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OBJECTIVE@#To study the preparation and properties of the hyaluronic acid (HA)/α-calcium sulfate hemihydrate (α-CSH)/β-tricalcium phosphate (β-TCP) material (hereinafter referred to as composite material).@*METHODS@#Firstly, the α-CSH was prepared from calcium sulfate dihydrate by hydrothermal method, and the β-TCP was prepared by wet reaction of soluble calcium salt and phosphate. Secondly, the α-CSH and β-TCP were mixed in different proportions (10∶0, 9∶1, 8∶2, 7∶3, 5∶5, and 3∶7), and then mixed with HA solutions with concentrations of 0.1%, 0.25%, 0.5%, 1.0%, and 2.0%, respectively, at a liquid-solid ratio of 0.30 and 0.35 respectively to prepare HA/α-CSH/ β-TCP composite material. The α-CSH/β-TCP composite material prepared with α-CSH, β-TCP, and deionized water was used as the control. The composite material was analyzed by scanning electron microscope, X-ray diffraction analysis, initial/final setting time, degradation, compressive strength, dispersion, injectability, and cytotoxicity.@*RESULTS@#The HA/α-CSH/β-TCP composite material was prepared successfully. The composite material has rough surface, densely packed irregular block particles and strip particles, and microporous structures, with the pore size mainly between 5 and 15 μm. When the content of β-TCP increased, the initial/final setting time of composite material increased, the degradation rate decreased, and the compressive strength showed a trend of first increasing and then weakening; there were significant differences between the composite materials with different α-CSH/β-TCP proportion ( P<0.05). Adding HA improved the injectable property of the composite material, and it showed an increasing trend with the increase of concentration ( P<0.05), but it has no obvious effect on the setting time of composite material ( P>0.05). The cytotoxicity level of HA/α-CSH/β-TCP composite material ranged from 0 to 1, without cytotoxicity.@*CONCLUSION@#The HA/α-CSH/β-TCP composite materials have good biocompatibility. Theoretically, it can meet the clinical needs of bone defect repairing, and may be a new artificial bone material with potential clinical application prospect.
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Calcium Phosphates , Bone and Bones , PhosphatesABSTRACT
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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Introduction@#Skills training using artificial bones became more critical in response to the Orthopedic surgical training restriction caused by the COVID-19 pandemic. To cut the expenses of buying commercial artificial bones, the Ilizarov Limb Reconstruction Service has decided to fabricate its artificial bones for surgical skills training. @*Objective@#To determine if resin-coated polyurethane (PU) rigid foam is a suitable, low-cost alternative to commercial artificial bone. @*Methods@#Tibiae were fabricated using PU rigid foam coated with epoxy resins. Three randomly selected fabricated tibia, and one standard artificial tibia was subjected to drilling with drill bits and K-wires. The time to penetration of one cortex of the three segments of the tibiae was recorded in seconds. An actual circular external fixator was applied. The actual cost of production was calculated. @*Results@#Each fabricated tibia costs ₱456.93. The fabricated tibiae mean time to penetration was 2.15s and 3.37s using drill bits and K-wires. The commercial artificial bone mean time to penetration was 3.41s and 3.57s with drill bits and K-wires. The fabricated tibia was able to withstand the application of a circular external fixator and corticotomy. @*Conclusion@#The fabricated tibia is a suitable and more affordable simulation model for surgical skills training.
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Education , Surgical Procedures, OperativeABSTRACT
BACKGROUND: Animal model experiments on bone tuberculosis showed that calcium sulfate artificial bone loading could slowly and permanently release antituberculosis drugs, increase local drug concentration, and repair local bone defects and promote bone fusion. OBJECTIVE: To evaluate the safety and efficacy of implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw in the treatment of lumbar tuberculosis under transforaminal endoscopy after removal of lesions. METHODS: Twenty-eight patients with lumbar spinal tuberculosis who were treated in the First Affiliated Hospital of Guangxi University of Chinese Medicine from July 2016 to June 2019 were selected, including 10 males and 18 females, at the age of 36-69 years. Twelve patients in the experimental group received implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw under transforaminal endoscopy after removal of lesions. Sixteen patients in the control group received bone graft fusion and internal fixation under anterior and posterior combined approach or bone graft fusion and internal fixation after posterior approach. Operation time, intraoperative blood loss, and hospital stay were recorded. At 3 months postoperatively and at the last follow-up, erythrocyte precipitation, C-reactive protein level and Cobb angle, visual analogue scale score, lumbar Japanese Orthopaedic Association score and Oswestry disability index score were compared between the two groups. The experiment was approved by the Ethics Committee of First Affiliated Hospital of Guangxi University of Chinese Medicine. RESULTS AND CONCLUSION: (1) The operation time, intraoperative blood loss and hospital stay in the experimental group were all less than those in the control group (P 0.05). (5) The results show that compared with the traditional posterior approach and combined anterior and posterior approaches in the treatment of lumbar tuberculosis, posterior lateral foramen endoscopic implantation of artificial bone with streptomycin sulfate combined with posterior percutaneous pedicle screw fixation can also achieve satisfactory clinical effect, and has the advantages of small trauma and rapid recovery.
