骨填充网袋与球囊椎体后凸成形修复骨质疏松性椎体压缩性骨折

BACKGROUND: It remains controversial about the clinical outcomes of bone filling mesh containers (BFMCs) and percutaneous kyphoplasty (PKP) in pain relief, kyphosis correction, vertebral height restoration and reduction of cement leakage. OBJECTIVE: To compare the clinical outcomes of BFMCs and PKP for osteoporotic vertebral compressive fracture. METHODS: A total of 90 patients with osteoporotic vertebral compressive fracture were equivalently randomized into two groups, followed by treated with BFMCs or PKP, respectively. During a more than 3-month follow-up, pain relief, kyphotic angle, the vertebral height and cement leakage were observed in the two groups to assess the therapeutic effects. RESULTS AND CONCLUSION:Pain in all patients was relieved at 24 hours after operation. There was no significant difference in pain relief between two groups (P > 0.05). PKP was more effective to restore the vertebral height (P < 0.05), while BMCFs significantly reduced the leakage rate of bone cement (P < 0.05). These results suggest that BFMCs and PKP have their own advantages in the treatment of osteoporotic vertebral compressive fracture, but both exert analgesic effects.     

经皮椎体成形使用骨水泥对心血管系统的影响

背景：目前关于经皮椎体成形中注射聚甲基丙烯酸甲酯骨水泥对患者心血管系统及呼吸系统不良反应影响的系统性研究非常有限。 目的：探讨经皮椎体成形中使用聚甲基丙烯酸甲酯骨水泥对患者心血管系统的影响。 方法：回顾性分析2011年7月至2013年9月经皮椎体成形治疗患者的临床资料,共104例167个椎体,根据麻醉记录对局部麻醉前、聚甲基丙烯酸甲酯注射前、聚甲基丙烯酸甲酯注射后0,3,5,10 min 6个时间点的平均动脉压、心率及血氧饱和度进行比较分析。 结果与结论：与聚甲基丙烯酸甲酯注射前相比,聚甲基丙烯酸甲酯注射后0,3,5 min均出现平均动脉压下降,以3 min时最为明显(P < 0.05,P < 0.01),10 min时恢复到注射前水平;同时心率也表现为聚甲基丙烯酸甲酯注射后0,3,5 min时间点明显加快,同样以3 min时最为明显(P < 0.05,P < 0.01),10 min时心率基本恢复到注射前水平。聚甲基丙烯酸甲酯注射前后所有时间点的血氧饱和度均在95%以上,与聚甲基丙烯酸甲酯注射前相比,注射后各时间点的血氧饱和度百分数均无明显变化。表明经皮椎体成形中注入聚甲基丙烯酸甲酯会对患者心血管系统产生一过性的影响。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

磷酸钙骨水泥复合骨形态发生蛋白6和血管内皮生长因子修复骨缺损

背景：单独将骨形态发生蛋白或血管内皮生长因子植入体内易被血液冲刷掉而不能最大限度发挥诱导成骨和血管生成作用,同时缺少载体的支撑作用。 目的：观察骨形态发生蛋白6、血管内皮生长因子及磷酸钙骨水泥联合应用在骨缺损修复过程中的作用。 方法：制作新西兰兔双侧股骨内侧髁骨缺损模型,左侧分别植入磷酸钙骨水泥/骨形态发生蛋白6/血管内皮生长因子、磷酸钙骨水泥/骨形态发生蛋白6及磷酸钙骨水泥,右侧不植入任何物质作为空白对照。植入8,16周通过硬组织切片组织学观察、电镜扫描等手段观察新骨形成情况。 结果与结论：各组材料的组织相容性良好,未见明显炎症组织反应。植入8周时,磷酸钙骨水泥/骨形态发生蛋白6/血管内皮生长因子组骨水泥-骨组织交界处基本上被新生骨小梁包绕,材料进一步降解,新生骨小梁表面可见大量活跃的成骨细胞;16周时,新生骨小梁继续长入,进一步增长、增粗、增多,有大量新生编织骨成网格状长入材料中,骨水泥材料降解明显,与周围组织结合紧密,降解与骨长入同步,此组不同时间点成骨速度及成骨效果均明显优于其他两组材料(P < 0.05)。表明3种材料联合应用可协同促进骨缺损修复。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

