Experimental study of effect of stress-relaxation bone plate on fracture healing

ＩＤｅｐａｒｔｍｅｎｔｏｆＯｒｔｈｏｐａｅｄｉｃｓ ,ＳｉｘｔｈＰｅｏｐｌｅ ｓＨｏｓｐｉｔａｌ,Ｓｈａｎｇｈａｉ 2 0 0 2 33 ,Ｃｈｉｎａ (ＺｈａｎｇＸＬａｎｄＺｈａｎｇＷ)ＤｅｐａｒｔｍｅｎｔｏｆＯｒｔｈｏｐａｅｄｉｃｓ ,ＳｈａｎｇｈａｉＮｉｎｔｈＰｅｏｐｌｅ ｓＨｏｓｐｉｔａｌ,ＳｈａｎｇｈａｉＳｅｃｏｎｄＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｓｈａｎｇｈａｉ2 0 0 0 11,Ｃｈｉｎａ (ＤａｉＫＲ)ＴｈｉｓｓｔｕｄｙｗａｓｓｕｐｐｏｒｔｅｄｂｙｔｈｅｇｒａｎｔｓｆｒｏｍｔｈｅＮａｔｉｏｎａｌＮａｔｕｒａｌＳ…     

No effect of Osteoset,a bone graft substitute,on bone healing in humans: a prospective randomized double-blind study

We studied the effects of a newly marketed bone substitute, Osteoset, on bone healing in a tibial defect in humans. 20 patients undergoing an ACL (anterior cruciate ligament) reconstruction with bone-patella tendon-bone graft were block-randomized into 2 groups of 10 each. In the treatment group, the tibial defect was filled manually with Osteoset pellets, in the control group the defect was left empty. CTs of the defect were taken on the first day after the operation, 6 weeks, 3 and 6 months postoperatively. We found about the same amount of bone in the defect in the Osteoset and control groups after 6 weeks, 3, and 6 months. In the control group, but not in the Osteoset group, the bone volume increased from 6 weeks to 3 months. The Osteoset pellets were almost resorbed after 6 weeks.     

人工虎骨粉对大鼠骨折愈合的影响

目的研究人工虎骨粉对大鼠骨折愈合的影响。方法 SPF级成年健康SD大鼠72只,麻醉状态下制作右侧胫中段骨折模型,模型制作完成后随机分为实验组和对照组,实验组术后每日灌服人工虎骨粉混悬液,对照组每日灌服蒸馏水。术后2周、4周、2月、3月分别进行影像学观察和组织学观察,术后2月、3月分别进行骨折侧生物力学测量、健侧生物力学测量,并计算骨折生物力学恢复率。结果影像学检查:术后4周,实验组骨痂形成较对照组更广泛、明显;术后2月,实验组皮质骨形成较对照组多。组织学观察:术后2周,实验组骨痂中软骨细胞较对照组明显多;术后4周,实验组骨小梁数量较多,骨痂改建较好;术后2月,实验组骨折处皮质层较厚度对照组大。生物力学测量:术后2月,骨折侧生物力学和骨折生物力学恢复率对照组分别为2.28±0.41N、40.94±10.55%,实验组分别为3.29±0.68N(P<0.05)、58.85±11.22%(P<0.05);术后3月,骨折侧生物力学和骨折生物力学恢复率对照组分别为2.67±0.52N、47.17±13.78%,实验组分别为4.14±0.47N(P<0.05)(P<0.05)、62.19±13.45%(P<0.05)。结论人工虎骨粉具有明显的促进骨折愈合作用,并可有效提高正常骨生物力学强度。     

