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Abstract The color stability of temporary restoration is crucial, especially in sensitive areas in terms of aesthetics. This research aimed to determine the effect of temporary cement on the color of temporary crowns made by conventional pressing methods (indirect) and CAM/CAD technologies using milling machines and 3D printers. This study was carried out in a laboratory, utilizing A2 color in all manufacturing methods. The color of the restorations was measured by a spectrophotometer after cementation with semi-permanent resin cement. Subsequently, color changes of the samples (ranging from 0 to 100) were calculated using the Commission International de l'Eclairage (CIE) Lab system. Data analysis was based on descriptive statistics methods and statistical tests, including one-way analysis of variance (ANOVA) and Tukey's post hoc test. According to the results of ANOVA, there was a significant difference between the three groups in terms of the 'a' and 'b' indexes (P<0.001). However, regarding the 'l' index, no significant difference was observed among the three groups (P=0.250). Also, based on Tukey's post hoc test, a significant relationship was seen between the first and second pairs in the 3D printer group, and between the first and third pairs in the milling group (P<0.001). However, no significant difference was observed in the conventional pressing group. The results showed that the 3D printing method exhibited the highest amount of color change among the three methods, while the milling method demonstrated the lowest amount of change.
Resumen La estabilidad del color de la restauración temporal es muy importante, especialmente en zonas sensibles desde el punto de vista estético. En la presente investigación, el objetivo fue determinar el efecto del cemento temporal sobre el color de coronas temporales realizadas mediante métodos de prensado convencionales (indirectos) y tecnologías CAM/CAD utilizando fresadora e impresora 3D. Este estudio se llevó a cabo en un laboratorio y se utilizó color A2 en todos los métodos de fabricación. El color de las restauraciones se midió mediante un espectrofotómetro después de cementarlas con cemento de resina provisional. Luego se calcularon los cambios de color de las muestras (de 0 a 100) utilizando el sistema CIE Lab. El análisis de los datos se basó en métodos de estadística descriptiva y pruebas estadísticas, incluido el análisis de varianza unidireccional (ANOVA) y la prueba post hoc de Tukey. Según los resultados del análisis de varianza unidireccional, hubo una diferencia significativa entre los tres grupos en términos de los índices a y b (P<0,001), pero en términos del índice l, no hubo diferencias significativas entre los tres grupos (P=0,250). Además, según la prueba post hoc de Tukey, se observó una relación significativa entre el primer y el segundo grupo de impresoras 3D y entre el primer y el tercer grupo de fresado (P<0,001). Sin embargo, no se observó ninguna diferencia significativa en el grupo de prensado convencional. Los resultados mostraron que el mayor cambio de color entre los tres métodos fue con el método de impresión 3D, y la menor cantidad fue con el método de fresado.
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A tumor that is locally aggressive is a giant cell tumor (GCT). The distal end of the femur, proximal end of the tibia, distal end of the radius, and proximal humerus are common locations. Presenting the case of a 52-year-old man who has a giant cell tumor in the unusual position of the lower end of the right tibia. Patient came with complaints of pain and swelling in the right ankle. The tissue's histopathology reveals spindle-shaped mononuclear cells suggestive of GCT and multinucleated giant cells with homogenous vesicular nuclei. Curettage and bone cement were used to treat the patient and fill the defect.
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OBJECTIVE@#To investigate the effect of bone cement containing recombinant human basic fibroblast growth factor (rhbFGF) and recombinant human bone morphogenetic protein-2 (rhBMP-2) in percutaneous kyphoplasty(PKP)treatment of osteoporotic vertebral compression fracture(OVCF).@*METHODS@#A total of 103 OVCF patients who underwent PKP from January 2018 to January 2021 were retrospectively analyzed, including 40 males and 63 females, aged from 61 to 78 years old with an average of (65.72±3.29) years old. The injury mechanism included slipping 33 patients, falling 42 patients, and lifting injury 28 patients. The patients were divided into three groups according to the filling of bone cement. Calcium phosphate consisted of 34 patients, aged(65.1±3.3) years old, 14 males and 20 females, who were filled with calcium phosphate bone cement. rhBMP-2 consisted of 34 patients, aged (64.8±3.2) years old, 12 males and 22 females, who were filled with bone cement containing rhBMP-2. And rhbFGF+rhBMP-2 consisted of 35 patients, aged (65.1±3.6) years old, 14 males and 21 females, who were filled with bone cement containing rhbFGF and rhBMP-2. Oswestry disability index (ODI), bone mineral density, anterior edge loss height, anterior edge compression rate of injured vertebra, visual analog scale (VAS) of pain, and the incidence of refracture were compared between groups.@*RESULTS@#All patients were followed for 12 months. Postoperative ODI and VAS score of the three groups decreased (P<0.001), while bone mineral density increased (P<0.001), anterior edge loss height, anterior edge compression rate of injured vertebra decreased first and then slowly increased (P<0.001). ODI and VAS of group calcium phosphate after 1 months, 6 months, 12 months were lower than that of rhBMP-2 and group rhbFGF+rhBMP-2(P<0.05), bone mineral density after 6 months, 12 months was higher than that of rhBMP-2 and group calcium phosphate(P<0.05), and anterior edge loss height, anterior edge compression rate of injured vertebra of group rhbFGF+rhBMP-2 after 6 months and 12 months were lower than that of group rhBMP-2 and group calcium phosphate(P<0.05). There was no statistical difference in the incidence of re-fracture among the three groups (P>0.05).@*CONCLUSION@#Bone cement containing rhbFGF and rhBMP-2 could more effectively increase bone mineral density in patients with OVCF, obtain satisfactory clinical and radiological effects after operation, and significantly improve clinical symptoms.