骨形态发生蛋白载体材料的研究和应用现状

骨形态发生蛋白用于骨缺损的修复需要有合适的载体,目前已经有多种材料用作BMP的载体,包括生物陶瓷,骨水泥,高分子多聚体,胶原,纤维蛋白凝块,异体骨,异种骨等,这些材料理化性能和生物学性能各不相同,因而与BMP复合后也各具特色,本介绍了不同载体与BMP复合成人体骨的各自性能特点,并回顾了各种载体材料的研究和实际应用现状。     

新型可注射磷酸钙骨水泥在椎体后凸成形术中的生物力学评价

目的 评价一种新型可注射磷酸钙骨水泥(CPC)在椎体后凸成形术中的体外生物力学性能,以探讨该材料能否有效替代聚甲基丙烯酸甲酯骨水泥(PMMA)应用于经皮椎体后凸成形术.方法 取老年尸体共20个胸腰椎新鲜标本(T11～L3),经双能X线吸收骨密度仪测试骨密度后完全随机分为CPC组和PMMA组.在材料试验机上制成椎体压缩骨折模型并测量两组椎体初始的强度和刚度,然后分别用CPC和PMMA两种材料行椎体后凸成形术,再次测量术后两组椎体的强度和刚度.结果 两种骨水泥都具有良好的可注射性,CPC固化后不放热,PMMA固化有明显放热反应,体外工作时间CPC长于PMMA,X线显影效果CPC优于PMMA.椎体后凸成形术后PMMA组椎体最大载荷(4.80±1.957)kN、抗压强度(4.794±1.683)kPa,均较术前明显增加,差异有统计学意义(P＜0.05).刚度高于骨折前,但差异无统计学意义(P＞0.05).CPC组椎体后凸成形术后最大载荷(3.412±1.078)kN、抗压强度(3.477±0.689)kPa,稍高于骨折前,差异无统计学意义(P＞0.05).而刚度(918±201)N/mm,低于骨折前,差异有统计学意义(P＜0.05).结论 新型CPC在椎体后凸成形术中能有效恢复椎体的生物力学性能,可望在椎体后凸成形术中作为PMMA的理想替代材料.     

椎体成形中填充人工骨修复老年椎体压缩性骨折:3个月效果随访CSCD

背景:采用椎体成形治疗骨质疏松性椎体压缩性骨折时,植入的骨水泥不可吸收且强度大于正常骨组织,可引起相邻节段的再骨折。目的:探讨椎体成形中填充复合人工骨治疗老年骨质疏松性胸腰椎骨折的短期效果。方法:纳入骨质疏松性椎体压缩骨折患者21例,其中男7例,女14例,年龄61-93岁,采用椎体成形中填充注射硫酸钙人工骨治疗。治疗前、治疗后0,24,48周进行目测类比评分与Oswestry功能障碍指数评定,应用X射线及CT观察人工骨的填充及渗漏情况。结果与结论:所有患者治疗后目测类比评分与Oswestry功能障碍指数评估均较治疗前明显改善(P<0.01)。X射线及CT复查3例有渗漏,未压迫脊髓及神经,3个月后复查人工骨大部分吸收。表明椎体成形填充复合人工骨能缓解骨质疏松性椎体压缩骨折患者的疼痛症状,改善生活状态。     

聚甲基丙烯酸甲酯骨水泥椎体成形修复老年骨质疏松性椎体压缩骨折

背景：经皮穿刺椎体成形骨水泥注射治疗具有微创、时间短、可有效恢复椎体高度、防止椎体进一步塌陷、止痛效果明显等优点,成为治疗老年骨质疏松性压缩骨折的有效方法。 目的：观察老年骨质疏松性压缩骨折经皮椎体成形骨水泥注射的治疗效果。 方法：纳入62例骨质疏松性胸腰椎压缩骨折患者,其中男22例,女40例,年龄55-92岁,累及86椎体,均在C形臂X射线机透视下行经皮椎体成形聚甲基丙烯酸甲酯骨水泥注射治疗。治疗后随访12-36个月,对比治疗前后的目测类比评分、Cobb角与Oswestry功能障碍指数评分。 结果与结论：治疗后随访12-36个月,11例出现并发症,其中骨水泥渗漏7例,临近椎体骨折2例,骨水泥拖尾1例,疼痛缓解不理想1例;末次随访的Cobb角、目测类比评分、Oswestry功能障碍指数评分均较治疗前显著改善(P < 0.05)。表明椎体成形聚甲基丙烯酸甲酯骨水泥注射治疗老年骨质疏松性压缩骨折,不仅能恢复伤椎外形、减少后凸畸形、重建脊柱稳定性,而且能明显减轻骨折所致疼痛,改善患者生活质量,短中期疗效肯定。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