掺锶硫酸钙及DBM复合材料骨修复能力评价

[目的]制备一种掺锶硫酸钙与DBM复合的骨修复材料,为临床提供一种成骨活性优良的骨修复材料。[方法]制备掺锶硫酸钙与DBM复合的活性骨修复材料,其中锶元素的量为钙含量的6%,掺锶硫酸钙与DBM按体积比1∶1复合。观察兔股骨髁骨缺损模型修复效果,利用X线片观察缺损区域的新骨形成情况,采用MicroCT评价局部的骨量和骨质变化,对组织切片予以Van Gieson(VG)复合染色法染色进行组织形态学观察,荧光双标观测计算成骨速率。[结果]术后动物无死亡,所有兔子切口无渗血或出现分泌物状况,术后活动正常。从MicroCT的BV/TV结果看出实验组在12周时缺损区域已经恢复;掺锶CaSO_4复合材料组缺损部位已经基本修复,CaSO_4组未完全修复。VG组织学观察显示各组均有新生骨小梁生成,荧光双标观测得到的矿化沉积率显示复合材料组新骨生长突出,矿化沉积率为(2.31±0.13)μm/d。[结论]通过MicroCT、VG组织学染色以及荧光双标观测对兔子股骨髁缺损修复效果进行评价,发现复合材料具有较好的骨缺损修复能力。     

Osseous healing with a composite of allograft and demineralized bone matrix: adverse effects of smoking

We report on our use of a composite graft of lyophilized cancellous allogenic chips and demineralized bone matrix (DBM; Grafton; Osteotech, Eatontown, NJ) to manage traumatic osseous defects and nonunions. Data were prospectively collected from all patients who received this composite bone graft between 1996 and 2000. Only acute fractures with bone loss resulting in a uncontained defect and atrophic non-unions were included in the present study. Demographic data and complications related to composite use, tobacco use, and other comorbidities that could affect healing were evaluated. One hundred seven patients (112 bone graft sites) were followed up for a mean of 32 months (range, 12-60 months). Graft sites included the forearm, femur and tibia. Of the 112 patients, there were 56 smokers (25 non-unions and 31 fractures) and 56 non-smokers (28 fractures and 28 non-unions). Healing occured in 38/56 smokers compared with 49/56 non-smokers. In failed cases, smoking was characteristic in 7/9 non-unions and 11/16 fractures. There were 26 acute uncontained injuries, 29 acute contained defects, and 67 nonunions. Grafting sites were radius/ulna (13 cases), humerus (17), femur (31), and tibia/fibula (51). Significant comorbidities were diabetes mellitus (4 cases), fungal osteomyelitis (1), and pulmonary alveolar proteinosis (1). Eight (73%) of the 11 patients with graft failure had a significant smoking history. This composite graft is an option for managing osseous defects and nonunions traditionally treated with autologous bone grafting but should be used with caution when treating patients who are smokers.     

黄骨髓对兔骨折愈合影响的实验研究

[目的]研究自体黄骨髓一期移植对骨折愈合作用的实验疗效,观察黄骨髓是否具有成骨能力,为进一步临床应用提供理论依据。[方法]36只新西兰大白兔随机分为3组,建立左侧胫骨骨折延迟愈合模型,A组仅以钢板内固定;B组钢板内固定后,植入空白明胶海绵,C组钢板内固定后,植入黄骨髓与明胶海绵复合物。术后每组分别于2、4、8、12周各处死3只动物,进行影像学检测、大体观察及HE染色检查,观察骨折愈合情况及骨痂形成情况。[结果]A组及B组在术后4周只可见少量骨痂形成,而C组在术后2周即可见骨痂形成,术后4周可见大量骨痂形成,至术后8周C组骨折线消失,而A、B组骨折线仍可见;术后12周,A、B组仍可见骨折线存在。[结论]黄骨髓在骨折后能明显促进骨折愈合,在预防骨不连或骨折延迟愈合中具有重要作用。     

双膦酸盐与骨折愈合和非典型性骨折

典型的骨折愈合过程包括血肿和炎症反应、原始软骨痂形成、成熟板层骨形成以及骨板重建和塑形等四个时期。骨重建包括骨吸收和骨形成两个方面。软骨痂和硬骨痂重建对骨折愈合具有重要意义。双膦酸盐类药理基础在于抑制破骨细胞活性和骨转化水平,通过干预骨重建对骨折愈合产生影响。长期使用双膦酸盐不利于骨折愈合,有引起股骨非典型性骨折发生的危险。     

