Combined magnetic fields accelerate bone‐tendon junction injury healing through osteogenesis

The objective of this study was to explore the effect of combined magnetic fields (CMFs) on osteogenesis and the remodeling of newly formed bone at bone‐tendon (BT) junction. Forty‐eight mature rabbits in whom partial patellectomy was performed were used to establish a BT junction injury model at the patella‐patellar tendon (PPT) complex and were then allocated to CMF treatment group (CMF group) or placebo treatment group (control group). Daily CMF therapy was delivered continuously from post‐operative day 3 to weeks 4, 8, and 16. At each time point, the animals were sacrificed, and the PPT complexes were harvested for radiographic, histological, peripheral quantitative computed tomography, and micro‐computed tomography (micro‐CT) evaluation. The area, length, and bone mineral density of the newly formed bone in the CMF group were significantly greater than the control group at post‐operative weeks 8 and 16. The micro‐CT results showed that the newly formed bone in the CMF group contained more and thicker trabeculae than the control group at weeks 8 and 16. Histologically, the CMF group showed better remodeling of the BT junction. In conclusion, CMF treatment was able to accelerate osteogenesis during BT junction repair, thus facilitating the healing of BT junction injury.     

Reconstruction by bone transport after resection of benign tumors of tibia: A retrospective study of 38 patients

Background:

The commonly used reconstructive options after post resection defects in bone tumors like megaprosthesis, autograft, allograft, bone graft substitutes and recycled bone have their own demerits on a long term. Bone transport that regenerates patient''s own bone is a less explored option of reconstruction after resection of benign bone tumors and reports on this are limited. This technique is very much relevant in tibia where Ilizarov fixator is surgeon and patient friendly. We report our experience.

Materials and Methods:

This is a retrospective series of resection and bone transport in 38 patients with benign tumor of tibia. There were 14 males and 24 females with mean age of 23.40 years (range 9–40 years). Lesion was located in proximal third tibia in 27, middle third in two and distal third in nine patients. The diagnosis was giant cell tumor in 32, chondroblastoma in three, chondromyxoid fibroma, enchondroma and desmoplasic fibroma in one patient each. The resection was intercalary in 28 and transarticular in 10 patients. Osteosynthesis was monofocal in three, bifocal in 31 and polyfocal in four cases.

Results:

Mean followup was 7.22 years (range 1.5–15 years). Mean resection length was 10.21 cm (range 3–22 cm). The mean duration of external fixator was 308.03 days (range 89–677 days) and mean external fixator index was 36.14 days/cm (range 16.84–97.43 days/cm). Twelve patients had difficulties in the form of 11 problems and five obstacles that were successfully managed. None of the patients had local recurrence of tumor or any long term complication. Mean Musculo-skeletal Tumour Society score at final followup was 27.18 (90.60%).

Conclusions:

Bone transport is an excellent option after resection of benign tumors of tibia with good local control and functional outcome, despite minor difficulties that need timely management.     

Comparative study of the results of compound tibial shaft fractures treated by Ilizarov ring fixators and limb reconstruction system fixators

Purpose: Ilizarov ring fixator and limb reconstruction system (LRS) fixators have been used in the management of complex tibial fractures with severe soft tissue injuries, compound tibial fractures, and infected tibial nonunion for which conventional internal fixation cannot be contemplated. Fracture union and distraction osteogenesis can be done simultaneously with these external fixators, allowing early weight bearing. Several previous studies have shown almost equal results of rail and ring fixators for the compound tibial shaft fractures. Thus we performed a prospective study to evaluate the union rate, functional outcome and amount of limb lengthening after the treatment of compound tibial shaft fractures with or without infected nonunion by ring or LRS fixators. Methods: This prospective study was done at Sarojini Naidu Medical College and Hospital, Agra, India and included 32 patients of compound tibial shaft fractures with or without infected nonunion. There were 26 males and 6 females and the average age was 40 years. Patients were randomly divided into two groups (n=16 for each): one underwent Ilizarov fixation and the other received LRS fixation. Cases were followed up for 3e24 months, 6 months on average from September 2012 to October 2014. Functional and radiological outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria for both rail and ring fixators. Results: Union was achieved in all cases. Radiological outcome was found excellent in 68.75%, good in 18.75% and fair in 12.50% of cases treated by rail fixators whereas it was excellent in 56.25%, good in 18.75%, fair in 12.50% and poor in 12.50% of cases treated by ring fixators. Functional result was satisfactory in 75.00% of cases treated by rail fixator and 68.75% of cases treated by ring fixators whereas the corresponding rate of unsatisfactory was 25.00% vs. 31.25%. Conclusion: In our short-term assessment, LRS fixators show a better result than Ilizarov fixators in terms of fracture union and functional outcome with soft tissue care and limb length.     

