Objective To explore an effective way fortreating severe complicated distal femoral fractures. Methods Twenty-six patients with complicated distal femoral fracture who all belonged to 33C3.3type according to AO/ASIF lassification, were treated with a lateral condylar buttress plate or self-desinged aliform anatomical plate, and operated on with allogeneic bone grafting. Results All cases were followed up for an average of 14 months (ranging 5-25 months). Twenty-four wounds were primary healing postoperatively, 2 wounds were infected and healed after dressing change. Twenty-four had bone healing after 411 months, 2 needed to operate again because of earlier weight-bearing resulting in fixation failure. According to shelbourne and Brueckmann score, the excellent and good rate was 88.46%. Conclusion The internal fixation forcomplicated distal femoral fracture by self-designed aliform anatomical plate and lateral condylar buttress plate with a great deal of allograft bone is an effective surgical method. As it has long oval holes and the holes are consecutive ,the aliform anatomical plate is more suitable for severe complicated fractures. At the same time, autogenous-ilium transplantation can be substituted by the allograft bone.
Objective To review the research advances of the seed cells , the scaffolds and the tissue fabrication of tissue engineering bone. Methods The literature concerned culturing human bone marrow cells, reshaping cuttlebones, and fabricating bone tissues was reviewed extensively. Results Osteoblasts from human bone marrow were successfully induced and differentiated; the cuttlebones were reshaped in cuttlebone hydroxyapatite for the first time; and some tissue engineering bones, such as the osteoblasts/CHA500R, osteoblasts/cuttlebone hydroxyapatite and osteoblasts/PBH were fabricated. Conclusion These tissue einineering bones construced by marrow-derived osteoblasts and CHA500R, cuttlebone hydroxyapatite or PBH are hopeful to be applied clinically.
Objective To study the effect of vascular endothelial cell growth factor (VEGF) on repair of bone defect with cortical bone allograft. Methods Forty five New Zealand white rabbits, weighted 2.5-3.0 kg, were made bone defect model of 1.5 cm in length in the bilateral radii and then were randomly divided into 3groups. The defect was repaired with only cortical bone allograft in the control group, with the cortical bone allograft and local injection of human recombinantVEGF in the experimental group, and with the cortical bone allograft and abdominal injection of VEGF PAb3 in the antagonist group. Roentgenography, immunohistochemical staining and tetracycline labelling were carried out to evaluate the reparative results 1, 3, 5, 8 and 16 weeks after operation. Results Immunohistochemical staining results showed that a great deal of blood vessels formed in the experimental group, and the number of blood vessels increased gradually with the time and reached the highest value at the 8th week. Tetracyclinelabelling showed the same result.The best results in callus formation, ossification rate and count of microvascular density were shown in the experimental group, while those in the control group were significantly better than those in the antagonist group (Plt;0.05),but there was no significant difference between the experimental group and the control group at the 8th week and the 16th week (Pgt;0.05). Conclusion VEGF can accelerates the bone formation and angiogenesis in the bone allografts, thus it can promote the repair of bone defects.
Objective To investigate effects of the basic fibroblast growth factor (bFGF) and fibronection (FN) on the osteoblast adhesion on the bio-derived bone. Methods The third generation of the osteoblast was treated with bFGF 0.1, 1, 10, and 100 ng/ml, respectively, and then was seeded in the bioderived bone, which had been modified with FN 0.1, 1, 10, and 100 μg/ml, or Polylysine, respectively. The cell adhesion was measured by the MTT assay. The cell density and the cell appearance were observed by the scanning electron microscope. The abovementioned procedures were repeated by an application of the GRGDS peptide. Results Both FN and bFGF could enhance the osteoblast adhesion efficiency on the bioderived bone (Plt;0.05). However, the osteoblast adhesion efficiency could be significantly strengthened bya combined use of FN and bFGF. FN and bFGF had a significant synergistic effectin statistics (Plt;0.01), but Polylysine and bFGF had no such synergistic effect (P＞0.05). The combined use of FN and bFGF had a better effect on the cell density and the cell appearance than either of them when observed with the scanning electron microscope. Adhesion efficiency generated by the combined use of FN and bFGF was significantly blocked by the application of the GRGDS peptide. Conclusion The combined use of FN and bFGF has a significant synergistic effect on the osteoblast adhesion efficiency on the bioderived bone. This effect is probably mediated by the RGD-integrin α5β1 pathway.