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Objective: This study aimed to examine differences in platelet-rich plasma (PRP) soak-loaded volumes of β-tricalcium phosphate (β-TCP) with or without a unidirectional porous structure.Materials and Methods: Leukocyte-rich PRP was extracted from 15 healthy volunteers by centrifugation. Two types of artificial bones were soaked for either ten seconds or ten minutes. The volume ratios of PRP soak-loaded onto the artificial bone and soaked area ratios were evaluated. Statistical analyses were performed using the Tukey-Kramer HSD test and the Games-Howell method. A P-value of <0.05 was considered statistically significant.Results: Regardless of the soaking time, the PRP soak-loaded volume ratio and soaked area ratio were significantly higher in the unidirectional porous β-TCP (UDPTCP) group than in the spherical porous β-TCP (SPTCP) group.Conclusion: PRP can be soak-loaded faster and in larger amounts onto UDPTCP compared to SPTCP. Understanding the basic biology of β-TCP soak-loaded with PRP can help develop more novel and effective β-TCP treatments for orthopedic surgery.
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BACKGROUND: At present, most of the treatment of unstable dislocation of sternoclavicular joint is to insert the hook plate of acromioclavicular joint into the cavity of sternal bone marrow or put it behind the sternum. The difficulty of operation is increased because of the insufficient application of steel plate, which reduces the effect of joint reduction. OBJECTIVE: The research team has developed a new type of sternoclavicular hook plate (Patent No. ZL201520515237.3), and compared the biomechanical properties of acromioclavicular hook plate and new sternoclavicular hook plate to fix sternoclavicular joint from the aspect of biomechanics. METHODS: The sternum and clavicle at both ends of the sternoclavicular joint were replaced with a rectangular artificial bone. Eighteen pairs of artificial sternoclavicular joints were randomly divided into two groups. In control group (n=6), the plate screw hole section of the shortest segment 3-hole common acromioclavicular hook plate was fixed to the artificial clavicle end; and the hook end was placed on the back side of the artificial sternum. Load and displacement changes in artificial sternal fractures were measured with MTS biomaterial test system. In the experimental group (n=12), the plate screw hole section of the shortest rod section 2 hole new sternoclavicular hook plate was fixed to the artificial clavicle end; and the hook end was inserted into the artificial sternum. The MTS biomaterial test system was used to detect changes in load and displacement of the anterior cortical bone (n=6) and posterior cortical bone (n-6). RESULTS AND CONCLUSION: In the control group, the mean of maximum destructive force was (390±51) N. The mean of maximum destructive force of anterior cortical bone was (421±55) N. In the experimental group, the mean of maximum destructive force of posterior cortical bone was (437±56) N. There were no significant differences between the three groups (P > 0.05). Results indicated that the new sternoclavicular hook plate did not increase the risk of sternum fracture, and it was a safe and effective internal fixation material.
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BACKGROUND: With the improvement in medical level, the clinical demand for bone repair materials is gradually Increasing, and the requirements are also getting more and more. OBJECTIVE: To review the related research progress In the field of bone repair materials In recent years, to analyze the advantages and disadvantages of different materials, and to guide future development In this research field. METHODS: A computer-based online search of CNKI, Wanfang, PubMed, Web of Science databases was performed to retrieve papers published during 1950-2019 with the search terms “tissue engineering, bone repair material, bone defect, natural bone material, bone graft replacement material, traditional Chinese medicine” in Chinese and English. A total of over 900 papers were retrieved, and 68 of them were included In the final analysis. RESULTS AND CONCLUSION: In recent year, with the flourish development of bone tissue engineering, the research of bone tissue repair materials is in the ascendant. In addition to optimizing natural bone, a variety of bone graft substitute materials have been developed, for example, natural macromolecule materials, synthetic macromolecule materials, biomedical ceramics materials, biomedical metal materials, etc., but these materials have different properties. Although there are many bone repair materials at present, the Ideal bone repair materials are few. Therefore, bone tissue repair and bone remodeling is still one of the urgent orthopedic problems to be solved In the clinic. In addition, the traditional Chinese medicine for bone repair, such as pyritum combined with modern bone repair materials, can effectively avoid some of the drawbacks of the current bone repair materials, thereby effectively treating bone defect diseases. This deserves In-depth investigation In the field of bone repair.