不同剂量阿司匹林对大鼠钛合金种植体早期骨整合的影响

目的探讨不同剂量阿司匹林对大鼠股骨钛合金种植体早期骨整合的影响,为临床使用阿司匹林患者的牙种植提供参考。方法48只8周龄SD雄性大鼠随机分为对照组和实验组(A、B、C组),每组12只,分别于右侧股骨干骺端植入直径1.4mm,长度6 mm的Ti 6Al 4V种植钉一枚。术后分别给予实验组A、B、C组8.93 mg/kg/d、17.86 mg/kg/d、26.79 mg/kg/d阿司匹林灌胃,对照组给予等剂量0.9%的氯化钠注射液灌胃至2周、4周。各组分别于术后2周、4周对种植区进行HE、Masson、BMP 2免疫组织化学及TRAP染色检测。结果HE染色结果显示,B、C组较对照组种植体周围新骨形成量降低,骨小梁稀疏,骨髓腔增大,且C组最明显,对照组与A组无明显差异;Masson染色结果显示,B、C组较对照组种植体周围新生骨组织中红染区域减少,且C组减少更明显,A组则与对照组未见明显差异;BMP 2免疫组织化学染色结果显示,A组与对照组BMP 2表达量差异无统计学意义(P>0.05),C组较其余组BMP 2表达量降低(P<0.05);TRAP染色结果显示,对照组、A、B、C组TRAP单位面积阳性染色个数依次降低,差异具有统计学意义(P<0.05)。结论阿司匹林可能通过抑制成骨细胞的形成和活性及破骨细胞的表达来减少骨组织的形成,且与剂量相关,高剂量的阿司匹林抑制成骨作用更明显。     

Exogenous phytoestrogenic molecule icaritin incorporated into a porous scaffold for enhancing bone defect repair

This study was designed to develop a bioactive scaffold to enhance bone defect repair in steroid‐associated osteonecrosis (SAON). Icaritin, a metabolite of the herb Epimedium, has been identified as an angiogenic and osteogenic phytomolecule. Icaritin was homogenized into poly lactic‐co‐glycolic acid/tricalcium phosphate (PLGA/TCP) to form an icaritin‐releasing porous composite scaffold (PLGA/TCP/icaritin) by fine‐spinning technology. In vitro, high performance liquid chromatography was used to determine the release of icaritin during degradation of PLGA/TCP/icaritin. The osteogenic effects of PLGA/TCP/icaritin were evaluated using rat bone marrow mesenchymal stem cells (BMSCs). In vivo, the osteogenic effect of PLGA/TCP/icaritin was determined within a bone tunnel after core decompression in SAON rabbits and angiography within scaffolds was examined in rabbit muscle pouch model. In vitro study confirmed the sustainable release of icaritin from PLGA/TCP/icaritin with the bioactive scaffold promoting the proliferation and osteoblastic differentiation of rat BMSCs. In vivo study showed that PLGA/TCP/icaritin significantly promoted new bone formation within the bone defect after core decompression in SAON rabbits and enhanced neovascularization in the rabbit muscle pouch experiment. In conclusion, PLGA/TCP/icaritin is an innovative local delivery system that demonstrates sustainable release of osteogenic phytomolecule icaritin enhancing bone repair in an SAON rabbit model. The supplement of scaffold materials with bioactive phytomolecule(s) might improve treatment efficiency in challenging orthopedic conditions. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:164–172, 2012     

Comparison between lengthening over nail and conventional Ilizarov lengthening: a prospective randomized clinical study

The aim of this study is to compare lengthening over an intramedullary nail to the conventional Ilizarov method with regard to percentage length increase, external fixation index, consolidation index and incidence of complications. This is a prospective randomized controlled study. Thirty-one limbs in 28 patients were included in the study; 15 were lengthened over an intramedullary nail, and 16 limbs were lengthened conventionally. The mean duration of external fixation in the lengthening over nail group was 52.2 days compared to 180.4 days in the conventional group. There was higher incidence of complications in the conventional method group. In comparison with conventional Ilizarov lengthening, lengthening over an intramedullary nail offers a shorter period of external fixation and fewer complications overall, but there is a high incidence of deep intramedullary infection which is serious.     

