Abstract An experiment was carried out to investigate the possibility of the establishment of an osteoblasts bank which could supply osteoblasts in repairing bone defect. Osteoblasts were isolated from thetibial periosteum of eight New-Zealand rabbits and cultured in votro. A bone defect, 1.5cm in length was made in both radii of each of the 8 rabbits. The cultivated osteoblasts, gelfoam as a carrier were randomly implanted into the defects of the radii of rabbits. Accordingly, the contralateral radial defects wereimplanted with gelfoam absorbed with the Hanks solution as control. The healing of bone defects was evaluated by roentgenographic examination at 2, 4, 8 and 12 weeks after operation, respectively. It was shown that the implanted cells had osteogenetic capability and could be possible to promote healing of the bone defects. It was suggested that further study needed to be carried out in this field.
Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
Objective To study efficiency of vascularized bone graft combining with reconstituted bone xenograft (RBX) in repairing bone defect and the expression of the vascular endothelial growth factor (VEGF) in serum. Methods From January 1998 to December 2002, 27 cases of bones defects were treated and randomly divided into 3 groups according to different repair materials: group A (the vascularized bone graft-RBX group, n=9), group B (the vascularized bone graft group, n=10)and group C(the RBX group, n=8). The bone defect repair, the bone healing time and the bone graft resorption were observed by radiograph after 3 months, 6 months and 12 months of operation, and the expression of VEGF in serum was assayed with lumino-enzyme immunoassay before operation and after operative 2 weeks, 4 weeks, 6 weeks and 8 weeks respectively. Results The X-ray films showed that the bonehealing was achieved in 8 cases of group A, in 6 cases of group B and in 3 cases of group C after 3 months; in 1 case of group A, respectively in 3 cases of both group B and group C after 6 months. The bone graft resorption was observed in1 case of group B and in 2 cases of group C after 12 months. The serum VEGF values after operative 2 weeks and 4 weeks were higher than those before operation in all of 3 groups(Plt;0.05), and the VEGF values of groups A and B were higher than that group C(Plt;0.05) after 4 weeks. There were no significant differences (Pgt;0.05) in serum VEGF level between postoperative 6, 8 weeks and preoperation in 3 groups. Conclusion The expression of serum VEGF obviously increase in the early period of bone transplanting, it is value of clinical evaluation of reparative efficiency of bone defect.
OBJECTIVE To investigate a good method for repairing the long bone defect of tibia combined with soft tissue defect. METHODS From 1988-1998, sixteen patients with long bone defect of tibia were admitted. There were 12 males, 4 females and aged from 16 to 45 years. The length of tibia defect ranged from 7 cm to 12 cm, the area of soft tissue defect ranged from 5 cm x 3 cm to 12 cm x 6 cm. Free fibula grafting was adopted in repairing. During operation, the two ends of fibular artery were anastomosised with the anterior tibial artery of the recipient, and the composited fibular flap were transplanted. RESULTS All grafted fibula unioned and the flap survived completely. Followed up for 6 to 111 months, 14 patients acquired the normal function while the other 2 patients received arthrodesis of the tibial-talus joint. In all the 16 patients, the unstable ankle joint could not be observed. CONCLUSION The modified method is characterized by the clear anatomy, the less blood loss and the reduced operation time. Meanwhile, the blood supply of the grafted fibula can be monitored.
Objective To investigate the effect of anti-infective reconstitutedbone xenograft (ARBX) as primary grafting on repair of a segmental contaminateddefect in canine radius. Methods The contaminated segmentaldefects of 1.5 cm were made in both radius of 8 canine and 1 ml of staphylococal suspension was injected into the defect region at a concentration of 5×106 CFU/ml. ARBX(experimental side) or RBX(control side) was implanted into the two sides of the defects respectively as primary grafting followed by internal fixation. The results were compared between the two grafting materials in repairing the contaminated segmental defect. Results In ARBX side, the defects were repaired completely in 5 cases and partially in 1 case, and there existed no osteomyelitis in all cases; while in RBX side, the defects were repaired partially in 1 case and were not repaired in 5 cases after 6 months of operation, and there existed osteomyelitis in all cases. Conclusion Besides its b osteoinductive and osteoconductive activity, ARBX is highly antibacterial and can be used as primary grafting in repairing contaminated segmental defects.
Abstract To examine the effects of porous tricalcium phosphate (TCP) combined with autogenous red bone marrow (BM) in therepar of bone defects, 21 cases of bone defects were implanted with the above prepared composite material, 17 cases had benign or low-grade malignant tumors and 4cases had old fractures. Serial X-ray films were taken after surgery. The results showed that new bone formation was seen between the interface of the implantand surrounding host bone after 6 weeks, and osseous union developed after 12 weeks. Evident osteogenesis in all patients was observed after a follow-up for 1～3 years. TCP-BM is both osteoconductive and osteoinductive. Its function was similar to the fresh autogenous cancellous bone graft and TCP-BM had the potencyof promoting the repair of osseous defect. It was suggested that TCP-BM might be an ideal material for treating bone defects.