Subject(s)
Male , Female , Humans , Middle Aged , Aged , Bone Cements/therapeutic use , Fractures, Compression/complications , Retrospective Studies , Spinal Fractures/complications , Osteoporotic Fractures/etiology , Kyphoplasty/adverse effects , Vertebroplasty/adverse effects , Calcium Phosphates/therapeutic use , Treatment Outcome , Recombinant Proteins , Transforming Growth Factor beta , Fibroblast Growth Factor 2 , Bone Morphogenetic Protein 2ABSTRACT
Objective To evaluate the diffusion distribution of bone cement in the vertebral body by quadrant method,and to analyze and evaluate the correlation between the diffusion distribution type of bone cement and new vertebral fractures after vertebral augmentation.Methods A total of 170 subjects who met the conditions from January 2020 to December 2021 were collected.According to the anteroposterior and lateral view of the spine,the injured vertebra was divided into four quadrants,and divided into homogeneous diffusion group and uneven diffusion group according to the postoperative diffusion distribution of bone cement in the injured vertebra.The incidence and types of refracture were followed up,and the VAS score and Cobb angle were compared between the two groups.Results 170 patients were followed up for at least 12 months,including 90 patients in homogeneous diffusion group and 80 patients in heterogeneous diffusion group.There were 33 cases of refracture(19.41%),12 cases of refracture(13.33%)in the diffuse homogeneous group,and 21 cases of refracture(26.25%)in the diffuse heterogeneous group,and the difference between the groups was statistically significant(P<0.05).The site of refracture in the diffuse homogeneous group was mainly the clinical vertebral fracture,while the probability of refracture in the diffuse heterogeneous clinical vertebra and the operated vertebra was similar.The incidence of postoperative bone cement leakage in the diffuse homogeneous group was significantly lower than that in diffuse heterogeneous group(P<0.05).The VAS score and Cobb angle were significantly improved in both groups after surgery and at the last follow-up compared with those before surgery,but there was no significant difference between groups.Conclusion The incidence of new vertebral fractures after vertebroplasty is closely related to the type of cement diffusion,and the risk of refracture defined as uneven cement diffusion by quadrant method is high.
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BACKGROUND:The proximal femoral nail antirotation is the preferred treatment for reverse osteoporotic intertrochanteric fractures.Bone cement enhancement can reduce the probability of proximal femoral nail antirotation cut-out and cut-through,but there are no relevant biomechanical studies demonstrating the effect of bone cement content and location on the stress and displacement of the fracture end. OBJECTIVE:To investigate the effects of different contents and locations of bone cement in cement-reinforced proximal femoral nail antirotation on stress,strain,and displacement of reverse osteoporotic femoral intertrochanteric fractures in the elderly by finite element analysis. METHODS:A healthy adult female right femur model was extracted by Mimics software and smoothed in Geometric software.Five types of internal fixation methods of proximal femoral nail antirotation(cementless,cephalic spherical 1 mL,cephalic spherical 2 mL,cephalic spherical 3.4 mL,and cylindrical 5 mL around spiral blade)and femoral intertrochanteric fracture(AO subtype 31-A3.1 type)model were established in Solidworks software.After assembly,the total stress distribution,peak stress and displacement of the five models of implants with the femur were compared in Ansys software. RESULTS AND CONCLUSION:(1)The peak stresses of proximal femoral nail antirotation with head-end spherical 1 mL,head-end spherical 2 mL,head-end spherical 3.4 mL,and cylindrical 5 mL enhanced proximal femoral nail antirotation around the spiral blade respectively were 571.07 MPa(located at the junction of the spiral blade and the main nail),495.45 MPa(located at the junction of the spiral blade and the main nail),467.20 MPa(located at the junction of the main nail and the distal screw connection),642.70 MPa(located at the junction of the main nail and distal screw connection),and 458.58 MPa(located at the junction of the spiral blade and the main nail).(2)The maximum displacements of proximal femoral nail antirotation with head end sphere 1 mL,head end sphere 2 mL,head end sphere 3.4 mL,and with cylindrical 5 mL enhancement around the spiral blade were 9.260 5,7.589 1,7.316 8,6.790 7,and 6.615 7 mm,respectively,all of which were located at the proximal end of the femoral head.(3)These findings revealed that for reverse femoral intertrochanteric fractures treated with proximal femoral nail antirotation,the bone cement enhancement had significant mechanical stability compared with no enhancement,and the enhancement of the spiral blade 5 mL around the perimeter was the best,which is more preferable for aged unstable intertrochanteric fractures.