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OBJECTIVE: Chronic osteomyelitis is a difficult orthopedic disease. The treatment process is complicated and prolonged. It is easy to relapse. At present, studies have confirmed that antibiotic artificial bone is effective in treating chronic osteomyelitis, but there is still no evidence-based basis. This study systematically evaluated the clinical efficacy and safety of antibiotic artificial bone in the treatment of chronic osteomyelitis. METHODS: The authors searched relevant literature in CNKI, Wanfang, VIP, CBM, PubMed, and Cochrane Llibrary databases. The limit of searching time was from inception to April 2020. Randomized controlled trials on the use of antibiotic artificial bones for chronic osteomyelitis were collected according to the criteria for inclusion and exclusion. Two researchers independently screened, evaluated, and extracted the retrieved documents. The quality evaluation was carried out according to the Cochrane evaluation manual and the NOS scale. The literature data were analyzed using RevMan 5.3 software through a meta-analysis. RESULTS: (1) Two randomized controlled clinical trials evaluated moderately biased quality, and 11 retrospective studies evaluated high-quality literature. A total of 744 patients were included in 13 clinical control trials, including 387 patients in the treatment group and 357 patients in the control group. (2) The results of meta-analysis showed that the treatment group had significant differences from the control group in terms of infection clearance rate, fracture healing rate, fracture healing time, incision healing time, treatment efficiency, length of stay, reoperation rate, complication rate and recurrence rate, and the treatment group was superior to the control group (P < 0.05). CONCLUSION: Antibiotic artificial bone treatment of chronic osteomyelitis can improve the treatment efficiency, shorten the treatment time, better control infection, and reduce complications and recurrence rate. This conclusion also needs a larger sample and higher quality randomized controlled trials to verify.
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BACKGROUND: Preliminary study has shown that the composite materials composed of magnesium-based materials and mineralized collagen have a good supporting effect on repairing the critical defects, which can improve the mechanical strength of mineralized collagen and premature collapse during bone healing to some extent. However, magnesium-based metals degrade fast in chloride-containing solutions (including human body fluids or plasma), and the effects of releasing magnesium ions on the proliferation and differentiation of osteoblasts are unknown. OBJECTIVVE: To investigate the effects of magnesium ion combined with mineralized collagen on osteogenic differentiation of mouse preosteoblasts in vitro. METHODS: Mineralized collagen extracts were prepared from complete medium with magnesium ion concentration of 0, 5, 10, and 20 mmol/L. Mouse preosteoblasts were cultured with four mineralized collagen extracts, respectively, which were divided into mineralized collagen group, and 5, 10 and 20 mmol/L Mg2++mineralized collagen groups. The mouse preosteoblasts cultured in complete medium were used as control group. The cell morphology, proliferation, apoptosis, intracellular microfilament actin, and the activity of alkaline phosphatase and expression level of the osteogenic gene Runx2 after osteogenic differentiation were detected. RESULTS AND CONCLUSION: (1) After 24 hours of culture, the cells in the mineralized collagen group, and 5 and 10 mmol/L Mg2++ mineralized collagen groups adhered well, which showed no significant difference from the blank control group, and the elongated spindle cells with many synapses linked to the adjacent cells were observed. The cells in the 20 mmol/L Mg2++mineralized collagen group showed obvious pyknosis. (2) After 1, 3 and 5 days of culture, the cell viability in the 10 mmol/L Mg2++mineralized collagen group was significantly higher than that in the other four groups (P 0.05). The cell viability in the 20 mmol/L Mg2++mineralized collagen group was significantly lower than that in the mineralized collagen group (P < 0.05). (3) After 3 days of culture, DAPI staining showed that 20 mmol/L Mg2++mineralized collagen group had obvious nuclear disintegration, the other four groups had no obvious nuclear disintegration. (4) After 24 hours of culture, phalloidin staining showed that except the blank control and 20 mmol/L Mg2++mineralized collagen groups, the other three groups showed completely extended cell structure, and clear actin microfilaments, especially the 10 mmol/L Mg2++mineralized collagen group. (5) After 7 days of osteogenic differentiation, except for 20 mmol/L Mg2++mineralized collagen group, the activity of alkaline phosphatase and the expression level of Runx2 gene in the other three groups were significantly higher than those in the blank control group (P < 0.05), and those in the 10 mmol/L Mg2++mineralized collagen group was significantly higher than those in the 5 mmol/L Mg2++mineralized collagen and mineralized collagen groups (P < 0.05). (6) These results suggest that the combination of magnesium ion with mineralized collagen should be applied with appropriate concentration range of magnesium ion (≤ 10 mmol/L).
