CaSO4 could serve as a good scaffold due to its pellet shape and easily absorbed, thus providing revascularization which is essential for bone healing.In addition, HA-CaSO4 does not interfere with MSC survival.
Subject(s)
Mesenchymal Stem CellsABSTRACT
PURPOSE: The aim of this study was to clinically and radiographically evaluate and compare treatment of intrabony defects with the use of decalcified freeze-dried bone allograft in combination with a calcium sulphate barrier to collagen membrane. METHODS: Twelve patients having chronic periodontal disease aged 20 to 50 years and with a probing depth >6 mm were selected. Classification of patient defects into experimental and control groups was made randomly. In the test group, a calcium sulphate barrier membrane, and in control group, a collagen membrane, was used in conjunction with decalcified freeze-dried bone graft in both sides. Ancillary parameters as well as soft tissue parameters along with radiographs were taken at baseline and after 6 months of surgery. Parameters assessed were plaque index, modified gingival index, probing depth, relative attachment level, and location of the gingival margin. A Student's t-test was done for intragroup and a paired t-test for intergroup analysis. RESULTS: Intragroup analysis revealed statistically significant improvement in all the ancillary parameters and soft tissue parameters with no statistically significant difference in intergroup analysis. CONCLUSIONS: The study concluded that a calcium sulphate barrier was comparable to collagen membrane in achieving clinical benefits and hence it can be used as an economical alternative to collagen membrane.
Subject(s)
Aged , Humans , Bone Substitutes , Calcium , Calcium Sulfate , Collagen , Guided Tissue Regeneration , Membranes , Periodontal Diseases , Periodontal Index , Transplantation, Homologous , TransplantsABSTRACT
[Objeetive]To report the repairing offect of cancellous bone defect with calcium sulphate.[Method]A defect 5mm in diameter and 12 mm in deep,which was drilled in the lateral aspect of rabbit lateral femoral condyle,was filled with CCaS(Citrated Calcium Sulphate)cylinder or Osteoset tablets respectively.Rabbits were killed 3,6,13 weeks after surgery.And then general oberservations and mechanical analyzing were conducted.[Result]After surgery,rabbits had good movements,spirits and eating,good healing of incision.There was no arthroedema and inflammatory response around the joints.Mechanical analyzing reports:both anticompressive strength and elasticity coefficient in the artificial bone repair bone defect area 3 weeks after surgery,were higher than in that of normal femur condyle;Anti-compressive strength and elasticity coefficient in the defect area 6 weeks,which drop comparing to 3 weeks,was lower than that of normal femur condyle;Anti-compressive strength and elasticity coefficient 13 weeks,which is higher than 6 weeks,is approaching normal.Mechanics intensity of two groups in the different time had no significant difference,but was significantly higher than one of the same time blank group.[Conclusion]To some extent,Calcium Sulphate has mechanical supportive effects on cancelloues bone defect in spite of the absorption and degradation of Calcium Sulphate.There is no significant difference between Citrated Calcium Sulphate and Osteoset tablets.
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[Objective]To explore the effects on surrounding tissue and bone regeneration by citrated calcium sulphate(CCaS) and Ostesset~.[Method]Bilateral or lateral femoral condyles were drilled into defects in 18 rabbits,and divided into 3 groups: A,12 rabbits,left defect filled with CCaS cylinder,right defect with osteoset~;B,3 rabbits,left defect with CCaS,right defect blank;C,3 rabbits,left defect with osteoset~GFDA3,right defect blank.The rabbits were sacrificed at 3 wks,6 wks and 13 wks,and defect samples were taken for histological exam,roengenographic observation and bone tissue calculation by image-plus CCD system.[Result]The defects that were not grafted were filled with bone marrow and there was minimal new bone,only at the margen of the defects CCaS and osteoset~GFDA3 implanted in the defects were gradually absorbed,and substituted by new bone trabecula,which became more mature and thicker.The area fraction and trabecula thickness of new bone in defects treated with CCaS were not significantly different from defects treated with osteoset~ after 3,6,13 wks.However,the degradation velocity of CCaS was slower than that of osteoset~.No inflammatory and foreign body response was observed.[Conclusion]Just like osteoset~,CCaS is more benefitial to new bone formation compared with osteoset~,because CCaS has relatively slower degradation velocity.
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The study was conducted in a Brachiaria decumbens pasture, in a dark red-yellow latosol, pH 5.2, with the objective of evaluating the influence of crescent levels of calcium sulphate application and cutting-age on dry matter yield and on N, S, Cu and nitrate content. Four treatments and three cuts were done as follow: T (control), 0 ton/ha of calcium sulphate; TA, 0.5 ton/ha; TB, 1.0 ton/ha; and TC, 1.5 ton/ha. The cuts were done 77, 133 and 341 days after the beginning of the experiment. The experiment was set in a randomized complete block design, with four replications. The dry matter yield of TA, TB and TC showed differences (P 0.05) related to the control treatment, although dry matter yield did not show differences (P>0.05) between TA, TB and TC. Concentrations of S, Cu, N and nitrate in dry matter did not show differences (P>0.05) between treatments. However, the grass cutting-age influenced grass mineral concentrations (P 0.05) in all treatments.
Em solo classificado como latossolo vermelho-amarelo, de pH igual a 5,2, foram estudados o efeito da adição crescente do gesso agrícola (CaSO4.2H2O) nos níveis de 0 t/ha (T); 0,5 t/ha (TA); 1,0 t/ha (TB) e 1,5 t/ha (TC), combinados com a aplicação de 20kg/ha de nitrogênio sob a forma de uréia mais 80kg de K2O/ha sob a forma de cloreto de potássio, sobre a produção de matéria seca (MS) da Brachiaria decumbens Stapf, no período de janeiro a dezembro. O delineamento experimental foi o de blocos ao acaso, com quatro repetições. Foram realizados três cortes (após 77, 133 e 341 dias do início do experimento) para determinar a produção de matéria seca/ha e as concentrações de enxofre (S), nitrogênio (N), cobre (Cu) e nitrato na forrageira. Observou-se que a produção de MS foi influenciada pelos tratamentos e época de corte da forrageira. Porém, não houve aumento significativo na produção de MS para níveis de adubação acima de 0,5 t/ha. As concentrações de S, N, Cu e nitrato não foram influenciadas pelos tratamentos.
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Objective:To evaluate the in vitro cytotoxicity,in vivo response and degradation of a new injectable nano-hydroxyapatite(n-HA)/calcium sulphate hemihydrate(CSH) bone substitute in rabbits and to discuss its possible bio-degeneration mechanism.Methods: Pure CSH,n-HA,10%n-HA+CSH,20%n-HA+CSH,and 40%n-HA+CSH(the last 3 containing 10%,20%,and 40% n-HA,respectively) were subjected to MTT assay for their in vitro cytotoxicities.20%n-HA+CSH was implanted into rabbits' muscle and bone defects in the right femur,and the general conditions of rabbits,the pathological and TEM manifestations of tissues,and the imaging alterations were all observed 5 days,2,3,4,6,8,and 12 weeks after implantation.Results: Test of cytotoxicity showed that the average cell proliferation rate was over 77% after treated with the solutions of 5 bone substitutes(P