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BACKGROUND:Bone transport has been used for a variety of reasons in bone defects with good clinical results.However,various complications have also attracted the attention of practitioners and the avoidance of non-healing of the docking point has become a common concern for doctors and patients. OBJECTIVE:To explore effective methods of avoiding non-healing of the docking point in the treatment of tibial bone defects by bone transport so as to shorten the treatment period and reduce the pain of patients. METHODS:The clinical data of 21 patients with unilateral tibial bone defect admitted to the No.910 Hospital of Joint Logistics Support Force of Chinese PLA from January 2018 to January 2021 were retrospectively analyzed,including 16 males and 5 females,aged(32.8±10.3)years,with an average bone defect length of 10.2 cm.All 21 patients received bone transport surgery,during which the bone defect area was filled with bone cement to reduce the adverse factors affecting the healing of the docking point.The Association for the Study and Application of the Methods of Ilizarov,healing index and incidence of adverse reactions were evaluated during postoperative follow-up. RESULTS AND CONCLUSION:The 21 patients were followed up for 15 to 24 months after surgery,and the extended area was all well mineralized and had no malformations,and no refractures occurred during treatment.Among them,one patient had foot drop,which could not be completely corrected after surgical release of the Achilles tendon and wearing foot and ankle orthotics.19 patients had different degrees of needle tract infection,and no deep infection occurred after timely needle tract nursing.The healing rate of the docking point was 100%;the healing index was 36-45 d/cm and the average was 38 d/cm.The Association for the Study and Application of the Methods of Ilizarov showed that bone healing was excellent in 17 cases(81%)and poor in 4 cases(19%).The results of limb function were excellent in 18 cases(86%)and good in 3 cases(14%).These findings show that bone cement segmental filling during bone transport is an effective method to solve the non-healing of the docking point,shorten the patient's treatment period and reduce the patient's pain.
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OBJECTIVE:Cement-augmentation pedicle screws have been widely used in spinal internal fixation surgery combined with osteoporosis in recent years,which can significantly improve the fixation strength,but compared with conventional methods,whether it has more advantages is still inconclusive of evidence-based medicine.To systematically evaluate the efficacy and safety of cement-augmented pedicle screw in the treatment of thoracolumbar degenerative diseases with osteoporosis. METHODS:Clinical controlled trials concerning the cement-augmented pedicle screw and the traditional pedicle screw placement for thoracolumbar degenerative diseases with osteoporosis were retrieved from the electronic databases such as CNKI,CBM,WanFang,VIP,PubMed,Cochrane Library,Web of Science and Embase.According to the unified criteria,we performed literature screening and quality evaluation.The meta-analysis was performed using RevMan 5.4 software. RESULTS:(1)Totally 20 articles were selected eventually,involving 2 randomized controlled studies and 18 retrospective cohort studies,totally 1 566 patients.Among them,789 cases were in the cement-augmented screw group and 777 cases in the conventional screw group.(2)Meta-analysis results showed that Japanese Orthopaedic Association score,intervertebral space height and fusion rate were higher in the cement-augmented screw group than those in the conventional screw group(MD=1.60,95%CI:1.14,2.07,P<0.000 01;MD=1.26,95%CI:0.62,1.90,P=0.000 1;OR=11.24,95%CI:2.86,44.14,P=0.000 5).Operation time was longer in the cement-augmented screw group than that in the conventional screw group(SMD=0.82,95%CI:0.42,1.23,P<0.000 1).Postoperative visual analog scale score,Oswestry dysfunction index score and incidence of screw loosening were lower in the cement-augmented screw group than those in the conventional screw group(MD=-0.50,95%CI:-0.78,-0.21,P=0.000 7;SMD=-0.49,95%CI:-0.88,-0.10,P=0.01;OR=0.08,95%CI:0.05,0.12,P<0.000 01).Hospitalization time,intraoperative blood loss,and postoperative drainage volume were not significantly different between the two groups(P>0.05). CONCLUSION:Compared with conventional pedicle screw placement,cement-augmented pedicle screw is more effective in the treatment of osteoporotic thoracolumbar degenerative disease by improving fusion rate and interbody height,reducing the incidence of screw loosening,and elevating long-term efficacy.
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BACKGROUND:Studies have exhibited that symmetrical distribution and effective dose of bone cement can reduce postoperative vertebral refractures and help improve outcomes,but obtaining better distribution and dose of bone cement during percutaneous vertebroplasty remains an issue for surgeons. OBJECTIVE:To investigate the risk factors of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture,and to analyze the correlation between these factors and recurrent fractures of the operative vertebral body and adjacent vertebral bodies after percutaneous vertebroplasty. METHODS:111 patients who underwent unilateral approach percutaneous vertebroplasty in Sixth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2021 were screened and divided into fracture group(n=17)and non-fracture group(n=94)according to whether refracture was observed during follow-up.The following variables were reviewed in both groups:Gender,age,body mass index,operation time,menopause age,bone cement distribution index,bone density T value,bone cement dose,location of bone cement distribution,percutaneous vertebroplasty stage,past history,adverse reactions and disc cement leakage of patients.These variables were analyzed by univariate analysis.The statistically significant factors were replaced by a binary Logistic regression model to analyze the correlation with vertebral refracture after percutaneous vertebroplasty. RESULTS AND CONCLUSION:(1)Univariate analysis demonstrated that after percutaneous vertebroplasty,vertebral refracture was associated with disc cement leakage(P=0.000),cement dose(P=0.049),and cement distribution location(P=0.017).(2)Binary Logistic regression revealed that bone cement leakage(P=0.000),cement dose(P=0.031),and location of cement distribution(P=0.015)were risk factors for recurrent fracture of the operative vertebral body and adjacent vertebral body after percutaneous vertebroplasty.Compared with cement distribution types I,II,and III,the risk of recurrent fracture in the operative and adjacent vertebrae was higher in cement distribution types IV and V(OR=36.340,P=0.016;OR=27.755,P=0.017).(3)It is concluded that recurrent fractures of the surgically operated vertebral body and adjacent vertebral bodies are caused by the interaction of multiple risk factors.Bone cement distribution and bone cement leakage were independent risk factors.Recurrent fractures of the operative vertebra and adjacent vertebrae are more likely when the cement is distributed in type IV and type V.Surgeons should fully assess these risk factors before surgery and develop targeted prevention and treatment strategies to help reduce the risk of future refractures.