The effect of vitamin D and bisphosphonate on fracture healing: An experimental study

BackgroundThe aim of the study was to evaluate the effects of the using bisphosphonate, vitamin D, and a combination of bisphosphonate and vitamin D on fracture healing, by comparison of radiological and histological findings of the study groups and a control group.MethodsA total of 24 rats were randomly divided into 4 groups. A mid-third fracture was created in the femur of all rats. Saline was administered to Group A, bisphosphonate (Alendronate) to Group B, bisphosphonate (Alendronate) + vitamin D (Calcitriol) to Group C and vitamin D (Calcitriol) to Group D. All preparations were administered orally for 28 days.ResultsNo statistically significant difference was determined between the groups in respect of the effect on fracture healing according to radiological findings. The histological findings of fracture healing showed Groups B and C to be significantly more advanced than Group A (p = 0.017, p = 0.009). However no significant difference was found in Group D comparison with Group A (p = 0.224).ConclusionAccording to the histological findings, advanced fracture healing was seen in the groups administered with bisphosphonate or combined bisphosphonate and vitamin D compared to the use of vitamin D alone and the control group. It was concluded that bisphosphonate treatment combined with vitamin D can be used safely without any negative effect on fracture healing.     

Metabolic measurement techniques to assess bone fracture healing: a preliminary study

The purpose of this study was to project the effectiveness of using positron emission tomography for evaluation of fracture healing using the analogous method of liquid scintillation. A reproducible comminuted fracture model in rabbit femurs was stabilized with external fixation. Thirty-nine rabbits were divided into four groups: Group A had slight distraction, Group B had shortening, Group C had a bone defect, and Group D was the sham control group. At 2 and 4 weeks after fracture, the femurs had liquid scintillation measurements using 2-[14C]-deoxyglucose (2DG C-14). Glucose uptake was significantly elevated in the experimental limb relative to the contralateral control femurs at both times. The distraction group showed a significant decrease in uptake from 2-4 weeks. There was a high correlation between the liquid scintillation measurements and the radiographic fracture healing scores, with higher levels of 2DG C-14 uptake corresponding to lower levels of fracture healing calcification. The high correlation found between 2DG C-14 uptake and radiographic scores suggests that positron emission tomography used in conjunction with a glucose-based radiopharmaceutical such as 2-[18F]fluoro-2-deoxyglucose can monitor the fracture healing process effectively.     

No effect of Osteoset ® , a bone graft substitute, on bone healing in humans: A prospective randomized double-blind study

We studied the effects of a newly marketed bone substitute, Osteoset, on bone healing in a tibial defect in humans. 20 patients undergoing an ACL (anterior cruciate ligament) reconstruction with bone-patella tendon-bone graft were block-randomized into 2 groups of 10 each. In the treatment group, the tibial defect was filled manually with Osteoset pellets, in the control group the defect was left empty. CTs of the defect were taken on the first day after the operation, 6 weeks, 3 and 6 months postoperatively. We found about the same amount of bone in the defect in the Osteoset and control groups after 6 weeks, 3, and 6 months. In the control group, but not in the Osteoset group, the bone volume increased from 6 weeks to 3 months. The Osteoset pellets were almost resorbed after 6 weeks.     