骨水泥材料在经皮椎体成形中的应用

背景：1987年首次报道经皮椎体成形应用于临床,目前该技术已广泛应用于治疗老年骨质疏松椎体压缩性骨折以及椎体肿瘤并取得良效,但仍有一些问题需关注和探讨。 目的：对国内外骨水泥材料在经皮椎体成形中的临床应用进展进行综述,了解椎体成形的主要理论观点及存在的争议问题。 方法：应用计算机检索2008-01/2011-01 PubMed数据库相关文章,检索词为“vertebroplasty”,并限定文章语言种类为English。同时计算机检索2006-01/2011-01 CNKI数据库相关文章,检索词为“椎体成形”,并限定文章语言种类为中文。共检索到文献725篇,最终纳入符合标准的文献28篇。 结果与结论：经皮椎体成形应用于临床治疗老年骨质疏松椎体压缩性骨折以及椎体肿瘤取得良效,它既可以消除或缓解疼痛症状,又能够加固和强化椎体从而防止进一步塌陷。但如何选择病椎,单侧还是双侧穿刺,经皮椎体成形还是经皮椎体后凸成形,骨水泥的注入时机和注入量,如何避免穿刺损伤以及骨水泥的渗漏等仍需进一步研究。     

重组人骨形态发生蛋白2/骨修复材料的制备与性能

BACKGROUND: It has become a hotspot to prepare the bone repair material that exhibits natural bone structure and is used in combination with biological factors. OBJECTIVE: To prepare the recombinant human bone morphogenetic protein-2 (rhBMP-2)/bone repair material, and to evaluate its capacities of release, activity and ectopic osteoinduction. METHODS: A collagen-binding domain was added to the N-terminal of native rhBMP-2 that allowed bind to collagens in the bone repair material. Then, rhBMP-2/bone repair material was obtained through freeze-dried method. The releasing ability of rhBMP-2 in vitro was assayed by ELISA. C2C12 cell lines were loaded to the composite material with 0.25, 0.5 and 1 µg rhBMP-2, respectively. Afterwards, alkaline phosphatase activity was detected at 72 hours. The composite materials with 0, 2, 5 and 10 µg rhBMP-2 were implanted into the quadriceps of Sprague-Dawley rats, respectively. Alkaline phosphatase activity and the newly formed bone were detected at 2 and 4 weeks after implantation. The CY-7-labeled composite material was implanted into the quadriceps of Sprague-Dawley rats to observe its stability. RESULTS AND CONCLUSION: Substantially no rhBMP-2 from the rhBMP-2/bone repair material was released within 45 days. The alkaline phosphatase activity of C2C12 was in a rise with the increased concentration of rhBMP-2. The stability of the composite material in vivo was better, the alkaline phosphatase activity and ectopic bone formation increased as the concentration of rhBMP-2 rose. To conclude, the rhBMP-2/bone repair material preserves the stability of rhBMP-2, and improves ectopic osteoinduction ability.     

新型可吸收生物玻璃注射体在骨质疏松椎体内支撑及诱导成骨的机制

BACKGROUND: Bioglass has good biocompatibility and biological activity, which can be combined with calcium phosphate bone cement to form an absorbable bioglass that has the advantages of both materials and is expected to have a better use of space. OBJECTIVE: To explore the mechamism of the new type of absorbable bioglass injection for vertebral body supporting and osteogenic induction in osteoporosis rats. METHODS: Twenty-seven female Sprague-Dawley rats were selected to make osteoporosis models by bilateral ovariectomy, and after 1 month, the rats were randomized into three groups. Bone defect models were established in the lumbar L4 segment of all the rats. Rats in the experimental group were subjected to absorbable bioglass injection; rats in the control group 1 underwent polymethylmethacrylate bone cement injection; and rats in the control group 2 were given injectable calcium phosphate. Twelve weeks after implantation, the compressive strength, degradation and osteogenesis of the implant materials were detected, and levels of serum bone morphogenetic protein-2 and transforming growth factor-β were measured. RESULTS AND CONCLUSION: The compressive strength, hydroxyapatite deposition amount, and weight loss ratio in the experimental group were significantly higher than those in the two control groups (P < 0.05); the relative volume, thickness and number of bone trabeculae in the experimental group were significantly higher than those in the control groups (P < 0.05); the bone morphogenetic protein-2 and transforming growth factor-β protein levels in the experimental group were significantly higher than those in the two control groups (P < 0.05). These findings indicate that the new-type absorbable bioglass can greatly strengthen the vertebral body supporting and promote osteogenic effect in osteoporosis by enhancing the bone morphogenetic protein-2 and transforming growth factor-β protein levels.      

