Objective To evaluate the biomechanical characteristicsof titanium mesh with anterior plate fixation or ilium autograft in anterior cervical decompression.Methods Six fresh cervical spine specimens(C3-7) of young cadaver were used in the biomechanical test. After C5, C5,6 and C4-6 were given vertebrectomy,ilium autograft and titanium mesh with anterior plate fixation were performed. Their stabilities of flexion,bilateral axial rotation,the lateral bending and the extension were tested. Intact cervical spine specimens served as control group. Results Ilium autograft improved the stability of the unstable cervical vertebrae and decreased the flexion, the lateral bending or the extension, showing a significant difference when compared with control group(Plt;0.05). Whereas, axial rotational motion was decreased insignificantly(Pgt;0.05). Titanium meshwith anterior plate fixation improved the stability of the unstable spine and decreased the flexion,the bilateral axial rotation,the lateral bending or the extension, showing a significant difference when compared with control group(Plt;0.05). Conclusion The vertebrectomy and anterior cervical fusion by ilium autograft was the least stable construct of all modes tested,and the titanium mesh implantation is stabler than the intact cervical sample.
Objective To investigate the clinical effect of free forearm flap and titanium mesh in repairing maxillary defects. Methods From January 2002 to November 2002,partial maxillectomy or maxillectomy wereperformed in 3 patients with maxillary gingival carcinoma, in 1 patient with palatine mucoepicermoid carcinoma and in 1 patient with maxillary sinus carcinoma. Maxillary defects were reconstructed withfree forearm flaps ranging from 4 cm×5 cm to 6 cm×7 cm and titanium mesh.The effect was estimated by clinical examination, CT and nasopharyngoscope. Results Five cases were followed up 515 months. All the flaps were alive. Facial, alveolar process and palatal contours were restored well. Epithelium was found on the nostril surface of the titanium mesh. The functions of speech and chew were restored well. Conclusion A combination of the free forearm flap and titanium mesh is an ideal method in reconstruction of maxillary defects.
The surface morphology of titanium metal is an important factor affecting its hydrophilicity and biocompatibility, and exploring the surface treatment strategy of titanium metal is an important way to improve its biocompatibility. In this study, titanium (TA4) was firstly treated by large particle sand blasting and acid etching (SLA) technology, and then the obtained SLA-TA4 was treated by single surface treatments such as alkali-heat, ultraviolet light and plasma bombardment. According to the experimental results, alkali-heat treatment is the best treatment method to improve and maintain surface hydrophilicity of titanium. Then, the nanowire network morphology of titanium surface and its biological property, formed by further surface treatments on the basis of alkali-heat treatment, were investigated. Through the cell adhesion experiment of mouse embryonic osteoblast cells (MC3T3-E1), the ability of titanium material to support cell adhesion and cell spreading was investigated after different surface treatments. The mechanism of biological activity difference of titanium surface formed by different surface treatments was investigated according to the contact angle, pit depth and roughness of the titanium sheet surface. The results showed that the SLA-TA4 titanium sheet after a treatment of alkali heat for 10 h and ultraviolet irradiation for 1 h has the best biological activity and stability. From the perspective of improving surface bioactivity of medical devices, this study has important reference value for relevant researches on surface treatment of titanium implantable medical devices.
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.
Objective
To compare the effectiveness of titanium elastic nail (TEN) and locking compression plate fixation in treating femoral subtrochanteric fracture in older children.
Methods
Between April 2015 and September 2016, 35 older children (aged 7-13 years) with femoral subtrochanteric fractures were treated, the clinical data were retrospectively reviewed. TEN fixation was used in 19 cases (group A) and locking compression plate fixation in 16 cases (group B). There was no significant difference in age, gender, sides, fracture causes, type of fracture, and time from injury to operation between 2 groups (P>0.05). The fluoroscopy times, operation time, intraoperative blood loss, fracture healing time were recorded and compared between 2 groups. The limb function was evaluated according to the Sanders scores and Flynnet al. outcome score.
Results
All the patients were followed up 6-24 months (mean, 11.46 months). The operation time, intraoperative blood loss, and fracture healing time of group A were significantly less than those of group B, but the fluoroscopy times of group A was significantly more than that of group B (P<0.05). All the fractures were healed, no breakage of screw, infection of deep tissue, nerve injury, osteonecrosis of the femoral head, or other complication occurred. At last follow-up, according to the Sanders scores, the results were excellent in 14 cases, good in 4 cases, and fair in 1 case in group A with an excellent and good rate of 94.74%; the results were excellent in 12 cases, good in 3 cases, and fair in 1 case in group B with an excellent and good rate of 93.75%; showing no significant difference between 2 groups (χ2=0.400, P=0.980). According to the Flynn et al. outcome score, the results were excellent in 13 cases, good in 5 cases, and fair in 1 case in group A with an excellent and good rate of 94.74%; the results were excellent in 11 cases, good in 3 cases, and fair in 2 cases in group B with an excellent and good rate of 87.50%; showing no significant difference between 2 groups (χ2=0.748, P=0.688).