雷奈酸锶对大鼠骨质疏松性骨折愈合的骨密度及骨微结构影响

目的 观察雷奈酸锶对大鼠胫骨骨质疏松性骨折愈合过程中的骨密度、骨微结构及愈合后生物力学特性的影响.方法 72只雌性SD大鼠卵巢去势制造骨质疏松模型,造模成功后制造开放性骨折并予克氏针内固定.术后分为对照组和治疗组,分别给予生理盐水和雷奈酸锶625mg/( kg·d)灌胃给药.结果 在治疗后6、8w时两组骨性愈合率并无明显差异,但Micro CT检验数据结果显示治疗组骨密度(BMD);骨小梁体积(BV)、组织体积(TV)、骨体积分数(BV/TV)、平均骨小梁厚度(Tb.Th)、平均骨小梁数目(Tb.N)均明显高于对照组(P＜0.05),且治疗组最大压缩荷载在治疗后4w(48.1±:5.6(治疗组)vs 21.8±4.8(对照组))、8w时亦明显高于对照组(96.5±9.7(治疗组)vs68.2±7.4(对照组)).结论 雷奈酸锶能够抑制骨折后的骨量丢失,增加骨密度,促进骨折愈伤组织的生长,改善骨小梁三维结构及骨组织的力学性能,可用来促进骨质疏松性骨折的愈合并改善骨质量,预防再骨折.     

The effect of a brain lesion on bone healing

Using a feline model, the effects of stereotaxic brain lesions producing unilateral spasticity on bilateral fibular osteotomies were observed. Healing in spastic limbs occurred with more new bone formation than on the contralateral (control) side. Union appeared to be slightly faster in spastic limbs. Histomorphometric analysis of resected fibular specimens following union revealed little difference between spastic and non-spastic limbs. When these brain-lesioned animals were compared with a group with identical osteotomies but no brain lesions in respect of various systemic biochemical and endocrine parameters, no differences were found.     

The effect of local administration of phenytoin on fracture healing: an experimental study

The antiepileptic drug phenytoin (Diphenylhydantoin) has been documented to have a beneficial effect on wound healing; its effect on fracture healing, however is still unclear. In an attempt to evaluate any potential benefits phenytoin may have on fracture healing, a prospective study was undertaken combining histology, histomorphometry and radiology, in which the effects of locally administered phenytoin were analysed. Twenty-four Wistar strain rats of 8-9 months age were assigned into two groups of 12 each (matched for age, sex and weight). In the study group, phenytoin 20 mg/kg was administered through a 24 gauge needle directly on to the fracture site every 72 hours, while in the control group an equivalent volume of normal saline was administered at similar intervals. At 28 days radiographic and histological analysis was done, the scoring for which did not show any statistical difference between the control and test animals. Histomorphometric analysis of the callus however, showed that the total periosteal callus on either side of the central bridging callus was mineralised to a greater extent in the phenytoin group animals as compared to the control group animals (p = 0.011). After analysing our data, we concluded that phenytoin does have an influence in fracture healing, albeit small, which is primarily on the hard callus region. The hard callus region is the high oxygen tension region and the first region to differentiate. It appears that the effect of phenytoin is probably exerted at the early mesenchymal differentiation stage. However our preliminary work shows that the effect is small and it is not justifiable at this stage to advocate the use of phenytoin clinically to augment fracture healing.     

新型硫酸钙和脱钙骨基质混合物的临床应用

目的 评价新型硫酸钙和脱钙骨基质混合物作为骨移植替代物的临床应用效果. 方法 2005年2月至2008年2月采用新型人工骨移植治疗51例患者,按照植入物不同分为两组:人工骨与自体骨混合组21例,即植人硫酸钙和脱钙骨基质混合物加自体骨;单纯人工骨组30例,只植入硫酸钙和脱钙骨基质混合物.术后定期复查,观察人工骨吸收和新骨生长情况. 结果 51例切口一期愈合,无局部红肿、渗出.3例患者失访,48例随访6～36个月,平均16个月.单纯人工骨组术后4周可见人工骨部分吸收,颗粒形态模糊,术后8～12周(平均9.6周)完伞吸收,可见新生骨质,术后8～16周(平均11周)骨性愈合.人工骨与自体骨混和组术后8～12周(平均11.5周)人工骨颗粒完全吸收,骨折不愈合患者术后14～24周(平均19周)获骨性愈合,其余患者术后9～20周(平均13周)获骨性愈合. 结论 新型人工骨能够发挥增加移植物容量、促进骨生成的作用,无局部不良反应,是一种安全有效的骨移植替代物.     

The effect of a composite of polyorthoester and demineralized bone on the healing of large segmental defects of the radius in rats.