兔双侧下颌骨牵引成骨动物模型的建立

目的:使用CBX01-15型兔下颌骨专用牵引器,建立兔双侧下颌骨牵引成骨动物模型,并评价其牵引效果。方法:新西兰大白兔8只,行双侧下颌骨截骨术,安置牵引器。延迟5天后,两侧下颌骨均以0.5mm/次,2次/天的速度牵引15天,牵引结束后固定8周,新骨分别行大体、放射学和组织学检查。结果:所有动物均良好耐受牵引及固定,未发生死亡,双侧下颌体均显著延长。固定8周时,两侧新骨均接近正常骨。结论:兔双侧下颌骨牵引成骨动物模型牵引效果可靠,新骨再生良好。     

牵张成骨联合正颌外科治疗成人严重小下颌畸形伴重度阻塞性睡眠呼吸暂停低通气综合征

目的:探讨牵张成骨术联合正颌外科的方法治疗小下颌畸形患者下颌骨严重发育不足伴重度睡眠呼吸暂停综合征(OSAHS)的效果。方法:对2例继发于颞下颌关节强直的小颌畸形患者首先采用牵张成骨技术进行治疗。手术在全麻下行双侧下颌角处截骨,安置牵引器,延长下颌升支及下颌体矫正小颌畸形及OSAHS。第二期在拆除牵引器的后行正畸治疗,继而采用正颌外科方法矫正颌面畸形及咬合关系,术后进一步正畸治疗矫正咬合关系排齐牙列。结果:2例患者均顺利完成治疗。下颌骨最小牵引距离25mm,最大牵引距离30mm,牵引区成骨良好。后气道间隙由治疗前的平均3.25mm增加到11.5mm;SNB角由术前平均67°增加到术后80°,OSAHS得以治愈。联合正颌外科及正畸治疗后小颌畸形得以矫治,面型及咬合功能均获得满意的效果。术后经过2年随访,未见复发。结论:牵张成骨技术联合正颌外科治疗成人严重小颌畸形伴重度OSAHS可以获得满意的效果。不仅可有效治疗伴发的OSAHS,而且能很好地矫治小下颌畸形引起的牙颌面畸形。     

Periosteal distraction osteogenesis and barrier membrane application: an experimental study in the rat calvaria

Background: Distraction of the periosteum results in the formation of new bone in the gap between the periosteum and the original bone. We postulate that the use of a barrier membrane would be beneficial for new bone formation in periosteal distraction. Methods: To selectively influence the contribution of the periosteum, a distraction plate with perforations was used alone or covered by a collagen barrier membrane. All animals were subjected to a 7‐day latency period and a 10‐day distraction period with a rate of 0.1 mm/day. Four animals per group with or without a barrier membrane were sacrificed at 2, 4, and 6 weeks after the end of the distraction. The height of new bone generated relative to the areas bound by the parent bone and the periosteum was determined by histomorphometric methods. Results: New bone was found in all groups. At the periphery of the distraction plate, significant differences in bone height were found between the hinge and the distraction screw for the group without barrier membrane at 2 weeks (0.39 ± 0.19 mm) compared to 4 weeks (0.84 ± 0.44 mm; P = 0.002) and 6 weeks (1.06 ± 0.39 mm; P = 0.004). Differences in maximum bone height with and without a barrier membrane were observed laterally to the distraction plate at 2 weeks (1.22 ± 0.64 versus 0.55 ± 0.14 mm; P = 0.019) and 6 weeks (1.61 ± 0.56 versus 0.73 ± 0.33 mm; P = 0.003) of the consolidation period. Conclusion: Within the limitations of the present study, the application of a barrier membrane may be considered beneficial for new bone formation induced by periosteal distraction.