ObjectiveTo explore the effectiveness of bone transportation by ring type extenal fixator combined with locked intramedullary nail for tibial non-infectious defect. MethodsBetween June 2008 and October 2012, 22 cases of tibial large segment defect were treated. There were 15 males and 7 females, aged 24-58 years (mean, 36.8 years), including 17 cases of postoperative nonunion or malunion healing, and 5 cases of large defect. After debridement, bone defect size was 5.0-12.5 cm (mean, 8.05 cm). Bone transportation was performed by ring type external fixator combined with locked intramedullary nail, the mean indwelling duration of external fixation was 10.2 months (range, 2-26 months); the external fixation index was 1.57 months/cm (range, 0.3-3.2 months/cm); and the mean length increase was 8.05 cm (range, 5.0-12.5 cm). ResultsAll patients were followed up 19-58 months (mean, 32 months). No infection occurred after operation and all patients obtained bony union, and the union time was 4.7-19.4 months (mean, 11.9 months). Complications included refracture (1 case), skin crease (1 case), lengthening failure (1 case), foot drop (2 cases), retractions of the transport segment (1 case), delay of mineralization (1 case), which were cured after corresponding treatment. According to Hohl knee evaluation system to assess knee joint function after removal of external fixator and intramedullary nail, the results were excellent in 15 cases, good in 5 cases, and fair in 2 cases, with an excellent and good rate of 90.9%; according to Baird-Jackson ankle evaluation system to evaluate ankle joint function, the results were excellent in 10 cases, good in 3 cases, fair in 7 cases, and poor in 2 cases, with an excellent and good rate of 59.1%. ConclusionBone transportation by ring type external fixator combined with locked intramedullary nail could increase stability of extremities, allow early removal of external fixator and avoid axis shift of extremities, so it has good effect in treating tibial noninfectious defect.
Objective To investigate the effect of astragalus polysaccharides(AP) on chitosan／polylactic acid(AP／C／PLA)scaffolds and marrow stromal cells(MSCs)tissue engineering on periodontal regeneration of horizontal alveolar bone defects in dogs． Methods MSCs were isolatedfrom the bone marrow and then cultured in conditioned medium to be induced to become osteogenic．The MSCs were harvested and implanted into AP／C／PLA and C／PLA scaffolds．A horizontal alveolar bone defect(5 mm depth, 2 mm width)were produced surgically in the buccal side of the mandibular premolar 3 and 4 of 10 dogs．The defects were randomly divided into 4 groups(n=10)：Group A, root planning only(blank contro1); group B, AP／C／PLA with conditioned medium(medium contro1);group C, C／PLA with MSCs(scaffolds contro1); and group D, AP／C／PLA with MSCs(experimental group)．Eight weeks after surgery， block sections of the defects were collected for gross, histological and X-ray analysis. Results MSCs induced in vitro exhibited an osteogenic phenotype with expressingcollagen I and alkaline phosphatase． X-ray film observation showed that the bone density and height had no changes in group A; in group B, the bone density was increased to a certain extent and furcation area reached a few height, but no height was increased in interdental septum; in group C，the bone density was increased and furcation area nearly reached the native height,but interdental septum reached a few height;in group D,the bone density was increased significantly and furcation area and interdental septum reached the native height. Histological evaluation showed that there was greater tissue formation in group D than that in groups A, B and C, in which new alveolar bone, new cementum, periodontal ligament with Sharpey’s fibers, and new bone tissue was similar to native periodontal tissues. Ingroup A，B, C and D respectively, the amount of new alveolar bone regeneration was 0.83±0.30, 1.46±0.55, 2.67±0.26 and 2.90±0.41 mm; new cementum regeneration was 0.78±0.45，1.30±0.60，2.29±0.18 and 2.57±0.22 mm; the amount of connective tissue adhesion was 0.80±0.22，1.33±0.34，2.23±0.42 and 2.64±0.27 mm; all showing significant differenecs between group D and groups A, Band C (Plt;0.05)．Conclusion The technology of tissue engineering with AP／C／PLAscaffolds and induced MSCs may contribute to periodontal regeneration．
ObjectiveTo review the related studies on the application of nanomaterials in the treatment of osteomyelitis, and to provide new ideas for the research and clinical treatment of osteomyelitis.MethodsThe literature about the treatment of osteomyelitis with nanomaterials at home and abroad in recent years was reviewed and analyzed.ResultsAt present, surgical treatment and antibiotic application are the main treatment options for osteomyelitis. But there are many defects such as antibiotic resistance, residual bone defect, and low effective concentration of local drugs. The application of nanomaterials can make up for the above defects. In recent years, nanomaterials play an important role in the treatment of osteomyelitis by filling bone defects, establishing local drug delivery system, and self-antibacterial properties.ConclusionIt will provide a new idea and an important research direction for the treatment of osteomyelitis to fully study the related characteristics of nanomaterials and select beneficial materials to make drug delivery system or substitute drugs.