The effect of a composite of demineralized bone mixed with polyorthoester on the healing of large segmental defects in the rat radius was studied. Sixty male Wistar rats were divided into four groups, A through D, and an osteoperiosteal diaphyseal defect of 50 per cent of the length of the bone was made in the right radius of each rat. In Group A, the defect was filled with polyorthoester and demineralized bone; in Group B, demineralized bone; and in Group C, polyorthoester. No material was implanted in the defects in the Group-D rats. The rats were killed fifty days postoperatively. The formation of bone in the defects was quantified with computer-assisted measurements of the area on radiographs. The host-tissue response was evaluated with light microscopy. Defects that had been filled with the composite of polyorthoester and demineralized bone or with demineralized bone alone showed regeneration of bone corresponding to 93.6 and 77.6 per cent of the area of the defect, respectively. Defects that had no implant or that had been filled with polyorthoester alone showed significantly less formation of bone. No inflammation was seen with light microscopy, and only traces of the polyorthoester could be detected in the defects that had been filled with the composite or with polyorthoester alone.     

人工骨和自体骨在复杂跟骨骨折异形钢板内固定术中的病例对照研究

目的 :比较人工骨与自体骨在复杂跟骨骨折异形钢板内固定术中的临床疗效。方法:自2015年4月至2019年4月收治60例复杂跟骨骨折患者行切开复位异形钢板内固定术治疗,按照植骨材料不同分为试验组和对照组,每组30例。试验组男21例,女9例;年龄18～71(36.85±7.42)岁;SandersⅢ型19例,SandersⅣ型11例;采用人工骨植入。对照组男23例,女7例,年龄20～69(37.26±7.38)岁;SandersⅢ型18例,SandersⅣ型12例;采用自体骨植入。比较两组患者手术时间、术中出血量、术后切口干燥时间、愈合时间及并发症情况,比较术前及术后3个月B?hler角及Gissane角变化情况,采用Maryland评分评价患足功能恢复情况。结果:两组患者术后均获得随访,时间3～15(10.15±2.67)个月。试验组手术时间、术中出血量分别为(89.32±12.43) min、(101.64±5.13) ml,对照组分别为(112.45±13.82) min、(119.01±5.26) ml,两组比较差异有统计学意义(P0.05);两组术后切口干燥时间、愈合时间、并发症比较差异无统计学意义(P0.05)。试验组术前、术后3个月B?hler角分别为(14.19±2.47)°、(34.52±4.41)°,对照组分别为(14.08±2.35)°、(33.67±4.36)°;试验组术前及术后3个月Gissane角分别为(90.16±6.43)°、(131.45±9.83)°,对照组分别为(90.11±6.37)°、(130.87±9.24)°;两组术后3个月B?hler角、Gissane角与术前比较差异有统计学意义(P0.05);但两组术后3个月B?hler角、Gissane角比较差异无统计学意义(P0.05)。末次随访时,两组Maryland评分各项目评分、总分及优良率比较差异无统计学意义(P0.05)。结论:在复杂跟骨骨折异形钢板内固定术中,采用人工骨和自体骨在促进骨折恢复方面效果相当,且术后切口干燥时间、愈合时间及并发症发生情况相近,但使用人工骨可减少术中出血量,缩短手术时间。     

The effect of methylmethacrylate on fracture healing.

Fractures were created in the femur of dogs by dividing the midshaft with an airdriven saw. Immobilization was achieved with a four-hole compression plate. No methylmethacrylate supplementation was used in the control groups. In the three experimental groups methylmethacrylate was added to the internal fixation by placing it on the endosteal, periosteal, and both surfaces of the bone. Healing of the fractures uniformly failed to occur when methylmethacrylate was apposed to both periosteal and endosteal regions. Histologic, fluorescent, and autoradiographic studies indicated that the bone surface in contact with methylmethacrylate was necrotic and did not incorporate tetracycline or Ca-45. New bone occurred only on the surface which was not in contact with methylmethacrylate.