Objective To investigate the biocompatibility of diamond-like carbon(DLC) coated NickelTitanium shape memory alloy with osteoblasts cultured invitro. Methods Rabbit’s osteoblasts were incubated with DLCcoated NickelTitanium shape memory alloy disks and uncoated ones of equal size for 5 days. The control group（without shape memory alloy in culture media） was performed simultaneously. The cultured cells were counted and graphed. The samples from culture media were collected and the concentrations of alkaline phosphatase (ALP) and nickel（Ni2+） were measured from the 1st to 5th day respectively. Results The proliferation of osteoblasts and the concentration of ALP in both DLC-coated group and control gruop was higher than uncoated group. The proliferation of osteoblasts on the 3rd, 4th, and 5th day in both DLC-coatedgroup and control group was significantly higher than that in the uncoated group(P＜0.05). The concentration of ALP in DLC-coated group on the 2nd, 3rd, and 5th day and in the control group on the 3rd, 4th, and 5th day was significantly higher than that in the uncoated group(P＜0.05). The concentration of Ni2+ on the 3rd, 4th, and 5th day was significantly lower than that in the uncoated group(P＜0.05). Conclusion DLC- coated NickelTitanium shape memory alloys appears to have better biocompatibility with osteoblast cultured in vitro compared to uncoated ones.
目的探讨可吸收肋骨钉与记忆合金接骨板内固定两种方法治疗多发性肋骨骨折的效果。 方法回顾性分析2009年1月至2014年1月在上海市第六人民医院胸外科行手术内固定的胸部外伤致多根多处肋骨骨折患者321例的临床资料，其中可吸收肋骨钉组70例，其中男62例、女8例，年龄（48.54±9.74）岁；记忆合金接骨板组251例，其中男187例、女64例，年龄（51.44±10.22）岁。分析两组患者疗效差异。 结果两组患者术前疼痛评分（7.74±0.89 vs.7.66±0.92）、术后疼痛评分（3.80±0.79 vs.3.82±0.85），术后胸腔引流时间[（6.00±2.84）d vs.（5.68±2.98）d]差异均无统计学意义（P>0.05）。记忆合金接骨板组住院时间[（20.06±7.39）d vs.（17.77±7.68）d]，及手术时间（101.29±30.67）min vs.（71.95±29.50）min]均短于可吸收肋骨钉组，且差异有统计学意义（P＜0.05)。术后3个月随访复查胸部X线，两组患者骨折再移位差异无统计学意义。 结论可吸收肋骨钉与记忆合金接骨板均是治疗多发性肋骨骨折较理想的术式，记忆合金接骨板手术操作更为简单，可吸收肋骨钉手术无需在体内留置金属内固定装置，但固定强度较接骨板略差，应根据情况选择合适的内固定方法。
Objective To investigate the effectiveness of nickel-titanium shape memory staples in treating multiple metatarsal fractures. MethodsThe clinical data of 27 patients with multiple metatarsal fractures who were treated between January 2022 and June 2023 and met the selection criteria were retrospectively analysed. The cohort consisted of 16 males and 11 females, aged 33-65 years (mean, 47.44 years). The causes of injury included heavy object impact in 11 cases, traffic accidents in 9 cases, and crush in 7 cases. Simultaneous fractures of 2, 3, 4, and 5 bones occurred in 6, 6, 4, and 8 cases, respectively, with tarsometatarsal joint injury in 3 cases. Fixation was performed using staples for 16, 22, and 9 fractures in the metatarsal neck, shaft, and the base, respectively, and 5 tarsometatarsal joint injuries. Preoperative soft tissue injuries were identified in 8 cases and classified according to the Tscherne-Oestern closed soft tissue injury classification as type Ⅰ in 5 cases and type Ⅱ in 3 cases. One case of type Ⅱexhibited preoperative skin necrosis. The patients were treated with fixation using nickel-titanium shape memory staples. Complications and fracture healing were documented. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used to evaluate the function, and the visual analogue scale (VAS) score was used to evaluate the pain. Results The 27 patients were followed up 9-19 months (mean, 12.4 months). Postoperative X-ray films revealed no loss of fracture reduction, and all fractures achieved bony union. No internal fixator loosening, breakage, or other mechanical failures was observed. The mean fracture healing time was 3.13 months (range, 3-4 months). Postoperatively, 4 cases (2 of Tscherne-Oestern type Ⅰ, 2 of type Ⅱ) developed superficial skin necrosis, which resolved with dressing changes. No infection was observed in the remaining patients, and all wounds healed. At last follow-up, the AOFAS forefoot score ranged from 70 to 95, with an average of 86.6, of which 19 cases were excellent, 6 cases were good, and 2 cases were fair, with an excellent and good rate of 92.6%; the VAS score ranged from 0 to 3, with an average of 0.9, of which 24 cases were excellent, and 3 cases were good, with an excellent and good rate of 100%. Conclusion The use of nickel-titanium shape memory staples in the treatment of multiple metatarsal fractures can effectively protect local skin and soft tissues and minimize secondary damage associated with internal fixator insertion. It is a viable surgical option for management of multiple metatarsal fractures.