Injection biomechanics of bone cements used in vertebroplasty

The incidence of osteoporotic bone fractures is growing exponentially as the western population ages and as life expectancy increases. Vertebroplasty, where acrylic or calcium phosphate cement is injected into the weakened vertebrae to augment them, is an emerging procedure for treating spinal fragility fractures. However, cement injection is currently limited because there are no clear standards for a safe, reproducible and predictable procedure. The purpose of this paper is to examine the role that bone cements play in the underlying bio-mechanisms that affect the outcomes of cement injection. Our most important finding after combining clinical, laboratory and theoretical research is that the process of cement injection poses conflicting demands on bone cements. The cements are required to be more viscous and less viscous at the same time. The challenge therefore is to develop biomaterials, techniques and/or devices that can overcome or manage the conflicting demands on cement viscosity.     

骨形态发生蛋白2和7共转染骨髓间充质干细胞的成骨分化

背景：骨形态发生蛋白最主要的作用是诱导骨形成,但因提取困难、代谢速度快、难以准确控制其使用浓度、价格昂贵等限制了其在体外和体内相关研究中的应用。 目的：构建含特异细胞生长因子基因骨形态发生蛋白2,7的腺病毒载体,观察骨形态发生蛋白2和骨形态发生蛋白7基因共转染对兔骨髓间充质干细胞成骨分化的促进作用。 方法：将全骨髓贴壁法分离得到兔骨髓间充质干细胞传至第3代,分为5组,空白组和常规诱导组分别以常规培养基和成骨诱导分化培养基培养;骨形态发生蛋白2, 7腺病毒转染组：分别单独以骨形态发生蛋白2、骨形态发生蛋白7腺病毒进行转染;联合转染组：以2种骨形态发生蛋白腺病毒联合转染。 结果与结论：转染第7天,联合转染组成骨相关基因Runx-2、Osx、Ⅰ型胶原和碱性磷酸酶mRNA表达均较其他各组增高(P < 0.05);骨形态发生蛋白2,7腺病毒转染组上述指标较空白组和常规诱导组增高(P < 0.05)。转染第14天,联合转染组4个指标均较其他各组明显增高(P < 0.05);同时,4个指标表达均高于第7天(P < 0.05)。病毒转染后第7天,联合转染组Ⅰ型胶原和骨钙素蛋白表达均较其他组明显增高(P < 0.05)。提示对骨髓间充质干细胞进行骨形态发生蛋白2腺病毒和骨形态发生蛋白7腺病毒共转染后,较单基因转染和成骨诱导液诱导更能促进成骨相关基因和蛋白的表达。     

负载转基因成肌细胞和骨形态发生蛋白组织工程化骨修复骨缺损

背景：近年来有报道提出了睫状神经营养因子能够抑制成肌细胞体外成肌分化,可保持成肌细胞去分化状态的理论。两者可通过基因工程技术结合为组织工程化骨的构建提供种子细胞,联合骨形态发生蛋白在一定条件下促进骨缺损的修复。 目的：探讨转染睫状神经营养因子基因成肌细胞与骨形态发生蛋白通过透明质酸钠凝胶载体结合修复兔桡骨节段性缺损的效果。 方法：新西兰大白兔制备左侧桡骨中段造成1.0 cm的节段性骨缺损,缺损处以1.4 cm硅胶管桥接固定,管内植入负载骨形态发生蛋白与转睫状神经营养因子基因成肌细胞的透明质酸凝胶(实验组)、仅复合骨形态发生蛋白的透明质酸凝胶(对照组)或仅植入透明质酸凝胶(空白组)。 结果与结论：动物体内实验表明实验组的X射线阻射密度、大体标本以及病理组织学观察情况均优于对照组和空白组,对照组也优于空白组。说明应用透明质酸钠凝胶复合转基因成肌细胞和骨形态发生蛋白因子作为膜内填充物构建组织工程化骨具有可行性,其应用于修复兔桡骨节段性缺损效果理想。     