Objective To evaluate the feasibility of poly-L-lactide(PLLA)/porcinederived xenogeneic bone(PDXB) composite as a scaffold for the bone tissue engineering. Methods The film and the scaffold of the PLLA-PDXB composite were respectively prepared by a solution casting method and a solution casting-particle leaching method. The composite film and scaffold were further treated by the surface alkaline hydrolysis. The surface morphology of the composite was observed by the scanning electron microscopy, and hydrophilicity degree of the composite was measured. The OCT-1 osteoblastlike cells were cultured and amplified in vitro as the seeding cells, which werethen implanted on the film and scaffold. The adherence rate, adherence shape,proliferating activity, and growing morphology of the OCT-1 osteoblastlikecells were observed on the film. Results The PDXB particle 50 μm in diameter on average had a similar phase structure to that of hydroxyapatite. But its Ca/P ratio was lower than that of hydroxyapatite. After the surface alkaline hydrolysis, the PDXB particle could be exposed on the surface of the PLLA-PDXB composite. The surface roughness and hydrophilicity of the PLLAPDXB composite were obviously enhanced. The cell adherence rate and the cell proliferation activity of the PLLAPDXB composite were higher than those of the pure PLLA material. The cells tended to grow on the exposed surface of the PDXB particles. The cells seeded on the composite scaffold could migrate to the inside of the composite scaffold and grew well. Conclusion The PLLA-PDXB composite has a good cell affinity, and this kind of composite can hopefullybecome a new scaffold material to be used in the bone tissue engineering.
Objective To explore the feasibility of combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation for correction of secondary midface deformities in cleft patients. Methods From January 2002 to January 2005, 10 patients suffering from secondary midface deformities were treated. There were 4 males and 6 females, aged from 16 to 32 years. The unilateral cleft was involved in 8 patients and the bilateral cleft in2 patients. All patients received combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation. The horizontal corticotomy of high level Le Fort Ⅰosteotomy on anterior wall of maxillary bone is higher than that of traditionalLe Fort Ⅰ osteotomy, it is only 5 mm close to infraorbital foramen. Results All 10 patients were satisfied with their appearances after operation. Dental articulation was improved greatly in 9 patients. With an X-ray re-examination, maxillary was returned to normal position in all patients. After a follow up from 6months to 2 years, dental arch had good appearance. The X-ray films showed no obvious bone absorption. The density of grafting bone was approximation to the normal bone.Conclusion High level Le Fort Ⅰ osteotomy can make notonly maxillary advance, but also regions of lateral and floor of nose and partial infraorbital region advance. Combining with bone grafting in the same operation can decrease the frequency of operation, save the treatment expense and obtain an ideal effect. So it is an effective method for correction of the secondary midface deformities in cleft patients.
OBJECTIVE To investigate the effect of percutaneous bone marrow graft for the management of nonunion of tibia. METHODS From March 1996 to June 2000, 56 cases with nonunion of tibia were treated by autogenous bone marrow graft. Among them, there were 38 males and 18 females, aged from 19 to 72 years. A marrow needle was inserted into the site of the nonunion under the X-ray, the autogenous bone marrow was injected into the site of nonunion. Compression bandage and appropriate immobilization material were applied after operation. This procedure was repeated every month, 2 or 3 times was needed. RESULTS 56 patients were followed-up for 4 months to 4 years and 2 months, averaged 2.8 years. Fracture healed in 53 cases and X-ray displayed fracture line disappeared and a great deal of continuous callus formed, and nonunion in 3 cases. CONCLUSION Percutaneous autogenous bone marrow graft can play a role in osteogenesis at the site of nonunion. It is easy to aspirate bone marrow and the operation is simple. It has clinical application value for the satisfactory effect.
