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自固化磷酸鈣人工骨在腰椎結核病灶清除術中的初步應用

BLOCK MROXYAPATITE ARTIFICIALBONE USED IN PLASTIC REPAIR OFMAXILLOFACIAL REGION:A PRELIMIN-ARY REPORT

The primary results of five patients in whomthe block hydroxyapatite artificial bone (BHAB)used in maxillofacial plastic repair were reported. All incisions healed up with no evidence ofinfection. None of the implants was rejected norhad resorption changes. Satisfactory estheticaleffects were maintained. The results demonst-rated BHAB had a good biocampatibility andcould be used as a bone graft substitute inmaxillofacial plastic repair. This kind of material could be carved and contoured ...

經皮撬撥復位加自固化磷酸鈣人工骨植入治療跟骨骨折

目的 總結經皮撬撥復位結合自固化磷酸鈣人工骨植入治療跟骨骨折的治療方法和效果。 方 法 2004 年6 月－ 2008 年6 月，收治跟骨骨折13 例。男11 例，女2 例；年齡18 ～ 61 歲，平均38 歲。高處墜落傷9 例，砸傷4 例。均為單側閉合骨折。按Sanders 分型：Ⅱ型5 例，Ⅲ型7 例，Ⅳ型1 例。X線片示Bouml;hler 角為— 10 ～ 15°，平均5°。受傷至手術時間4 h ～ 2 d。行經皮克氏針撬撥復位骨折，于骨折缺損處注入4 ～ 6 mL 注射型自固化磷酸鈣人工骨修復。 結果 術后無軟組織壞死及感染發生。13 例均獲隨訪，隨訪時間1 ～ 2 年。X 線片示骨折均于術后3 ～ 5 個月愈合；Bouml;hler 角為15 ～ 40°，平均27.8°。關節面復位高度無丟失，骨折愈合后逐漸恢復負重行走功能。注射型材料未引起血磷、血鈣增高及過敏、毒性反應。11 例于術后6 個月自固化磷酸鈣人工骨完全降解，2 例于8 個月降解完全；降解同時骨組織生成。按美國足踝外科學會（AOFAS）評分：優7 例，良4 例，一般2 例，優良率84.6%。 結論 經皮撬撥復位加自固化磷酸鈣人工骨植入治療跟骨骨折具有操作簡便、創傷小、并發癥少的優點。

Local injection of angiopoietin 2 promotes angiogenesis in tissue engineered bone and repair of bone defect with autophagy induction in vivo

ObjectiveTo investigate the mechanism of early vascularization of the tissue engineered bone in the treatment of rabbit radial bone defect by local injection of angiopoietin 2 (Ang-2).MethodsForty-eight New Zealand white rabbits were established unilateral 1.5 cm long radius defect models. After implantation of hydroxyapatite/collagen scaffolds in bone defects, the rabbits were randomly divided into 2 groups: control group (group A) and Ang-2 group (group B) were daily injected with 1 mL normal saline and 1 mL saline-soluble 400 ng/mL Ang-2 at the bone defect within 2 weeks after operation, respectively. Western blot was used to detect the expressions of autophagy related protein [microtubule associated protein 1 light chain 3 (LC3), Beclin-1], angiogenesis related protein [vascular endothelial growth factor (VEGF)], and autophagy degradable substrate protein (SQSTMl/p62) in callus. X-ray films examination and Lane-Sandhu X-ray scoring were performed to evaluate the bone defect repair at 4, 8, and 12 weeks after operation. The rabbits were sacrificed at 12 weeks after operation for gross observation, and the angiogenesis of bone defect area was observed by HE staining.ResultsWestern blot assay showed that the relative expressions of LC3-Ⅱ/LC3-Ⅰ, Beclin-1, and VEGF in group B were significantly higher than those in group A, and the relative expression of SQSTMl/p62 was significantly lower than that in group A (P<0.05). Radiographic and gross observation of specimens showed that only a few callus were formed in group A, the bone defect was not repaired; more callus were formed and complete repair of bone defect was observed in group B. The Lane-Sandhu scores in group B were significantly higher than those in group A at 4, 8, and 12 weeks after operation (P<0.05). HE staining showed that the Harvard tubes in group B were well arranged and the number of new vessels was significantly higher than that in group A (t=–11.879, P=0.000).ConclusionLocal injection of appropriate concentration of Ang-2 may promote early vascularization and bone defect repair of tissue engineered bone in rabbits by enhancing autophagy.