In order to investigate the possibility of porous hydroxyapatite ceramics (HAC) in the repair of skull bone defect, twenty-four rabbits were used. The bone defect model was created by operation to obtain a defect in parietal bone in a size of 1 cm x 1 cm. Filled the defect with HAC and methyl-methacrylate-syrene copolymer (MMAS) to fill the defect as control. At 1st, 2nd and 3rd months after operation, behavior of the rabbits was observed and then these animals were sacrificed and specimens were examined under microscope. Results showed as follows: after operation, behavior of all animals were normal. By histological examination, it was found that in HAC group, there were granulation tissue, fibrous tissue and newly formed vessels grew into the pores and the osteoblasts formed osseous trabeculae. There was no inflammatory cell infiltration. In the MMAS grafted asea, there was formation of fibrous membrane. It suggested that HAC might be a good material for bone substitute in repair of skull bone defect.
Objective To evaluate the potential of bioresorbable collagen membrane in a combination with bone marrow stromal cells (BMSCs) or platelet rich plasma (PRP) in repairing alveolar bone defects. Methods The first and second premolars were extracted from the bilateral maxillary and mandibular bone and fouralveolar intrabone defects (8 mm in height, 5 mm in width,15 mm in length) werecreated in 3 male mongrel dogs. The experiment included 4 groups: group A (nothing was used as control group), group B (only Bio-Gide® group C (Bio-Gide® BMSCs) and group D (Bio-Gide®／PRP). The macroscopic, radiographic and histological observations were performed at 4, 8 and 12 weeks after surgery. Results The cells were circle or short spindleshape after 1 day of coculture; and the cellswere polygon and long spindleshape with process after 3 days. The macroscopic observation: after 4 weeks in the defect region, obvious excavation and organization of hematoma were seen in group A; and new bone formation and little organization of hematoma were seen in groups B, C, D. After 8 weeks, excavation was not obvious, fibrous tissue was seen at the top of defect, organized hematoma wasgradually replace by new bone in group A; the edge of membrane broke and adhered to deep tissue and needle could pierce the surface ofdefect in groups B, C, D. After12 weeks,excavation disappeared in 4 groups and fibrous tissue at top of alveolar ridge in group A was thicker than that in groups B, C, D. The radiographic observation: defect was full of new bone. In groups A, B, C and D, the grey values were 68, 50, 56 and 49 after 4 weeks; 46, 30, 24 and 30 after 8 weeks; and 24, 17, 15 and 20 after 12 weeks respectively. The histological observation:after 4 weeks, a lot of fibrous connective tissues granulation tissues were seen no obvious new bone formed in group A; and the collagen structure of membrane remained and new bone formed in medial surface in groups B, C, D. After 8 weeks, new bone trabecula displayed clump and web in group A; the collagen structureof membrane were not of integrity, and many bone islands and few fibrous connective tissue formed in groups B, C, D. After 12 weeks, defect was filled with newbone in 4 groups. Conclusion Guided bone regeneration (GBR) treatment with collagen membranes may significantly enhance bone regeneration within 8 weeks. Theinfluence of GBR in combination with BMSCs or PRP in accelerating the repair of alveolar bone defects shoud be further investigated.