ObjectiveTo summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion.MethodsBetween January 2013 and January 2017, 11 patients of old scaphoid fracture and nonunion were treated with nitinol memory alloy two foot fixator and autologous cancellous bone grafting. All patients were male with an average age of 26.1 years (range, 18-42 years). The fractures were caused by sport in 3 cases, falling in 7 cases, and a crashing object in 1 case. The interval between injury and operation was 6-18 months (mean, 8.9 months). Postoperative outcome measures included operation time, fracture healing time, grip strength, range of motion (ROM) of flexion, extension, ulnar deviation, and radial deviation, Mayo score, visual analogue scale (VAS) score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe operation time was 35-63 minutes (mean, 48 minutes). All incisions had primary healing with no infection and loosening or breakage of internal fixator. All patients were followed up 12-30 months (mean, 20.7 months). X-ray films showed that fracture healing was achieved in all patients with an average time of 15 weeks (range, 12-25 weeks). All internal fixators were removed after 10-12 months of operation (mean, 11.2 months). At last follow-up, the grip strength, ROMs of flexion, ulnar deviation, and radial deviation were superior to those before operation (P<0.05), no significant difference was found in ROM of extension between pre- and post-operation (t=0.229, P=0.824). There were significant differences in above indexes between affected and normal sides (P<0.05). At last follow-up, the Mayo, VAS, DASH scores were also significantly superior to those before operation (P<0.05).ConclusionFor the old scaphoid fracture and nonunion, Ni-Ti arched shape-memory alloy fixator and autologous cancellous bone grafting can obtain good effectiveness, which is an effective treatment.
Objective To evaluate the histocompatibil ity of porous hydroxyapatite (HAP) coating NiTi shape memory alloy and to provide a theoretical basis for its cl inical appl ication in bone defect repair. Methods Twenty-four Chinchilla rabbits weighing 2.0-2.5 kg were randomized into experimental group and control group (n=12). HAP coating NiTi shape memory alloy was implanted into the distal part of left femur of 12 rabbits in the experimental group, while holes without alloy implantation were performed on the control group. At 7, 14, 28 and 56 days after implantation, the animals werekilled (3 rabbits in each group at a time). Gross observation, histology observation, BMP-2 immunohistochemistry observation and image grey scale analysis were performed. And the histology observation was evaluated by GB/T16886.6-1997 in terms of inflammation, capsule wall of fibrous tissue, materials degradation and the response of peripheral tissue. Results All of the animals survived until being killed. The implants reached a peak embedded in bone tissue wholly, without loosening and bone absorption. The inflammatory cell infiltration and fibrous hyperplasia were at 7 days after implantation, with the formation of cyst wall of fibrous tissue and the implant wrapped by the cyst wall. The response of connective tissue proliferation was still obvious in partial samples of experimental group at 56 days after implantation, which was wrose than the control group but consistent with the in vivo implantation standard of GB/T16886.6-1997. Immunohistochemistry observation displayed the endogenous BMP-2 were in the cytoplasm of MSCs and osteoblast. The result of image analysis showed the expression of BMP-2 were staged in line with the repair of bone defect, two groups witnessed the peak expression of the BMP-2 at 14 days after implantation. There wereno significant differences among different time points in the staining gray scale of BMP-2 (P gt; 0.05). Conclusion HAP coating NiTi shape memory alloy, as a biomedical material, has excellent histocompatibility with bone.
【摘要】目的探索内镜直视下应用带膜记忆合金支架对晚期食管、贲门恶性狭窄的介入治疗方法。方法2005年1月2009年11月对49例失去手术机会或拒绝手术的晚期食管癌或贲门癌致食管或贲门狭窄患者,行电子胃镜引导下放置镍钛合金支架;对狭窄程度重、胃镜不能通过者,先行Savary探条扩张再放置支架。结果49例均成功置入支架,解除狭窄有效率达100%。结论内镜直视下带膜支架置入操作方法简便、安全,可改善患者的生存质量,延长生存时间。
Objective To analyze the effectiveness of shape memory alloy embracing device in the treatment of Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty. Methods The clinical data of 30 patients (30 hips) with Vancouver B2 periprosthetic femoral fracture after primary hip arthroplasty between January 2019 and January 2021 were analyzed retrospectively. Among them, 15 cases were treated with shape memory alloy embracing device for fracture fixation (group A) and 15 cases with titanium cable cerclage (group B). There was no significant difference in general data such as gender, age, body mass index, the cause of primary arthroplasty and surgical method, prosthesis type, the cause and side of femoral fracture, the time from injury to operation, and comorbidities between the two groups (P>0.05). The operation time, intraoperative blood loss, and hospital stay of the two groups were recorded. The fracture healing was examined by X-ray film, and the hip joint function was evaluated by Harris score. Results The operations in both groups were completed successfully, and the incisions healed by first intention after operation with no vascular or nerve injury. The operation time and hospital stay in group A were significantly shorter than those in group B (P<0.05), but there was no significant difference in intraoperative blood loss between group A and group B (t=−0.518, P=0.609). Patients were followed up 12-20 months (mean, 16.3 months) in group A and 12-22 months (mean, 16.7 months) in group B. X-ray film showed that all fractures healed, the healing time was (14.73±2.05) weeks in group A and (17.27±2.60) weeks in group B, and there was a significant difference between the two groups (t=−2.960, P=0.006). During follow-up, there was no complication such as prosthesis loosening, periprosthetic infection, joint stiffness, or internal fixator loosening. The Harris score of group A was significantly better than that of group B at 3, 6, and 12 months after operation (P<0.05). Conclusion Compared with titanium cable cerclage, using shape memory alloy embracing device to fix Vancouver B2 periprosthetic femoral fracture can accelerate fracture healing, shorten operation time, and reduce intraoperative blood loss. Patients can perform functional exercise earlier and restore joint function better.