Conclusion
Both TEN and locking compression plate have satisfactory outcomes for treating pediatric femoral subtrochanteric fractures. TEN method has minimally trauma, security, and faster fracture healing when compared with locking compression plate.
Objective To study the reconstruction method and effectiveness of titanium plate and Teflon patch for the chest wall after resection of sternal tumors. Methods Between October 2006 and November 2009, 4 patients with sternal tumors were treated and the thoracic cages were reconstructed. There were 2 males and 2 females, aged 30-55 years. The patientswere admitted because of chest lump or pain. The sizes of palpable lump ranged from 4 cm × 3 cm to 10 cm × 8 cm. CT examination showed bone destruction. After sternal tumor resection, defect size ranged from 10 cm × 8 cm to 18 cm × 14 cm, and titanium plate and Teflon patch were used to repair and reconstruct the chest wall defect. Results The operations of the tumor resection and reconstruction of chest wall defect were successfully performed in 4 cases. Incisions healed by first intention with no abnormal breath, subcutaneous emphysema, pneumothorax, and infection. One case failed to be followed up after 6 months; 1 case died of intracranial hemorrhage; and 2 cases were followed up 1 and 4 years respectively without tumor recurrence. The chest wall had good remodel ing. No loosening and exposure of titanium plate, difficulty in breathing, chest distress, and chest pain were observed during followup. Conclusion Surgical resection of sternal tumors will cause large chest wall defect which can be repaired by titanium plate and Teflon patch because it had the advantages of easy operation, satisfactory remodel ing, and less compl ication.
Objective To compare the clinical effects of treating prolapse of the cervical intervertebral disc by the Solis cage fusion, the titanium cage fusion or the autogenous iliac crest graft combined with the titanium plate fixation. Methods Sixty-four patients with prolapse of the cervical intervertebral discadmitted to hospital from February 2002 to May 2005 were retrospectively analyzed. In Group A, 20 patients (15 males and 5 females, aged 38.76 years, 30 intervertebral spaces) were treated with the Solis cage fusion, and the preoperative JOAscores were 9-16, averaged 11.4; in Group B, 21 patients (15 males and 6 females,aged 37-78 years, 23 intervertebral spaces) were treated with the titanium cagefusion, and the preoperative JOA scores were 8-13, averaged 10.1; in Group C, 23 patients (18 males and 5 females, aged 32-76 years, 28 intervertebral spaces)were treated with the autogenous iliac crest graft combined with the titanium plate fixation, and the preoperative JOA scores were 9-14, averaged 10.6. The comparative analysis was made among the 3 groups in the following aspects: X-ray exposure time, time working on the iliac bone, operation time, hemorrhage amount，complication incidence after operation, cervical vertebral fusion rate, symptom relief rate, and recovery rate of the JOA score. Results According to the follow-upfor 2-15 months averaged 12 months, the time working on the iliac bone was longer in Group C than in Groups A and B (11.5±2.4 vs 4.1±1.7 minand 4.2±1.9 min, P＜0.05); the operation time was longer in Group C than in Groups A and B (98.3±14.7 min vs 55.5±10.3 min and 56.8±12.6 min, P＜0.05); and the X-ray exposure time was longer in Group C than in Groups A and B (7.8±1.8 min vs 4.3±1.2 min and 4.2±1.3 min, P＜0.05). Also, the hemorrhage amount in Group C was much greater than in Groups A and B (145.8±19.3 ml vs 65.8±10.2 ml and 67.2±12.3 ml,P＜0.05). The postoperative complication rate was lower in Groups A and Bthan in Group C (P＜0.05). There was a significant difference in the complication rate in the cervical region between Group A (5.0%±1.8%) and Group B (14.3%±2.6%,Plt;0.05）. The fusion rate in Groups A and B was 100% 3-4 monthsafteroperation, and there was no difference when compared with that in Group C. The recovery rates of the JOA scores in the three groups were 81.9%±3.2%，78.9%±7.3%, and 76.3%±9.4%, respectively, and there was no significant difference among the three groups. Conclusion The Solis cage fusion has a better therapeutic effect in treating prolapse of the cervical intervertebral disc than the titanium cage fusion and the autogenous iliac crest graft combined with the titanium plate fixation. The Solis cage fusion also makes the operation easier, with a more rapid recovery rate and fewer postoperative complications in the patient.