Objective To conduct anatomical study on the iliac crest chimeric tissue flap and summarize its effectiveness of clinical application in repairing limb wounds. Methods Latex perfusion and anatomical study were performed on 6 fresh adult cadaver specimens with 12 sides, to observe the initial location, distribution, quantity, and direction of the common circumflexa iliac artery, the deep circumflexa iliac artery, and the superficial circumflexa iliac artery, and to measure their initial external diameter. Between December 2020 and September 2022, the iliac crest chimeric tissue flap repair was performed on 5 patients with soft tissue of limbs and bone defects. There were 3 males and 2 females, with an average age of 46 years (range, 23-60 years). Among them, there were 3 cases of radii and skin soft tissue defects and 2 cases of tibia and skin soft tissue defects. The length of bone defects was 4-8 cm and the area of skin soft tissue defects ranged from 9 cm×5 cm to 15 cm×6 cm. The length of the iliac flap was 4-8 cm and the area of skin flap ranged from 12.0 cm×5.5 cm to 16.0 cm×8.0 cm. The donor sites were directly sutured. Results Anatomical studies showed that there were 10 common circumflex iliac arteries in 5 specimens, which originated from the lateral or posterolateral side of the transition between the external iliac artery and the femoral artery, with a length of 1.2-1.6 cm and an initial external diameter of 0.8-1.4 mm. In 1 specimen without common circumflexa iliac artery, the superficial and deep circumflex iliac arteries originated from the external iliac artery and the femoral artery, respectively, while the rest originated from the common circumflex iliac artery. The length of superficial circumflex iliac artery was 4.6-6.7 cm, and the initial external diameter was 0.4-0.8 mm. There were 3-6 perforator vessels along the way. The length of deep circumflex iliac artery was 7.8-9.2 cm, and the initial external diameter was 0.5-0.7 mm. There were 3-5 muscular branches, 4-6 periosteal branches, and 2-3 musculocutaneous branches along the way. Based on the anatomical observation results, all iliac crest chimeric tissue flaps were successfully resected and survived after operation. The wounds at recipient and donor sites healed by first intention. All patients were followed up 8-24 months, with an average of 12 months. The tissue flap has good appearance and soft texture. X-ray film reexamination showed that all the osteotomy healed, and no obvious bone resorption was observed during follow-up. Conclusion The common circumflex iliac artery, deep circumflex iliac artery, and superficial circumflex iliac artery were anatomically constant, and it was safe and reliable to use iliac crest chimeric tissue flap in repairing the soft tissue and bone defects of limbs.
Objective To evaluate the osteogenic effect of dextran sulfate/recombinant human bone morphogenetic protein 2/chitosan (DS/rhBMP-2/CS) combined with coralline hydroxyapatite (CHA) in repairing large segmental bone defects by radiographic feature. Methods Fifty-seven 24-week-old male New Zealand rabbits were prepared for establishing right radius bone defect model of 20 mm in length. In which 54 rabbits were randomly divided into 3 groups (n=18), and the CHA, DS/rhBMP-2/CS/CHA, and rhBMP-2/CHA artificial bone grafts were implanted into the bone defect in groups A, B, and C respectively; the remaining 3 rabbits were implanted nothing as blank control group. After operation, the gross condition of the animals was observed; at 4, 8, and 12 weeks after operation, X-ray film observation, Micro-CT scanning, and three-dimensional reconstruction were performed to obtain the volume of the new bone. Results The experimental animals recovered well and were in normal condition. X-ray observation showed that the bone healing in group B was better than that in groups A and C at each time point. At each time point after operation, the X-ray scores of group B were significantly higher than that of group A and group C (P<0.05); the scores of group C at 8 and 12 weeks after operation were significantly higher than that of group B (P<0.05). Micro-CT scanning and three-dimensional reconstruction observation showed that at each time point after operation in group A, the bone defect area had less bone formation and poor osteogenesis; in group B, there were many new bone tissues in bone defect area, and the bone remodeling was well, and gradually closed to normal bone morphology at 12 weeks; in group C, there were many new bone tissues in bone defect area, but the bone formation was general. The new bone volume of group B was significantly higher than that of group A and group C (P<0.05) at each time point after operation, and the score of group C was higher than that of group A at 8 weeks after operation (P<0.05). Conclusion The osteogenic effect of DS/rhBMP-2/CS/CHA sustained-release artificial bone is much better than that of single CHA and rhBMP-2/CHA, which can provide a new idea for treating bone defect by using bone tissue engineering in the future.
ObjectiveTo compare the effectiveness using bone transport and bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects. MethodsBetween January 2004 and May 2012,31 patients with tibial bone and soft tissue defects were managed by Ilizarov technique,the clinical data were retrospectively analyzed.Bone transport was used in 18 cases (group A),and bone shortening-lengthening in 13 cases (group B).There was no significant difference in age,gender,type of fracture,defect location,size of bone and soft defects,and time from injury to operation between 2 groups (P>0.05).Postoperative complications were observed;Paley's criterion was used to assess the bone healing and function recovery of the limb. ResultsAll the flaps survived and healing of wounds by second intention was obtained in all cases of group A;healing of wounds by first intention was obtained in 1 case,delayed healing in 3 cases,and healing by second intention in 9 cases in group B.All patients were followed up 1.5-4.5 years (mean,2.4 years).Pin loosening or pin tract infection occurred in 15 cases of group A and in 10 cases of group B,and limb length discrepancy in 1 case of group B;there was no significant difference in the rate of complication (χ2=0.003,P=0.955).In the distracted zone,all fractures healed naturally with excellent scale.The healing time was (251±39) days in group A,and was (239±45) days in group B,showing no significant difference (t=0.800,P=0.430);the healing index was (4.26±0.19) d/mm in group A,and was (4.13±0.19) d/mm in group B,showing no significant difference (t=1.775,P=0.086).In the bone defect zone,natural healing was obtained in 12 cases and healing after second operation or bone grafting in 6 cases,with healing time of (341±55) days (excellent in 17 cases and good in 1 case) in group A;natural healing was obtained in 11 cases and healing after second operation or bone grafting in 2 cases,with the healing time of (295±62) days (excellent in 12 cases and good in 1 case) in group B;and there was significant difference in the healing time (t=2.195,P=0.036),but no significant difference in the healing scale (Z=-1.693,P=0.091).At last follow-up,the function recovery was excellent in 7 cases,good in 6 cases,and fair in 5 cases in group A,and was excellent in 3 cases,good in 6 cases,and fair in 4 cases in group B,showing no significant difference (Z=-0.660,P=0.509). ConclusionUsing bone transport or bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects,the overall outcomes are similar,but the healing of bone defect zone is faster when using bone shortening-lengthening.