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BACKGROUND:At present,the treatment methods for necrotizing fasciitis mostly use negative pressure sealing suction after thorough debridement.This method requires repeated debridement to completely remove necrotic infected tissue,causing serious physical and economic burdens to patients. OBJECTIVE:To introduce a rare clinical case of calf compartment syndrome caused by diabetic foot necrotizing fasciitis,and summarize the clinical experience of using antibiotic-loaded bone cement for treatment and comprehensive management. METHODS:A total of 6 patients with calf compartment syndrome caused by diabetic necrotizing fasciitis admitted to Wuxi 9th Affiliated Hospital of Soochow University from August 2017 to August 2020 were selected,including 5 males and 1 female with an average age of 54 years.During the perioperative period,the patients'general condition was evaluated and systemic nutritional support treatment was given.In the first stage,all patients received complete debridement to control infection,antibiotic-loaded bone cement packing,and negative pressure sealed drainage.In the second stage,bone cement was removed and wound repair was performed.The wound healing,as well as the occurrence of redness,swelling,and exudation was observed during the follow-up. RESULTS AND CONCLUSION:(1)The wounds of four patients were fresh after twice antibiotic-loaded bone cement packing,and the membrane formation was good,and one patient was good after three times of antibiotic-loaded bone cement packing,and the wounds of all five patients healed well after the second stage of skin grafting.Due to the difficulty in maintaining intraoperative blood pressure and infection in all four compartments of the lower leg,a patient underwent emergency knee amputation.Meanwhile,the stump wound was placed with antibiotic-loaded bone cement.The wound was closed directly after the secondary bone cement was removed,and the wound healed in the first stage.(2)The six patients were followed up for 6-24 months after discharge.At the last follow-up,all six patients had good wound healing and no symptoms such as redness,swelling,and exudation.The quality of life of the patients was significantly improved,and all of them were satisfied with the curative effect.(3)The occurrence of calf compartment syndrome should be vigilant when diabetic foot necrotizing fasciitis is highly suspected.Early diagnosis and timely incision decompression are of great importance.Besides,the application of antibiotic-loaded bone cement in the treatment of calf compartment syndrome caused by diabetic necrotizing fasciitis has a good short-term effect.
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BACKGROUND:Most of the silver coating materials prepared using active screen plasma technology in the past do not involve the nanotechnology field.The formed silver coating is in a"thin film"form,which is coated on the surface of the substrate,and the distribution of silver particles on the surface is uneven.Its long-term antibacterial ability is challenged. OBJECTIVE:To prepare nano silver coatings capable of being"buried"within stainless steel(SS)substrates using active screen plasma surface modification(ASPSM)and to observe antibacterial activity. METHODS:The nano-silver coating was prepared by ASPSM technique on stainless steel substrate.Three groups of coating samples were prepared by adjusting the bombardment time(1,2,and 4 hours),which were denoted as 1 h-Ag-ASPSM@SS,2 h-Ag-ASPSM@SS and 4 h-Ag-ASPSM@SS,respectively.The antibacterial activity of the coatings was analyzed by antibacterial ring test and Gram staining.The antibiotic coating samples of gentamicin combined with vancomycin were prepared by using stainless steel as substrate and were recorded as ACNs.Stainless steel,2 h-Ag-ASPSM@SS,and ACNs were inserted into Staphylococcus aureus or Pseudomonas aeruginosa suspension,respectively.The long-acting(84 days)antibacterial activity of the samples was analyzed by coating plate method.Bone marrow mesenchymal stem cells were co-cultured with stainless steel,2 h-Ag-ASPSM@SS,and ACNs,respectively.CCK-8 assay,dead/alive staining,and lactate dehydrogenase activity of cell supernatant were detected.Stainless steel,2 h-Ag-ASPSM@SS,and ACNs were taken after continuous exposure to Staphylococcus aureus suspension for 12 weeks.The amount of residual viable bacteria on the surface of the material was evaluated by spread plate method.Vancomycin drug sensitive disk method was used to evaluate the resistance of residual live bacteria on the surface of materials. RESULTS AND CONCLUSION:(1)With increasing bombardment time,the diameter of nano silver on the sample surface and the silver content in the coating gradually increased.Among them,the 2 h-Ag-ASPSM@SS exhibited the highest surface silver content while forming uniformly spherical nanoparticles.(2)Antibacterial ring test and Gram staining results demonstrated that compared with 1 h-Ag-ASPSM@SS and 4 h-Ag-ASPSM@SS,the 2 h-Ag-ASPSM@SS exhibited better inhibitory effect on Staphylococcus aureus and pseudomonas aeruginosa.After co-culturing with bacteria for 42 and 84 days,the number of viable bacteria on the spread plate method was significantly lower in the 2 h-Ag-ASPSM@SS group compared to the stainless steel and ACNs groups.After co-culturing with Staphylococcus aureus for 84 days and Pseudomonas aeruginosa for 42 days,the number of viable bacteria on the surface of the eluate from the ACNs group was higher than that of the stainless steel group.(3)CCK-8 assay,live/dead staining and lactate dehydrogenase activity of cell supernatant displayed that 2 h-Ag-ASPSM@SS did not have obvious cytotoxicity.ACNs showed obvious cytotoxicity.(4)After co-culture with Staphylococcus aureus for 12 weeks,the residual viable bacteria on the surface of 2 h-Ag-ASPSM@SS group was less than that of stainless steel group,and the residual viable bacteria on the surface of the ACNs group was more than that of stainless steel group.Compared with the stainless steel group,the sensitivity to vancomycin was significantly decreased in the ACNs group(P<0.001),and there was no significant change in sensitivity to vancomycin in 2 h-Ag-ASPSM@SS group(P>0.05).(5)The above results indicate that the silver nanoparticle coated stainless steel greatly improves the deposition efficiency of silver nanoparticles on the stainless steel surface and has long-lasting antibacterial properties and good cell compatibility.