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OBJECTIVES@#To evaluate the repairing ability of nano-pearl powder bone substitute in rabbit with defect of distal femur bone.@*METHODS@#Thirty-two New Zealand rabbits were randomly divided into four groups: a nano-pearl powder/recombinant human bone morphogenetic protein 2 (rhBMP-2)/hyaluronic acid group, a nano-pearl powder/hyaluronic acid group, a nano-pearl powder group and a blank control group (=8 in each group). A defect with the diameter of 7 mm and height of 10 mm was prepared at the distal femoral metaphysis line of the rabbit.Different bone substitutes were planted, and the effect of repair was evaluated by macroscopic observation, imaging examination, and histopathological examination.@*RESULTS@#The results of imageology showed that: the bone repairing effect in the nano-pearl powder/rhBMP-2/hyaluronic acid group was better than that in the pure pearl powder group and the nano-pearl powder/hyaluronic acid group, and which in the 3 experimental groups was better than that in the blank control group; The results of histology showed that: at the 4th, 8th and 12th weeks after the modeling operation, the speed of bone repair in the nano-pearl powder/rhBMP-2/hyaluronic acid group was faster than that in the pure pearl powder group and the nano-pearl powder/hyaluronic acid group, and which in the blank control group was far slower than that in the 3 experimental groups. The results of immunohistochemistry staining for osteocalcin antibody showed that: the osteogenic effect in the nano-pearl powder/rhBMP-2/hyaluronic acid group was better than that in the pure pearl powder group and the nano-pearl powder/hyaluronic acid group (both 0.05); however, there was significant difference between the pure pearl powder group and the blank control group (0.05), but the osteogenic effect in the nano-pearl powder/hyaluronic acid group was better than that in the pure pearl powder group and the blank control group (both <0.05).@*CONCLUSIONS@#Nano-pearl powder and its bone substitute can promote the repair of bone defect, and the nano-pearl powder which contains rhBMP-2 has better osteogenic and repairing effect on defect.
Subject(s)
Animals , Humans , Rabbits , Bone Morphogenetic Protein 2 , Bone Substitutes , Collagen , Femur , Osteogenesis , Powders , Recombinant Proteins , Transforming Growth Factor betaABSTRACT
Objective@#To research the clinical effect of platelet rich plasma combined with Bio-oss artificial bone meal in repairing bone defects around implants.@*Methods@#From January 2015 to January 2017, 70 cases who completed the implant repair in Lishui People's Hospital, and later confirmed the defects around the implant were selected in the research.They were equally divided into observation group and control group according to admission, with 35 cases in each group.The control group was treated with Bio-oss artificial bone powder.The observation group was treated with platelet rich plasma combined with Bio-oss artificial bone powder.The clinical effects of the two groups were compared and analyzed.@*Results@#Before treatment, the probe depth (PD), clinical attachment loss (CAL), plaque index (PI), gingival sulcus hemorrhage index (SBI) of the observation group and the control group were (7.18±1.31)mm, (5.68±0.87)mm, (1.23±0.31), (2.48±0.34) and (7.22±1.28)mm, (5.74±0.83)mm, (1.27±0.33), (2.53±0.36), respectively, which were significantly higher than those after treatment (all P<0.05). Before treatment, the bone mineral density (BMD) levels of the two groups were (35.48±4.58)g/cm3 and (35.74±4.61)g/cm3, respectively, which were significantly lower than those after treatment (all P<0.05). The levels of PD, CAL, PI and SBI in the observation group at 3 months and 6 months after treatment were (4.48±1.01)mm, (4.27±0.53)mm, (0.68±0.21), (1.12±0.13) and (3.43±0.76)mm, (3.58±0.54)mm, (0.38±0.07), (0.41±0.08), respectively, which were significantly lower than those in the control group [(5.19±0.83)mm, (4.83±0.71)mm, (0.89±0.27), (1.46±0.21) and (4.14±0.98)mm, (4.21±0.62)mm, (0.49±0.11), (0.63±0.13)], the differences were statistically significant (t=3.213, 3.739, 3.632, 8.144 