COMPARATIVE STUDY OF LUMBAR SPONDYLOLISTHESIS TREATED BY THREE DIFFERENT MATERIALS

Objective To evluate the clinical outcome of autograftsof ilium and interbody fusion cage or bone morphogenetic protein(BMP)／artificial bone material／ cage in treating lumbar spondylolisthesis. Methods From January 1997 to January 2004，114 patients with lumbar spondylolisthesis were treated with posterior lumbar interbody fusion and pedicle screw fixation． There were 45 males and 69 females with an average age of 43 years ranging from 32 to 61 years. Of 114patients, 85 cases were classified as degree Ⅰ, 24 cases as degree Ⅱ and 5 cases as degree Ⅲ. The patients were divided into three groups accordingto the material used for interbody fusion: autografts of ilium (group A, n=42), interbody fusion cages(group B, n=36), and BMP／artificial bone material／ cage (group C, n=36)．The clinical and radiographic results of the patients were compared among three groups． Results All patients were followed from 13 to 30 months with an average of 15 months． There were no statistically significant differences in surgical time, blood loss, and disc space height of preoperation(P＞0.05) among three groups. No severe complication occurred in the three groups(P＞0.05). The excellent and good rates in groups A，B and C were 81.0％, 80.6％, and 83.3％ respectively, showing no statisticallysignificant difference(P＞0.05)．The fusion rate of group C(97.0%) was significantly higher than those of group A(81.0%) and group B(83.3%) (P＜0.05) after 1 year of operation．And the average loss of disc space height in groups B and C was significantly lower than that in group A(P＜0.05). Conclusion Higher fusion rate and lower loss of disc space height can beobtained in treating lumbar spondylolisthesis with BMP／artificial bone materiel.It is an effective method in the treatment of spondylolisthesis.

EXPERIMENTAL STUDY OF THE EFFECT OF NEW BONE FORMATION ON NEW TYPE ARTIFICIAL BONE COMPOSED OF BIOACTIVE CERAMICS

Objective To investigate the osteogenic potential of four kinds of new bioactive ceramics combined with bovine bone morphogenetic proteins (BMP) and to explore the feasibility of using compounds as bone substitute material.Methods Ninety-six rats were divided into 4 groups(24 in each group). BMP was combined with hydroxyapatite(HA), tricalcium phosphate(TCP), fluoridated-HA(FHA), and collagen-HA(CHA) respectively. The left thighs of the rats implanted with HA/BMP, TCP/BMP, FHA/BMP,and CHA/BMP were usedas experimental groups. The right thighs of the rats implanted with HA, TCP, CHA, and decalcified dentin matrix(DDM) were used as control groups. The rats weresacrificed 1, 3, 5 and 7 weeks after implantation and bone induction was estimated by alkaline phosphatase(ALP),phosphorus(P), and total protein(TP)measurement. The histological observation and electronic microscope scanning ofthe implants were also made. Results The cartilage growth in the 4 experimental groups and the control group implanted with DDM was observed1 week after operation and fibrous connective tissues were observed in the other 3 control groups. 3 weeks after implantation, lamellar bone with bone marrow and positive reaction in ALP stain were observed in the 4 experimental groups. No bone formation or positive reaction in ALP stain were observed in the control groups. The amount of ALP activity, P value, and new bone formation in the experimental groups were higher than those in the control group(Plt;0.05). The amount of ALP activity, P value, and new bone formation in TCP/BMP group were higher than those in HA/BMP, CHA/BMP and FHA/BMP groups(Plt;0.05). There was no significant difference in TP between the BMP treatment group and the control groups. From 5th to 7th week, new bone formation, histochemistry evaluation, and the level of ALP、P、TP value were as high as those in the 3rd week. Conclusion New composite artificial bone of TCP/BMP, HA/BMP, CHA/BMP, and FHA/BMP all prove to be effective, but TCP/BMP is the most effective so that it is the most suitable biomaterial replacement of tissue. 