Objective To investigate the effect and safety of the anterior uncovertebral joint resection in treatment of cervical spondylotic myelopathy accompanied by radiculopathy. Methods From March 2002 toJuly 2004, 9 patients (5 males, 4 females; aged 38-66) with cervical spondylotic myelopathy accompanied by radiculopathy underwent the anterior uncovertebral joint resection and discectomy using the titanium cage implantation. There were 6 unilateral and 3 bilateral compressed nerve roots. Results During the follow-up for 3-16 months, CT scanning or X-ray films revealed thatall the patients improved with an enlargement of the intervertebral foramen, and MRI demonstrated that compression of the spinal cord and nerve roots vanished.Seven patients had a relief in the radicular pain although the other 2 still had a residual pain. All the patients improved to some extent in symptoms of myelopathy. No patient suffered vertebral artery injury during the operation. Conclusion The uncovertebral joint resection can directly decompressthe nerve roots. The key to avoidance of an injury to the vertebral artery is agood understanding of the regional anatomy and a good performance of the operation.
ObjectiveTo study the efficacy of anterior cervical Vectra-t dynamic plate and titanium mesh for cervical spondylosis.
MethodsA retrospectively analysis involving 20 cases (44 sections) from June 2010 to October 2012 was performed in the department of orthopaedic in the West China Hospital of Sichuan University. All patients received the operation of anterior cervical vertebral resection decompression, titanium mesh and bone graft, and Vectra-T plate. The data of the JOA scores, cervical curvature, the conditions of vertebral body fusion after bone graft and the situation of titanium mesh subsidence were all collected. Statistical analysis were performed using SPSS 19.0 software.
Resultsa) All the 20 cases received a 12-to 30-month follow-up. The results of statistical analysis showed that:the JOA scores were as follows:7.68±1.66 for preoperative, 10.91±1.97 for after surgery and 12.74±1.27 for the endpoint of follow-up, and significant differences were found between these scores (P < 0.05). b) There was no loose of screw or plate. The local cervical angle and regional cervical angle were improved after surgery. In the 44 segments of fusion, 43 segments fused within 6 months, one of the segment delayed to fuse 12 months after surgery. c) The subsidence of titanium mesh were 2.7±2.7 mm on average in 3 months after surgery, 3.6±1.0 mm on average in 6 months after surgery, 3.9±1.2 mm on average in 12 months after surgery and 4.0±1.2 mm on average in last follow-up. Titanium mesh subsidence mainly concentrated in the postoperative period of 6 months. After six months of titanium mesh subsidence was no longer apparent.
ConclusionThe application of Vectra-T dynamic plate can effectively improve the curvature of the cerical sagittal position, prevent protrusion deformity, reduce the related complications after bone graft, effectively avoid the stress shelter in the static plate, andspromote the fusion between the cervical vertebral bodies. However, the long-term curative effects are still needed to be assessed by large sample randomized controlled trials with long-term follow-up.
ObjectiveTo investigate the effects of micro/nano-structure and antimicrobial peptides (AMPs) on antibacterial properties of titanium (Ti) metallic surface.MethodsTi disks were treated via sandblasted large-grit acid-etched (SLA) and alkali-heat treatment (AHT) to build the micro/nano-structure, on which AMPs were spin-coated with a certain amount (10, 30, 50, 70, and 90 μg). Scanning electron microscope (SEM) and energy dispersive spectroscopy (EDS) were used to observe the surface structure and characterize the surface elements (i.e. contents of C, N, O, and Ti). Ti disks loaded with AMPs of difference amounts were co-cultured with Staphylococcus aureus (S. aureus) for 24 hours. After that, the formation and dimension of antibacterial circle were measured. Furthermore, the Ti disks treated with different approaches (untreated, SLA treatment, SLA+THA treatment, and 90 μg AMPs-loaded samples) were co-cultured with S. aureus and Escherichia coli (E.coli) for 3 hours, bacterial adhesion on the disks were evaluated by using SEM. The antibacterial performances in solution were quantitatively evaluated by immersing the Ti disks in bacterial solutions and measuring the absorbance (A) values.ResultsIt was found that the nanoporous structure could be easily constructed by SLA+AHT approach. After spin-coating AMPs, the nanopores with the diameter less than 200 nm were almost covered. According to the element analysis, with the increase of AMPs, the C content gradually increased; the N content was not detected until AMPs amount reached 70 μg on the disks. The diameter of antibacterial circle clearly depended on the AMPs amount. The Ti disks loaded with 90 μg AMPs had significantly larger antibacterial circles than the other Ti disks (P<0.05). Based on the SEM observation, the Ti disks loaded with 90 μg AMPs has the least bacterial attachment compared with the other Ti disks (P<0.05). TheA value of bacterial solution immersed with the Ti disks loaded with 90 μg AMPs was much lower than the other Ti disks (P<0.05).ConclusionThe approach of micro/nano-structure and AMPs can improve the antibacterial properties of Ti metallic surface.