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BACKGROUND:Our previous studies found that adding barium sulfate could improve the mechanical and radiopaque properties of calcium phosphate cement.However,with the degradation of calcium phosphate,the remaining radiopaque agent is difficult to degrade,and the space-occupying and osteoclast effects at the implantation site affect the bone repair process.Therefore,it is necessary to develop a new biodegradable radiopaque material. OBJECTIVE:To discuss the radiopaque ability of bioactive degradable material strontium polyphosphate(SrPP)and its impact on the physicochemical properties and osteogenic effect of calcium phosphate cement. METHODS:(1)Calcium phosphate cement(CPC),starch modified calcium phosphate cement(CPS)and starch modified calcium phosphate cement(20%SrPP-CPN)containing SrPP(20%mass fraction of bone cement powder)were prepared respectively,and the physicochemical properties of the three groups of bone cements were characterized.(2)The three groups of bone cement extracts were co-cultured with rat bone marrow mesenchymal stem cells,respectively,to detect cell proliferation,energy metabolism,and osteogenic differentiation.(3)Bone defects with a diameter of 5 mm were made on each side of the top of the skull of 24 SD rats,and they were randomly divided into control group(without any intervention),CPC group,CPS group,and 20%SrPP-CPN group for intervention,with 6 rats in each group.Relevant tests were performed after 4 and 12 weeks of intervention. RESULTS AND CONCLUSION:(1)Compared with the other two groups of bone cement,20%SrPP-CPN had enhanced radiopaque ability,increased compressive strength and degradation rate,and prolonged curing time,and 20%SrPP-CPN could release Sr2+ stably during degradation.(2)CCK-8 assay showed that 20%SrPP-CPN did not affect the proliferation of bone marrow mesenchymal stem cells.Cell starvation test(serum-free culture)showed that 20%SrPP-CPN could promote the proliferation of bone marrow mesenchymal stem cells compared with the other two groups of bone cement.Compared with the other two groups of bone cements,20%SrPP-CPN increased adenosine triphosphate concentration in bone marrow mesenchymal stem cells.Alkaline phosphatase and alizarin red staining showed that 20%SrPP-CPN could promote osteogenic differentiation of bone marrow mesenchymal stem cells compared with the other two groups of bone cement.(3)In the rat skull defect experiment,Micro-CT scanning and histological observation(hematoxylin-eosin and Masson stainings)showed that bone cement in 20%SrPP-CPN group was significantly degraded compared with that in CPC and CPS groups,and a large number of new bone tissues were dispersed in degraded bone cement.Immunohistochemical staining showed that Runx2 protein expression was increased in 20%SrPP-CPN group compared with CPC group and CPS group(P<0.01).(4)These results show that 20%SrPP-CPN has good radiopaque ability and osteogenic properties.
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BACKGROUND:In recent years,the treatment method of injecting bone cement into the intervertebral space has been introduced from abroad for the treatment of lumbar recurrent pain caused by lumbar disc degeneration and intervertebral space narrowing;however,some patients had vertebral fractures after treatment;the fracture may occur because the bone cement injected into the intervertebral space has a poor elastic modulus. OBJECTIVE:To analyze the effect of bone cement with different elastic moduli injected into the intervertebral space on the maximum stress of upper and lower vertebrae using a three-dimensional finite element model. METHODS:A volunteer with normal spine was recruited to obtain CT data.The finite element model of L2-L5 lumbar spine was established using Mimics,Geomagic,SolidWorks,and Ansys.Subsequently,a L3-L4 intervertebral space injection model with different doses(1 mL and 4 mL)of bone cement was established.Four different elastic moduli(1 000,2 000,4 000,and 8 000 MPa)were assigned to bone cement at each dose.Pressure and bending moment were applied on the surface of the L2 vertebral body to analyze the stress on the lower surface of the L3 vertebral body and the upper surface of the L4 vertebral body. RESULTS AND CONCLUSION:(1)In the case of the same amount of bone cement injection,as the elastic modulus of bone cement increased,the stress on the lower surface of L3 vertebral body and the upper surface of L4 vertebral body increased.Among them,the bone cement with an elastic modulus of 1 000 MPa had the least effect on the lower surface of L3 vertebral body and the upper surface of L4 vertebral body.Bone cement with elastic modulus of 8 000 MPa had the greatest effect on the lower surface of L3 vertebral body and the upper surface of L4 vertebral body.Bone cement with different elastic moduli had little effect on the motion range of the whole lumbar spine.(2)The results indicate that injecting bone cement with lower elastic modulus while meeting treatment requirements can reduce the risk of postoperative fractures.