and 3.387, 4.533, 4.991, 8.526, P=0.002, 0.000, 0.000, 0.000, 0.001, 0.000, 0.000, 0.000, 0.000, 0.000). The levels of TA anterior temporalis muscle EMG and MA masseter muscle EMG in the two groups at 6 months after treatment were (76.81±15.17)mV, (67.56±14.43)mV, (74.24±13.28)mV, (68.27±13.03)mV, (66.44±13.28)mV, (58.76±13.07)mV, (65.58±11.55)mV, (59.04±10.76)mV, respectively, which were significantly higher than those before treatment [(46.48±11.15) mV, (38.19±13.04) mV, (54.83±12.57) mV, (56.48±13.13) mV and (45.71±10.98) mV, (38.23±13.11)mV, (55.14±12.69) mV, (56.61±13.08) mV] (all P<0.05). After treatment, the ICP-HB, ICMAP-MC, TA, EMG levels in the observation group were significantly higher than those in the control group, the differences were statistically significant (t=3.042, 2.674, 2.911, 2.994, P=0.003, 0.009, 0.004 and 0.003).@*Conclusion@#The effect of rich plate plasma combined with Bio-oss artificial bone powder on the repair of bone defect around the implant is significant.The platelet rich plasma can speed up and improve the repair speed and repair quality of bone defect around the implant, so that the therapeutic effect of implant repair can be maintained for a long time.
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To investigate the effect and application value of transplantation of the free cutaneous fibular flap combined with antibiotic-loaded calcium sulfate artificial bone graft for the treatment of antibrachial chronic osteomyelitis of Cierny-Mader type IV. Methods From August, 2013 to May, 2017, 12 cases of ulna or (and) radius chronic osteomyelitis of Cierny-Mader type IV were treated by transplantation of the free cutaneous fibu-lar flap combined with antibiotic-loaded calcium sulfate artificial bone graft. There were 7 males and 5 females, with an average age of 36.3 (21-47) years.Pure ulnar osteomyelitis in 7 cases, radius osteomyelitis in 4 cases, and both ul-nar and radius osteomyelitis in 1 case. The average range of osteomyelitis lesions was 6.3 (3.0-9.0) cm. The area of soft tissue defect (including bone scar) ranged from 8.0 cm×2.0 cm to 15.0 cm×5.0 cm. The area of the flap was 10.0 cm×3.5cm-17.0 cm×7.0 cm.The average length of the fibular flap was 8.8 (5.0-12.0) cm.Locking plate internal fixa-tion was used in 9 cases, external fixator in 2 cases, and plate combined with external fixator in 1 case. Vancomycin/gentamicin, an effective component of calcium sulfate artificial bone, averaged 0.64 g/102.7 kU (0.4 g/64 kU-1.0 g/160 kU).Routine postoperative treatment.And monthly outpatient review in the first half year after operation, and outpatient review every 3 months after half a year.One year after operation, comprehensive evaluation of elbow, forearm and wrist function with Mayo Elbow Function Index, Anderson Forearm Double Fracture Evaluation System and Cooney Wrist Function Score. Results Vascular crisis occurred in 1 case after operation, prompt surgical exploration, and ultimately all flaps survived completely.The donor sites healed well in all cases.The lower extremity functions of donor sites had no change compared with that before operation.Followed-up of an average of 22.7 months, there were 2 cases who had sen-sory disturbance in the ulnar nerve innervation area and returned to normal 3 months after operation. The fibular flaps healed satisfactorily with an average healing time of 4.7 (3-6) months.No calcium sulphate artificial bone granules were seen on X-ray at 3 months after operation.One year after operation, bone healing, forearm appearance and wrist function recovered well, but elbow and forearm motor function recovered unsatisfactorily. Conclusion On the basis of master-ing the applied anatomy and vascular anastomosis techniques of microsurgery, this method of transplantation of the free cutaneous fibular flap combined with antibiotic-loaded calcium sulfate artificial bone graft for the treatment of an-tibrachial chronic osteomyelitis of Cierny-Mader type IV has achieved satisfactory results.The recipient area is beautiful. The bone healing is reliable.And it has little influence on the recipient area and the donor area.It is worthy of clinical application.