APPLICATION OF THREE-DIMENSIONAL PRINTING TECHNIQUE IN ARTIFICIAL BONE FABRICATION FOR BONE DEFECT AFTER MANDIBULAR ANGLE OSTECTOMY

ObjectiveTo investigate the application of three-dimensional (3-D) printing technique combining with 3-D CT and computer aided-design technique in customized artificial bone fabrication, correcting mandibular asymmetry deformity after mandibular angle ostectomy. MethodsBetween April 2011 and June 2013, 23 female patients with mandibular asymmetry deformity after mandibular angle ostectomy were treated. The mean age was 27 years (range, 22-34 years). The disease duration of mandibular asymmetry deformity was 6-16 months (mean, 12 months). According to the CT data and individualized mandibular angle was simulated based on mirror theory, 3-D printed implants were fabricated as the standard reference for manufacturers to fabricated artificial bone graft, and then mandible repair operation was performed utilizing the customized artificial bone to improve mandibular asymmetry. ResultsThe operation time varied from 40 to 60 minutes (mean, 50 minutes). Primary healing of incisions was obtained in all patients; no infection, hematoma, and difficulty in opening mouth occurred. All 23 patients were followed up 3-10 months (mean, 6.7 months). After operation, all patients obtained satisfactory facial and mandibular symmetry. 3-D CT reconstructive examination results after 3 months of operation showed good integration of the artificial bone. Conclusion3-D printing technique combined with 3-D CT and computer aided design technique can be a viable alternative to the approach of maxillofacial defects repair after mandibular angle ostectomy, which provides a accurate and easy way.

足背動脈島狀皮瓣聯合載萬古霉素硫酸鈣治療脛骨遠端創傷性骨髓炎伴軟組織缺損

目的 總結采用逆行足背動脈島狀皮瓣聯合載萬古霉素硫酸鈣植骨治療合并軟組織缺損的脛骨遠端創傷性骨髓炎的療效。 方法 2014 年 3 月—2016 年 4 月采用一期徹底清創，足背動脈島狀皮瓣結合載萬古霉素硫酸鈣植骨治療脛骨遠端創傷性骨髓炎 11 例。男 10 例，女 1 例；年齡 43～72 歲，平均 51.6 歲。均為骨折內固定術后所致慢性骨髓炎，病程 4 周～5 個月。骨折原因：交通事故傷 5 例，高處墜落傷 3 例，機械絞傷 2 例，扭傷 1 例。皮膚軟組織缺損范圍 3 cm×3 cm～13 cm×9 cm；創面細菌培養均為陽性。 結果 術后 2～3 周患者切口均 Ⅰ 期愈合，供受區均未發生感染。11 例均獲隨訪，隨訪時間 6 個月～2.5 年，平均 15.5 個月。術后骨折均愈合，愈合時間 3～9 個月，平均 4.6 個月。末次隨訪時足部功能采用美國矯形足踝協會（AOFAS）評分，獲優 9 例，良 2 例；皮瓣感覺 S4 8 例，S3 2 例，S2 1 例。所有患者骨髓炎均治愈；1 例脛腓骨中下段骨髓炎術后出現骨缺損，大小約 4 cm×3 cm，再次手術植入自體髂骨后骨愈合。 結論 足背動脈島狀皮瓣移植聯合萬古霉素硫酸鈣人工骨植骨治療伴軟組織缺損的脛骨遠端創傷性骨髓炎，手術簡便有效，是一種較理想的方法。

HYDROXYAPATITE PARTICULATE ARTIFICIAL BONE FOR REPAIRING SUNKEN DEFORMATION OF FRONTAL BONE FOLLOWING REMOVAL OF DERMOID CYST