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BACKGROUND:Diabetic foot patients with wound infections constitute a large patient population,and there is currently no satisfactory treatment approach. OBJECTIVE:To investigate the clinical efficacy of a modified tibial cortex transverse transport combined with antibiotic-loaded bone cement for treating refractory diabetic foot ulcers. METHODS:A total of 46 diabetic foot ulcers patients,27 males and 19 females,with an average age of 64.37 years,were selected from Beijing Chaoyang Hospital,Capital Medical University and Beijing Chaoyang Integrative Medicine Rescue and First Aid Hospital from January 2020 to January 2023.All of them underwent the modified tibial cortex transverse transport combined with antibiotic-loaded bone cement treatment.Ankle-brachial index,WIFi(Wound/Ischemia/Foot infection)classification,pain visual analog scale score,and ulcer area were recorded before and 3 months after surgery. RESULTS AND CONCLUSION:(1)The mean ulcer healing time for the 46 patients was(58.07±24.82)days.At 3 months postoperatively,there were significant improvements in ankle-brachial index,pain visual analog scale score,ulcer area,and WIFi classification in 46 patients,as compared to the preoperative values,with statistically significant differences(P<0.05).Two patients experienced pin-tract infections,without infection or ulcer recurrence during the follow-up period.(2)These findings indicate that the modified tibial cortex transverse transport combined with antibiotic-loaded bone cement effectively alleviates patients'pain,improves lower limb circulation,controls infections,and promotes ulcer healing.
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BACKGROUND:Percutaneous vertebroplasty has become the main treatment method for osteoporotic vertebral compression fractures due to its advantages of convenient operation and low trauma.However,the optimal bone cement-vertebral volume ratio has not been determined. OBJECTIVE:To investigate the effect of bone cement-vertebral volume ratio on percutaneous vertebroplasty for osteoporotic vertebral compression fractures. METHODS:The clinical data of 100 patients with single-stage osteoporotic vertebral compression fractures admitted to Xinjiang Bazhou People's Hospital from July 2019 to July 2022 were retrospectively analyzed.All patients received percutaneous vertebroplasty.According to the bone cement-vertebral volume ratio,they were divided into the low volume group(15%≤ratio≤20%)and the high volume group(20%<ratio≤25%)with 50 cases in each group.The visual analog scale score,Oswestry disability index,vertebral anterior margin height,Cobb angle of injured vertebra,bone cement distribution pattern,and bone cement leakage rate were analyzed before surgery,3 days and 1 year after surgery. RESULTS AND CONCLUSION:(1)Compared with the preoperative results,the visual analog scale scores,vertebral anterior margin height,Cobb angle of injured vertebra at 3 days and 1 year after surgery,and Oswestry disability index at 1 year after surgery were significantly improved in 100 patients(P<0.05).There were no significant differences in visual analog scale scores at 3 days and 1 year after surgery and Oswestry disability index at 1 year after surgery between the low volume group and the high volume group(P>0.05).The vertebral anterior margin height in the low volume group was lower than that in the high volume group at 3 days and 1 year after surgery(P<0.05).The Cobb angle of the injured vertebrae in the low volume group was higher than that in the high volume group at 3 days and 1 year after surgery(P<0.05).(2)There were 10 H-type and 40 O-type bone cement distributions in the low volume group.There were 36 H-type and 14 O-type bone cement distributions in the high volume group,and there was no significant difference in bone cement distributions between the two groups(P<0.05).The bone cement leakage rate in the high volume group and low volume group was 10%and 6%,respectively.(3)It is indicated that both low and high bone cement-vertebral volume ratios can improve postoperative pain and functional dysfunction,but high bone cement-vertebral volume ratio can improve the morphological recovery of injured vertebral,which may be related to the fact that the distribution of bone cement in this group is more H-type.
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BACKGROUND:Studies have shown that good bone cement distribution during percutaneous vertebroplasty reduces postoperative secondary vertebral fractures and helps improve prognosis.However,how to get a good distribution of bone cement is a problem for spine surgeons. OBJECTIVE:To analyze the correlation of bone cement distribution with surgical and adjacent vertebral refractures after percutaneous vertebroplasty. METHODS:A total of 193 patients with thoracolumbar compression fracture(≤2 fractured vertebrae)admitted to Xinjiang Uygur Autonomous Region Orthopedic Hospital from January 2018 to December 2022 were selected.They underwent percutaneous vertebroplasty via unilateral approach and were followed up after surgery.They were divided into fracture group(n=30)and non-fracture group(n=163)based on whether the surgical and adjacent vertebral fractures were observed during the follow-up period(more than 6 months).The basic data of the two groups were analyzed by univariate analysis.Statistically significant factors were replaced with binary logistic regression model to explore the correlation with recompression fracture of surgical and adjacent vertebrae after percutaneous vertebroplasty. RESULTS AND CONCLUSION:(1)Univariate analysis showed that there was no significant difference between the two groups in gender,body mass index,menopause age of female patients,bone cement dose,previous history,smoking history,drinking history,operation segment,operation time,and hospital stay(P>0.05).There were significant differences in age,bone mineral density T value,bone cement leakage,and bone cement distribution between the two groups(P<0.05).(2)Binary logistic regression analysis showed that age(95%CI:1.016-1.167,P=0.016),bone cement leakage(95%CI:0.080-0.582,P=0.002),bone mineral density T value(95%CI:1.214-22.602,P=0.026),and bone cement distribution(P=0.007)were risk factors for recurrent fractures after percutaneous vertebroplasty and adjacent vertebroplasty.Patients with type I bone cement distribution(which did not touch the upper and lower endplates of the vertebral body)had a higher risk of recurrent fractures of surgical and adjacent vertebrae after percutaneous vertebroplasty.(3)The results of this study show that refracture of surgical and adjacent vertebrae is caused by the interaction of various risk factors.Age,bone cement leakage,T value of bone mineral density and bone cement distribution are independent risk factors for surgical and adjacent vertebral refracture.Refracture of surgical and adjacent vertebrae can easily occur when bone cement is distributed type I.