To evaluate the method and effectiveness of anterior focus clearance with autograft bone fusion and internal fixation in treating of adjacent multivertebral tuberculosis in one-stage. Methods Between March 2007 and September 2009, 8 cases of thoracic vertebra tuberculosis were treated. Of 8 cases, 6 were male and 2 were female, aged 32 years on average (range, 20-42 years). The disease duration ranged from 8 to 14 months (mean, 10.2 months). Affected vertebrae included thoracic vertebrae in 35 cases and lumbar vertebrae in 11 cases; 5 vertebrae were involved in 4 cases, 6 vertebrae in 3 cases, and 8 vertebrae in 1 case. According to Frankel classification, there were 2 cases of grade C, 4 cases of grade D, and 2 cases of grade E. All patients had different kyphosis with the Cobb angle of (25.1 ± 6.6)°. All patients received antituberculous therapy 4-6 weeks preoperatively; after complete clearance lesions, autograft bone fusion and internal fixation were performed, and then antituberculous therapy was given for 18 months. Results All incisions healed by first intention. Eight patients were followed up 18-48 months (mean, 29 months). According to JIN Dadi et al. criterion, 7 cases recovered after first operation, 1 case of relapsed tuberculosis with sious was cured after re-focus clearance. The Cobb angle was (19.5 ± 4.2)° at 7 days after operation and was (22.3 ± 3.6)° at last follow-up, showing significant differences when compared with the preoperative value (P lt; 0.05). The nerve function of all cases were classified as Frankel grade E. CT scan showed bone graft fusion at 6-8 months after operation. No loosening or displacement of grafted bone and internal fixation occurred during follow-up. Conclusion The treatment of adjacent multivertebral tuberculosis by anterior focus clearance, intervertebral autograft, and internal fixation in one-stage is effective. Anterior bone fusion and internal fixation in one-stage can correct kyphosis effectively and rebuild spinal stabil ity, so it is a good choice for surgical treatment of adjacent multivertebral tuberculosis.
Objective To investigate the cl inical efficacy of the cancellous granule-type calcium phosphate cement in repair bone defect. Methods Between July 2008 and July 2009, 35 patients (42 l imbs) with fractures, nonunion, and benign bone tumor were treated with cancellous granule-type calcium phosphate cement. There were 32 males and 3 females,with an age range from 9 to 73 years (median, 41 years), including 24 l imb fractures (19 cases), 4 osteotomy for deformity of ulna and radius (2 cases), 2 femur intertrochanteric bony cysts (2 cases), 3 enchondroma (3 cases), 5 bone defect at donor il ium (5 cases), 3 nonunion (3 cases), and 1 lumbar spinal stenosis (1 case). The size of bone defect was 1-5 cm. Bone defect was repaired with cancellous granule-type calcium phosphate cement (1-5 g). Results All cases were followed up 8-23 months (13.7 months on average). Thirty-nine incisions (32 cases) healed by first intention and the suture was removed after 10-14 days. Incision dehiscence occurred in 2 cases, and wounds healed after second debridement and removal of artificial bone. Exudation of incision occurred in 1 case, and wound healed after symptomatic treatment. No local red swell ing, higher temperature, maculopapule, and ulceration of skin occurred at implantation site. X-ray films showed that bone graft fusion was achieved and bone defect was radically repaired at 6 months after operation and artificial bone was absorbed completely at 12 months. Conclusion Cancellous granule-type calcium phosphate cement can be used as a new graft bone material, which is suitable for defect fill ing after traumatic fracture, benign bone tumors, and il iac bone donor.
OBJECTIVE To manufacture adriamycin-porous tricalcium phosphate (A-PTCP) ceramic drug delivery system (DDS) as a possible method for bone defect treatment after bone tumor operation. METHODS A-PTCP DDS was made from putting adriamycin into PTCP. Thirty rabbits were divided randomly into group A(24 rabbits) and group B(6 rabbits). A-PTCP was implanted in the greater trochanter of the right femur in group A. Adriamycin were injected into veins in group B. Muscle around A-PTCP and plasma were taken out at different period. Adriamycin concentrations in muscle and plasma were measured by high performance liquid chromatography (HPLC). RESULTS A-PTCP could gradually release adriamycin over 10 weeks. Adriamycin concentrations in the muscle were higher than that in plasma. CONCLUSION A-PTCP may be a new method for repairing bone defects after bone tumor operation.