ObjectiveTo investigate the short-term effectiveness of three-dimensional (3D) printing personalized prosthesis in the treatment of giant cell tumor of bone around knee joint.MethodsA clinical data of 9 patients with giant cell tumor of bone around knee joints and met the inclusive criteria between May 2014 and August 2017 was retrospectively analysed. There were 4 males and 5 females, with an average age of 35.8 years (range, 24-50 years). The lesion located at the distal femur in 4 cases and at the proximal tibia in 5 cases. The disease duration was 5-25 months (mean, 12.9 months). According to Campanacci grading, there were 2 patients of grade Ⅰ and 7 of grade Ⅱ. The 3D printing personalized prosthesis was designed based on the CT scanning and 3D reconstruction prepared before operation. All patients were treated with the tumor resection and 3D printing personalized prosthesis reconstruction. The radiological examination was taken to observe the tumor recurrence and the Musculoskeletal Tumor Society 1993 (MSTS93) score was used to evaluate the knee function.ResultsAll operations were successful and all incisions healed by first intention without early complications. All patients were followed up 24-40 months (mean, 31.2 months). At last follow-up, no complication such as pain, pathological fracture, prosthesis loosening, or tumor recurrence occurred. The MSTS93 score was 20-29 (mean, 24.7). The knee function was rated as excellent in 6 cases and good in 3 cases, with the excellent and good rate of 100%. ConclusionFor giant cell tumor of bone around knee joint, 3D printing personalized prosthesis has the advantages of bio-fusion with host bone, mechanical stability, good joint function, and ideal short-term effectiveness. But the middle- and long-term effectiveness still need to be further observed.
【Abstract】 Objective To investigate the anti-infection and bone repair effects of cationic l i posome-encapsulatedvancomycin combined with the nano-hydroxyapatite/chitosan/konjac glucomannan (n-HA/CS/KGM) composite scaffold invivo. Methods Fifty-one 6-month-old New Zealand white rabbits, weighing 1.5-3.0 kg, were selected to prepare chronicinfectious tibia bone defect model by using Staphylococcus aureus. After 4 weeks, 48 survival rabbits were randomly divided into 4 groups (n=12). After debridement, defect was treated with nothing in group A, with n-HA/CS/KGM composite scaffold in group B, with vancomycin and n-HA/CS/KGM composite scaffold in group C, and with cationic l i posome-encapsulated vancomycin and n-HA/CS/KGM composite scaffold in group D. After 8 weeks of treatment, general observation, X-ray, HE staining, the bacterial culture, and the measurement of the longest diameter of bone defect were done. Results At 4 weeks after modeling, 48 rabbits were diagnosed as having osteomyelitis, including periosteal new bone formation, destruction of bone, and soft tissue swell ing. The Norden score was 3.83 ± 0.52. At 8 weeks after treatment, sinus healed in groups C and D, but sinus was observed in groups A and B; the gross bone pathologieal scores of group D were significantly better than those of groups A and B (P lt; 0.05). Bone defects were repaired completely in group D, the results of the longest diameter of bone defects in group D was significantly better than those in the other 3 groups (P lt; 0.05). New bone formation was observed in groups C and D, but periosteal reactionand marrow low-density shadow were observed in groups A and B; Norden score in group D was significantly better than those in groups A, B, and C (P lt; 0.05). HE staining showed that there were a large number of trabecular bone formation and fibrosis, with no obvious signs of infection in groups C and D, but neutrophil accumulation was observed in groups A and B; Smeltzer scores in groups C and D were significantly better than those in groups A and B (P lt; 0.05). Bacteriological results showed higher negative rate in groups C and D than in groups A and B (P lt; 0.05). Conclusion Cationic l iposome-encapsulated vancomycin and n-HA/CS/KGM composite scaffold can be a good treatment for infectious bone defects in rabbits, providing a new strategy for the therapy of bone defects in chronic infection.