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BACKGROUND:Bioactive glass is a multifunctional synthetic composite material that releases active ions slowly and exhibits certain biological activities after affinity with tissues.Their versatility stems from the versatility of their preparation processes and components,allowing them to be applied in different clinical scenarios. OBJECTIVE:To review the main application forms,application fields of bioactive glass,as well as the influence of doping different elements on its function. METHODS:A literature search was conducted across WanFang Medical Database,CNKI Database,PubMed Database,and Web of Science Database,using the search terms"bioactive glass,slow-release ions,bone tissue engineering,composite scaffold,tissue regeneration and repair,biomedical engineering"in Chinese and English.The timeframe was limited from 2000 to 2023.Finally,88 articles were included for review. RESULTS AND CONCLUSION:(1)In terms of application forms,bioactive glass can be fabricated as coatings,particles,bone cements,and scaffolds according to needs.Coatings have the potential to enhance the biological activity of implants,yet they are susceptible to instability as a result of degradation.Particles offer a viable solution for the repair of irregular bone defects;however,particles produced through traditional methods often possess limited functionality.Bone cement provides the benefits of minimal invasiveness and injectability,yet its application is restricted to smaller bone defects.Scaffolds exhibit excellent mechanical properties and are commonly used for larger-sized bone defects,yet they have limited toughness.(2)In terms of applications,bioactive glass can be used in a variety of tissue regeneration and repair and disease treatment fields,including dentistry,orthopedics,soft tissue engineering,and cancer.(3)In terms of element doping,the addition of specific elements to bioactive glass not only improves its mechanical properties but also endows it with special biological functions such as bioactivity,degradability,and antibacterial properties.(4)Biologically active glass is a versatile material that can be used in different forms and functions by adjusting the preparation process and element doping to meet various clinical needs in bone tissue engineering and is widely used in the field of biomedical engineering.
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BACKGROUND:How to improve the accuracy of puncture,reduce surgical damage,and improve surgical efficiency during vertebroplasty is currently one of the focuses of exploration and improvement in vertebroplasty techniques. OBJECTIVE:To explore the clinical significance of application of mixed reality technology in percutaneous vertebroplasty for spinal fractures. METHODS:Two patients with osteoporotic vertebral compression fracture in Dalian Second People's Hospital in June 2023 were selected.Before operation,128-row CT scanning of the lumbar spine was performed and the original data of digital imaging and communications in medicine(DICOM)were obtained.Visual Volume software was used to build the three-dimensional network model of vertebral compression fracture.Holographic imaging glasses were used to accurately map 3D network model images to the real world,assist the surgeon in completing preoperative simulation,explaining preoperative conditions and treatment plans,and guiding puncture and bone cement injection during surgery. RESULTS AND CONCLUSION:(1)Precise puncture was achieved with the assistance of a mixed reality technology.Postoperative imaging examination showed good bone cement filling and no obvious leakage.The postoperative symptoms of the patient were alleviated well,and they were able to move to the ground on the same day after surgery.(2)It is concluded that a mixed reality technology is helpful for preoperative surgical design and communication efficiency with patients and their families.Assisting with precise puncture during surgery,shortening surgical time,and reducing side injuries is a new and effective clinical diagnosis and treatment model,which has development potential in minimally invasive,precise,and personalized treatment of spinal surgery.
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BACKGROUND:With the innovation of examination technique,the number of patients with spinal metastases in different stages is increasing year by year.Percutaneous vertebroplasty is an important treatment for spinal metastases;however,there is no report on the biomechanical effect in different stages and different activities after operation. OBJECTIVE:To simulate thoracic T10 bone stress and displacement of the different locations of the tumor metastasis based on the three-dimensional finite element model. METHODS:According to thoracic three-dimensional CT images of a 30-year-old healthy male,Mimics software was used to construct a three-dimensional geometric model of thoracic vertebrae(T9-T11),including ribs,ligaments and intervertebral discs.Three-dimensional models of T9-T11 vertebral bodies and different parts of the posterior thoracic vertebrae invaded by thoracic metastatic tumors were simulated,including the control group with intact vertebral structure,unilateral metastasis involving the vertebral body area(experimental group 1),unilateral metastasis involving the vertebral body and pedicle area(experimental group 2),unilateral metastasis involving the vertebral body,pedicle and transverse process area(experimental group 3),and bilateral metastasis involving the vertebral body,pedicle and transverse process area(experimental group 4).Abaqus software was used to create a three-dimensional finite element model.The von Mises stress distribution and the displacement of the model were analyzed under the loading condition,buckling condition,extension condition,and rotation condition. RESULTS AND CONCLUSION:(1)In the study of the maximum total displacement of loading points in different experimental groups under loading,flexion,extension,and rotation conditions,with the increase of metastatic tumor invasion site and invasion surface,the total displacement of loading points increased,and the overall stiffness decreased,especially the total displacement of loading points in experimental group 4 was the largest.(2)Under flexion condition,the maximum Von Mises stress value increased significantly after vertebral body and pedicle destruction,while the maximum Von Mises stress value was almost unchanged when the thoracocostal joint destruction was added.(3)On the basis of finite element analysis and simulation of bone tumor model,the elements in the bone cement region were set as a single set,and the bone cement region was set as the corresponding material properties to simulate bone cement filling.The results showed that the maximum total displacement under loading,flexion,extension,and rotation conditions was less than that of each experimental group.(4)The maximum stress values of the simulated percutaneous vertebroplasty patients in the loading,flexion,extension and rotation conditions were significantly lower than those of the femoral model.(5)It is concluded that the three-dimensional finite element model based on thoracic T9-T11 conducive to the biomechanics characteristics of thoracic vertebrae tumor metastasis,and on the basis of the thoracic vertebrae tumor metastasis model can accurately simulate load point after percutaneous vertebral body under different conditions of total displacement and the maximum Von Mises stress situation.