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Objective To research the clinical effect of platelet rich plasma combined with Bio-oss artificial bone meal in repairing bone defects around implants.Methods From January 2015 to January 2017,70 cases who completed the implant repair in Lishui People's Hospital,and later confirmed the defects around the implant were selected in the research.They were equally divided into observation group and control group according to admission,with 35 cases in each group.The control group was treated with Bio-oss artificial bone powder.The observation group was treated with platelet rich plasma combined with Bio-oss artificial bone powder.The clinical effects of the two groups were compared and analyzed.Results Before treatment,the probe depth (PD),clinical attachment loss (CAL),plaque index (PI),gingival sulcus hemorrhage index (SBI) of the observation group and the control group were (7.18 ± 1.31)mm,(5.68 ±0.87)mm,(1.23 ±0.31),(2.48 ±0.34) and (7.22 ± 1.28)mm,(5.74 ±0.83) mm,(1.27 ± 0.33),(2.53 ± 0.36),respectively,which were significantly higher than those after treatment (all P ＜ 0.05).Before treatment,the bone mineral density (BMD) levels of the two groups were (35.48 ± 4.58) g/cm3 and (35.74 ±4.61) g/cm3,respectively,which were significantly lower than those after treatment (all P ＜ 0.05).The levels of PD,CAL,PI and SBI in the observation group at 3 months and 6 months after treatment were (4.48 ± 1.01) mm,(4.27 ±0.53)mm,(0.68 ±0.21),(1.12 ±0.13) and (3.43 ±0.76) mm,(3.58 ±0.54)mm,(0.38 ±0.07),(0.41 ±0.08),respectively,which were significantly lower than those in the control group [(5.19 ± 0.83) mm,(4.83 ±0.71)mm,(0.89 ±0.27),(1.46 ±0.21) and (4.14 ±0.98)mm,(4.21 ±0.62)mm,(0.49 ±0.11),(0.63 ±0.13)],the differences were statistically significant (t =3.213,3.739,3.632,8.144 and 3.387,4.533,4.991,8.526,P =0.002,0.000,0.000,0.000,0.001,0.000,0.000,0.000,0.000,0.000).The levels of TA anterior temporalis muscle EMG and MA masseter muscle EMG in the two groups at 6 months after treatment were (76.81 ± 15.17) mV,(67.56 ±14.43)mV,(74.24 ± 13.28) mV,(68.27 ± 13.03) mV,(66.44 ± 13.28) mV,(58.76 ± 13.07) mV,(65.58 ±11.55) mV,(59.04 ± 10.76) mV,respectively,which were significantly higher than those before treatment [(46.48 ±11.15) mV,(38.19± 13.04) mV,(54.83 ±12.57) mV,(56.48 ±13.13) mV and (45.71 ±10.98) mV,(38.23 ±13.11)mV,(55.14±12.69) mV,(56.61 ± 13.08) mV] (all P ＜0.05).After treatment,the ICP-HB,ICMAP-MC,TA,EMG levels in the observation group were significantly higher than those in the control group,the differences were statistically significant (t =3.042,2.674,2.911,2.994,P =0.003,0.009,0.004 and 0.003).Conclusion The effect of rich plate plasma combined with Bio-oss artificial bone powder on the repair of bone defect around the implant is significant.The platelet rich plasma can speed up and improve the repair speed and repair quality of bone defect around the implant,so that the therapeutic effect of implant repair can be maintained for a long time.