Objective To evaluate the clinical effects of fibula flap grafts on the repair of the extremities with traumatic compound tissue defects. Methods In 12 cases, the fibula flap grafts were employed to restore the extremities with traumatic compound tissue defects. Of the 12 patients, 9 were males, 3 were females; their ages ranged from 12 to 45. There were 2 cases of tibia defect combined with fibula fracture, 2 cases of tibia defect, 2 cases of radius defect, 3 cases of ulna defect, 1 case of calcaneus defect,and 2 cases of firstmetatarsus defect. The bone defect length ranged from 4.2 to 10.6 cm, 7.8 cm in average.The skin defect area ranged from 10.0 cm×4.5 cm to 27.0 cm×15.0 cm. The free transplantation of fibular flaps were used in 9 cases, the lapse operation were used in 2 cases, retrograde shift were used in 1 case. Results Postoperational vein crisis and commonperoneal nerve traction injury were observed in category mentioned above respectively. All the 12 fibula flaps survived after proper treatments such as removalof great saphenous vein. Follow-ups were done for 6 to 24 months. Both the transferred fibula and the recipient broken end reflected bones were healed. Four patients underwent the second-phase reconstruction operation oftendon moving power. One wrist and 1 ankle underwent arthrodesis in 3 to 6 months.All the effects were satisfactory. Conclusion The fibula flap grafts provide arelatively better alternative to repair the extremities with long bone compoundtissue defects. In addition, the sensory function reconstruction of fibula flaps should be given full attention.
Objective To investigate the ability of plateletrich plasma(PRP) combined with cells and artificial bone in accelerating the repair of bone defect. Methods The marrow stromal stem cells (MSCs) of rabbit were cultured and induced into the osteoblast-like cells in vitro. PRP was produced with low-density twice centrifugations. Forty-eight New Zealand rabbits were made 1.2 cm bilateral radius defect models and divided into 4 groups averagely at random: group A(left:PRP／MSCs／β-tricalcium phosphate(β-TCP), right: MSCs／β-TCP), group B (left:autoradius, right: PRP／MSCs／β-TCP)； group C (left:autoradius,right: MSCs／β-TCP), and group D(left:PRP／β-TCP; right:β-TCP). At 2, 6 and 12 weeks after operation， the repair of bone defect was evaluated by the generalobservation, histology, biomechanics and histomorphology. Results There was a stable platelet concentration in PRP and it was about 5.45±0.23 times of whole blood. In the aspect of bone bridge and conture of the defects, at 2 and 6 weeks, PRP／MSCs／β-TCP and MSCs／β-TCP displayed asimilar outcome and were less than auto in general sample and X-ray;at12 weeks，PRP／MSCs／β-TCP was similar to autoradius and better than MSCs／β-TCP.in the aspect of quantity and quality of bone formation，histology showed that PRP／MSCs／β-TCP and autoradius were better than MSCs／β-TCP（P＜0.05），and there was nosignificantdifference between PRP／MSCs／β-TCP and autoradius（P＞0.05）. At 2 and 6 weeks，there was no significant difference between PRP／β-TCP and β-TCP（P＞0.05）。At 12 weeks，PRP／β-TCP was better than β-TCP（P＜0.05）. In the aspect of intensity f bone formation，at 6 and 12 weeks，PRP／MSCs／β-TCP and autoradiuswere better than MSCs／β-TCP（P＜0.05）. At 6 weeks，autoradius was better than PRP／MSCs／β-TCP（P＜0.05）. At 12 weeks，there was no significant difference between PRP／MSCs／β-TCP and auto（P＞0.05）. PRP／TCP and β-TCP had no significant difference at 12 weeks（P＞0.05）. Conclusion PRP／MSCs／β-TCP demonstrated excellent ability of forming bone in experiment. PRP was most likely to accelerate the repair of bone defect through increasing the activity of proliferation and differentiationof MSCs and osteoblasts.
OBJECTIVE To introduce a new method of bone defect repairing after bone cyst curettage. METHODS Eight cases with bone cyst were treated with this new method. The pieces of autogenous periosteum were implanted into the hematoma within the enveloped bone defect created after the bone cyst curettage. Among these patients, there were 5 males and 3 females, aged from 14 to 36 years old. All the lesions located in the upper of femur except one being located in humerus. The results were evaluated through the postoperative radiological findings with the preoperative ones and analysis of clinical functions. RESULTS All the patients were followed up for 2 to 11 years. X-ray films showed that osteogenesis developed well and that the enveloped bone defects had been repaired. No recurrence was found and the function of the affected limbs were maintained. CONCLUSION Autogenous periosteum grafting is effective in the treatment of solitary bone cyst.
Objective To introduce the basic research and cl inical appl ication of the injectable bone repair biomaterials. Methods The recent original articles about the injectable bone repair biomaterials were extensively reviewed. Results The injectable bone repair biomaterials could fill irregularly shaped defects and might allow bone augmentation, both with minimal surgical intervention, and the injectable bone repair material had a good prospect by the medical profession and attach great importance to the academic material, but there were some deficiencies and shortcomings. Conclusion The injectable bone repair biomaterials may be a future approach to repair bone defect．