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BACKGROUND:Percutaneous vertebroplasty is the most widely used method for the treatment of osteoporotic vertebral compression fractures,and most studies have concluded that percutaneous vertebroplasty increases the probability of adjacent vertebral secondary compression fractures in patients with osteoporotic vertebral compression fractures.However,controversy remains regarding the risk factors associated with adjacent vertebral re-fracture caused after percutaneous vertebroplasty. OBJECTIVE:To summarize the influencing factors of adjacent vertebral compression fractures after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures,in order to provide a certain reference for reducing the risk of its occurrence as well as formulating the corresponding treatment plan. METHODS:Using"osteoporosis,fracture,percutaneous vertebroplasty,adjacent vertebral compression fractures,risk factors"as the Chinese search terms,"osteoporosis,osteoporotic vertebral compression fractures,percutaneous vertebroplasty,adjacent vertebral compression fractures,risk factors"as English search terms,computerized searches were conducted on CNKI,Wanfang Medical Network,VIP,PubMed,Springer,ScienceDirect,and Elsevier databases.The search timeframe focuses on January 2018 through September 2023,with the inclusion of a few classic forward literature.The literature was screened by reading the titles and abstracts,and 83 papers were finally included in the review. RESULTS AND CONCLUSION:(1)Osteoporotic vertebral compression fractures are one of the most common complications of osteoporosis,placing elderly patients at a significant risk of disability and death.Percutaneous vertebroplasty is a practical and effective treatment for osteoporotic vertebral compression fractures.(2)With the popularity of percutaneous vertebroplasty,its secondary vertebral compression fractures have gradually increased,with adjacent vertebral compression fractures being the most common.(3)Previous studies have only discussed the effects of factors such as bone mineral density,multiple vertebral fractures,body mass index,age,sex,amount of bone cement,cement leakage,and anti-osteoporosis treatment on secondary compression fractures of adjacent vertebrae after percutaneous vertebroplasty,and summarized the number of vertebral fractures,timing of the operation,surgical approach,cement material,diffuse distribution of bone cement,recovery height of the injured vertebrae,and wearing of a support after surgery,which is not yet comprehensive.The analysis of the specific mechanisms of risk factor-induced adjacent vertebral fractures is relatively rare.(4)The results of the article showed that low bone mineral density,advanced age,perimenopausal women,multiple vertebral fractures,excessive recovery of the height of the injured vertebrae,cement leakage,comorbid underlying diseases,and poor lifestyle habits were the risk factors for secondary adjacent vertebral compression fractures after percutaneous vertebroplasty,and that maintaining a normal body mass index,early surgery,bilateral percutaneous vertebroplasty,use of a new type of cement material,an appropriate volume of bone cement injection and uniform cement dispersion,regular anti-osteoporosis treatment,and postoperative brace wearing are protective factors for secondary adjacent vertebral compression fractures after percutaneous vertebroplasty.
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【Objective】 To investigate the clinical efficacy and significance of percutaneous cement discoplasty (PCD) in treating elderly patients with spinal instability and vacuum phenomenon on imaging. 【Methods】 We retrospectively analyzed 27 patients with spinal instability and vacuum phenomenon on imaging who underwent PVABC between June 2019 and September 2022. We recorded the surgery duration, bone cement usage, intraoperative bleeding, and total hospitalization time. We evaluated the improvement in pain and lumbar function by comparing pre- and postoperative visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and lumbar Japanese Orthopedic Association (JOA) scores. We also compared the change in intervertebral height and the distribution rate of bone cement in the intervertebral space by pre- and postoperative imaging data. 【Results】 All the 27 patients who underwent PCD had effective follow-up. The mean hospitalization time was (4.2±1.85) days, and the mean surgery duration was (32.3±4.51), (53.6±12.17), (74.4±6.33), and (90.0±10.36) minutes for single-, double-, triple-, and quadruple-level procedures, respectively. The intraoperative bleeding volume ranged from 2 to 13 mL, which was significantly lower than that of traditional intervertebral fusion surgery. Postoperative VAS pain scores, ODI scores, and JOA scores were significantly improved compared to those before surgery. In terms of imaging, the intervertebral height of the patients improved after surgery, and the distribution of bone cement in the intervertebral space was relatively good in the operated segments. Mechanical stability of the spine was restored. 【Conclusion】 For patients who are not suitable for open surgery due to severe complications, PCD is a feasible treatment option.