Objective To investigate aesthetic outcomes and postoperative complications of hydroxyapatite particulate artificial bone for repairing sunken deformation of frontal bone following removal of dermoid cyst. Methods From February 2000 to May 2005, hydroxyapatite particulate artificial bone was used to repair the sunken deformation of frontal bone in 13 cases (9 males and 4 females), and the age of the patients was from 17 to 41 years. The dermoid cysts were all found during infant period, and the length and width of the cysts ranged from 6 cm×4 cm to 10 cm×8 cm. Anincision along the hairedge or tumor margin was made to excise the dermoid cyst in the forehead. After complete removal of dermoid cyst, the sunken frontal bone was examined and repaired with hydroxyapatite particulate artificial bone. The clinical checkup and Xray examination were utilized to determine aesthetic outcomes and postoperative complications at 1 week, 1 month and 6 months after operation. Results The primary wound healing was obtained in allpatients postoperatively, and no complications such as hematoma, infection, recurrence of dermoidcysts or displacement of hydroxyapatite particulate artificial bone were observed. With a followup from 1 to 20 months, all sunken deformations were completely repaired with satisfactorily aesthetic outcomes. Through clinical checkup and X-ray examination, the implants were found to integrate with the frontal bones without any gaps and displacement. Conclusion It is a simple and viable method torepair sunken deformation of frontal bone with hydroxyapatite particulate artificial bone.

Clinical study of calcium phosphate cement loaded with recombinant human bone morphogenetic protein 2 combined with calcium phosphate cement loaded with antibiotic for chronic osteomyelitis with bone defect

ObjectiveTo compare the effectiveness of calcium phosphate cement (CPC) loaded with recombinant human bone morphogenetic protein 2 (rhBMP-2) combined with CPC loaded with antibiotic versus CPC loaded with antibiotic alone in one stage for chronic osteomyelitis with bone defect.MethodsA single-blind prospective randomized controlled clinical trial was conducted. Between April 2018 and April 2019, 80 patients of chronic osteomyelitis with bone defect in accordance with the random number table were randomly divided into two groups, 40 in the trial group (CPC loaded with rhBMP-2 combined with CPC loaded with antibiotic) and 40 in the control group (CPC loaded with antibiotic). There was no significant difference in gender, age, disease duration, lesion, and preoperative white blood cells (WBC) count, platelet count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) between the two groups (P>0.05). All patients were implanted the corresponding CPC and external fixator after lesion clearance in the two groups. The postoperative WBC count, platelet count, ESR, CRP, hospital stay, cure rate of osteomyelitis, repaired bone defect volume, the time of external fixator removal, and the time of full weight-bearing of the affected limb were compared between the two groups.ResultsAll patients were followed up 12-24 months, with an average of 18.4 months. There was no significant difference in WBC count, platelet count, ESR, and CRP between the two groups at 4 weeks after operation (P>0.05). There were significant differences in WBC count, platelet count, and CRP in the two groups between 1 week before operation and 4 weeks after operation (P<0.05). And the ESR showed no significant difference between pre- and post-operation in the two groups (P>0.05). In the trial group, the anaphylactic exudate occurred in 1 patient with tibial osteomyelitis and the incision healed after oral administration of loratadine. The incisions of other patients healed by first intention in the two groups. One case of distal tibial osteomyelitis recurred in each group, and 1 case of humeral osteomyelitis recurred in the control group. The cure rates of osteomyelitis were 97.5% (39/40) in the trial group and 95% (38/40) in the control group, showing no significant difference between the two groups (χ2=0.000, P=1.000). There was no significant difference in the repaired bone defect volume and hospital stay between the two groups (P>0.05). X-ray film and CT showed that the bone defects were repaired in the two groups. The time of external fixator removal and the time of full weight-bearing of the affected limb were significantly shorter in the trial group than in the control group (P<0.05).ConclusionApplication of CPC loaded with rhBMP-2 and antibiotic in one stage is effective for the chronic osteomyelitis with bone defect, which can accelerate the bone regeneration in situ to repair bone defect, reduce the trauma, shorten the course of treatment, and obtain good function of the affected limb.