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Objective: To treat vertebral fractures with posterior wall injury in the elderly, vertebral bone grafting is generally performed through a posterior transpedicular approach, combined with pedicle screw fixation. An autologous bone is ideal to treat this disorder. However, harvesting autologous bones from the elderly with osteoporosis is limited by the amount and quality of available autologous bone. Thus, we developed a bone-grafting substitute. The newly developed unidirectional porous β-tricalcium phosphate, with a porosity of 57% (UDPTCP; Affinos®, Kuraray Co., Ltd., Tokyo, Japan), is used in the bone-grafting procedure. This is the first report of UDPTCP used as an artificial bone graft in patients with an acute vertebral burst fracture.Materials and Methods: UDPTCP (mean: 4.2 g) was implanted through the pedicle, and posterior instrumentation was achieved with pedicle screws in five elderly patients. Resorption of UDPTCP and substitution with the autologous bone were evaluated on computed tomography (CT) and plain X-ray performed immediately and at 3, 6, and 12 months after the operation.Results: In case 1, the pedicle screws did not loosen, and UDPTCP was completely resorbed and replaced with the autologous bone at 3 postoperative months. In the other four cases, although the pedicle screws or the caudal part loosened because of osteoporosis, resorption of UDPTCP was observed at 3 postoperative months. At 6 postoperative months, progressive substitution with the autologous bone was confirmed, and at 12 postoperative months, formation of the good autologous bone was confirmed.Conclusion: This preliminary case series demonstrated that the newly developed UDPTCP shows good clinical potential as a bone-graft substitute for acute vertebral burst fractures in the elderly, including patients with osteoporosis.
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<p><b>Objective</b>Combining artificial scaffolds with stimulatory factors to reconstruct lost bone tissues is one of the hottest research directions. The purpose of this review was to conduct a retrospective survey on the latest reports on artificial bone fabrication with functional cytokines.</p><p><b>Data Sources</b>The status of related scientific research from the year 2005 to 2018 was analyzed through the mode of literature retrieval in PubMed and VIP Database. The retrieval words are as follows: "bone tissue engineering," "angiogenesis," "cytokines," "osteogenesis," "biomimetic bone marrow," "sol-gel," "delivery system," and the corresponding Chinese words.</p><p><b>Study Selection</b>After reading through the title and abstract for early screening, the full text of relevant studies was evaluated and those not related with this review had been ruled out.</p><p><b>Results</b>According to the literature retrospective survey, there were three key points for the successful construction of functional artificial bones: (1) the continuous supply of relatively low concentration of cytokines during the required period; (2) the delivery of two or more cytokines essential to the process and ensure the relatively spatial independence to reduce the unnecessary interference; and (3) supporting the early-stage angiogenesis and late-stage osteogenesis, respectively, regulating and balancing the crosslinking of both to avoid the surface ossification that would probably block the osteogenesis inside.</p><p><b>Conclusions</b>The synergistic effect of both angiogenic factors and osteogenic factors applied in bone regeneration is a key point in the combined functional artificial bone. Through analysis, comparison, and summary of the current strategies, we proposed that the most promising one is to mimic the natural bone marrow function to facilitate the regeneration process and ensure the efficient repair of large weight-bearing bone defect.</p>
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Objective To investigate the effects of open reduction and internal fixation plus calcium sulfate artificial bone graft for the treatment of Sanders type Ⅲ and Ⅳ calcaneal fractures.Methods Thc clinical data of patients with Sanders type Ⅲ and Ⅳ calcaneal fractures treated from January 2012 to December 2015 were retrospectively reviewed by case-control study.The patients were divided into two groups as bone graft group (open reduction and internal fixation combined with artificial bone graft) and control group (open reduction and internal fixation).The bone graft group was composed of 17 cases,among which there were 12 males and five females with age range of 19-62 years [(41.6 ± 12.9) years].In bone graft group,there were 12 cases of Sanders Ⅲ and five cases of Sanders Ⅳ.The control group was composed of 13 cases,among which there were eight males and five females with age range of 20-59 years [(39.4 ± 11.8) years].In control group,there were ten cases of Sanders Ⅲ and three cases of Sanders Ⅳ.The follow-up visits were done at 1,2,3,6,and 12 months after surgery with record of complication occurrence.The changes of Bohler's angle and Gissan's angle were observed preoperatively as well as at 2 days and 12 months after surgery.The function recovery was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up visit.Results Five cases of marginal necrosis of the incision and two cases of superficial soft tissue infection were seen in bone graft group,while there were two cases of marginal necrosis of the incision and one cases of superficial soft tissue infection in control group.In early postoperative comparison between two groups,the variation of Bohler's angle and Gissan's angle had no significant difference (P ＞ 0.05).At 12 months after surgery,Bohler's angle of bone graft and control groups were (23.2 ± 9.0) ° and (19.5 ± 11.1) °,respectively.The losses of Bohler's angle were (3.6 ± 2.7) ° and (6.9 ± 3.1) °,respectively.The difference in the losses of angle in two groups had statistical significance (P ＜ 0.05).Gissan's angle of bone graft and control groups were (123.4 ± 9.4)o and (122.2 ± 9.0)°,respectively.The losses of Gissan's angle were (2.8 ± 1.8) °and (3.8 ± 2.3) °,respectively (P ＞ 0.05).At the final follow-up,bone union was found in all cases,and there was no significant difference in AOFAS score between the two groups (P ＞ 0.05).Conclusions Open reduction and internal fixation can attain good treatment results for Sanders type Ⅲ and Ⅳ calcaneal fractures,no matter whether bone graft is carried out.However,artificial bone graft may have good effects to sustain the stability of fracture fragments and provide early mechanical support for the subtalar joint.
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Objective To investigate the X-ray gray scale changes of calcium sulfate and evaluate its clini-cal effect in traumatic fracture treatment. Methods 23 traumatic fracture cases were treated from September 2014 to January 2016 in our hospital. The degradation rate of calcium sulfate was evaluated by X ray assay. Results Af-ter surgery,about 69%remnants at 1 week,53%remnants at 2 weeks,26%remnants at 4 weeks,7%remnants at 6 weeks were observed,while no remnants were found at 8 weeks after surgery. The initial time window of callus appearance was 3 to 9 weeks and the mean time was(6.5 ± 1.6)weeks. The fracture union time was 8 to 24 weeks and the mean time was(15.0 ± 5.2)weeks. One patient with distal humeral comminuted fracture had non-infec-tious delayed healing wound.One case of hemolytic staphylococcus in incision was cultured. Conclusion Calcium sulfate degrades rapidly,cautions should be taken for the application in the superficial bone.
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Objective To evaluate the the effect of vancomycin artificial bone on the treatment of elderly patients with chronic osteomyelitis and the influence to TNF-α.MethodsIn Yongkang orthopaedic hospital, 48 cases of elderly patients with chronic osteomyelitis were selected as the object of study, and were randomly divided into the control group and the experimental group, 24 cases in each group.This is a retrospective study.Three days before operation, the control group were given cloxacillin 2g/d by 4 times intravenous drip.The experimental group were given Norvancomycin Hydrochloride 0.8g/d by two times intravenous drip.In the process of operation, the control group were given bone graft substitutes 5-10g and the experimental group were given Norvancomycin Hydrochloride 1g that is added to the water to form a paste.After operation, the control group were given cloxacillin 2g/d by 4 times intravenous dripand the experimental group were given Norvancomycin Hydrochloride 0.8g/d by 2 times intravenous drip.The two groups were treated continuously for two weeks.The effect,CRP, ESR, TNF-α, NF-κB and adverse drug reactions were compared between the two groups.ResultsThe effect in the experiment group was 95.45%,is significant higher than that in the control group 81.82%(P<0.05).The serum level of CRP、ESR、TNF-α and NF-κB decreased post-treatment in the experiment group much lower than that in the control group (P<0.05).The adverse drug reactions was not statistically different between the two groups.ConclusionVancomycin artificial bone on the treatment of elderly patients with chronic osteomyelitis was effective with high safety and it can decrease the level of TNF-α.
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The paper retrieved the literature information on the artificial bone and composite artificial bone in CNKI, Wanfang data and foreign databases such as Pubmed and SCI-E from 2009 to 2016, and summarized the characteristics and deficiency of all kinds of artificial bone materials.On this basis, it briefly described the functional application and the principles of the composite artificial bone repair materials, and introduced the application of tissue engineering and 3D printing technology in the field, which could provide reference for the exploration of new types of composite artificial bone repair materials.
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Objective:To study the feasibility of a new composite mineralized collagen membrane in alveolar ridge preservation.Methods:The third mandibular premolars on both sides were extracted from 12 dogs,the 24 alveolar sockets were randomly assigned into A,B and C groups(n =8).The distal alveolar sockets of group A was immediately implanted with the new composite mineralized collagen membrane and bone graft material,those of group B with bone graft material,group C was the blank control.The healing of sockets was evaluated by gross observation,morphological measurements,X-ray microscope and photographs of spiral CT.Results:The horizontal width of the alveolar process of group A was bigger than that of group B (P ＜ 0.05),that of group B was bigger than that of group C (P ＜ 0.05).The region of extraction interest in spiral CT value was higher in group A than that in group B and C (P ＜ 0.05).The extraction sockets were generated new bone and the degree of reconstruction measurements was higher in group A than that in group B and C (P ＜ 0.05).Conclusion:The new composite mineralized collagen membrane can induce the regeneration of new bone,and preserve the alveolar.