经骨形态发生蛋白7成骨预处理聚乳酸三维支架的体外培养

BACKGROUND: To improve the cell affinity of polylactic acid, the three-dimensional polylactic acid scaffold is made after pretreatment with bone morphogenetic protein 7 (BMP7). OBJECTIVE: To evaluate the compatibility of BMP7-pretreated three-dimensional polylactic acid scaffold with  periosteum-derived cells.  METHODS: Passage 3 human periosteum-derived cells undergoing osteogenic induction at a density of 1×109/L were seeded into culture media containing the three-dimensional polylactic acid scaffold (experimental group) or seeded into simple culture media (control group). In the experimental group, the scaffold was pretreated with BMP7 for 24 hours. At 1, 3, 5, 7, 9, 11 days after culture, cell counting kit-8 method was used to measure cellular proliferation; at 3, 6, 9, 12 days, the cell-scaffold complex was observed under an electron microscope. RESULTS AND CONCLUSION: In the two groups, the cells had an S-shaped growth curve. Compared with the control group, the cell proliferation in the experimental group was faster at the logarithmic phase, but slower at the stationary phase (P < 0.05). Under the transmission electron microscope, in the experimental group, the number of adherent cells was increased gradually, and the cells grew well with exuberant organelles at 3-6 days of co-culture, but cell aging and apoptosis were found at 9 days of co-culture. Under the scanning electron microscope, in the experimental group, the number of adherent cells on the scaffold surface gradually increased at 3-9 days of co-culture, and then cell apoptosis was notable at 12 days. These findings indicate that BMP7-pretreated three-dimensional polylactic acid scaffold has good cytocompatibility, and the optimal in vitro co-culture duration is 1 week.     

骨形态发生蛋白2抑制骨髓间充质干细胞成脂分化的优选浓度

BACKGROUND:Bone morphogenetic protein 2 cannot only promote osteogenesis, but also at different concentration ranges regulate the differentiation of bone marrow mesenchymal stem cells into adipocytes. Therefore, it is very important for the prevention and treatment of osteoporosis, if the range of concentrations of bone morphogenetic protein 2 can be found to regulate the differentiation of bone marrow mesenchymal stem cells into adipocytes, after the induction of bone marrow mesenchymal stem cells. OBJECTIVE:To determine the optimal concentration of bone morphogenetic protein 2 to inhibit the differentiation of bone marrow mesenchymal stem cells into adipocytes. METHODS:Bone marrow samples were obtained from the femur and tibia of rats. Primary cultured bone marrow mesenchymal stem cells were obtained by adherent culture method in vitro. Flow cytometry was used to identify the surface antigens of passage 2 bone marrow mesenchymal stem cells. Cells at passages 2 and 3 were taken and cultured in adipogenic induction medium for 3 days followed by the addition of 0.5, 5, 50, 100, 200 μg/L bone morphogenetic protein 2, or culture medium of bone marrow mesenchymal stem cells (control group), respectively. RESULTS AND CONCLUSION: Bone marrow mesenchymal stem cells cultured were identified by the flow cytometry. Oil red O staining results showed that the increasing number of lipid droplets was shown in bone marrow mesenchymal stem cells induced by bone morphogenetic protein 2 under the increasing concentration of 0.5 to 50 μg/L; while the number of lipid droplets in bone marrow mesenchymal stem cells decreased after 17 days of induction with bone morphogenetic protein 2 under the concentration of 100 to 200 μg/L. These findings indicate that 100 μg/L bone morphogenetic protein 2 can inhibit adipogenic differentiation of bone marrow mesenchymal stem cell, so as to reduce the formation of adipocytes in rats. Therefore, 100 μg/L bone morphogenetic protein 2 is better to inhibit adipogenic differentiation of bone marrow mesenchymal stem cells.     

骨形态发生蛋白4和骨形态发生蛋白4/7基因转染对骨髓基质干细胞成骨活性差异的比较

背景：有文献报道骨形态发生蛋白(bone morphogenetic proteins,BMPs)异源二聚体比同源二聚体的活性高,目前国内外尚无BMP-4/7异源二聚体与BMP-4同源二聚体间诱导成骨活性比较的报道。 目的：观察不同基因BMP-4、BMP-4/7对骨髓基质干细胞(bone marrow mesenchymal stem cells,BMSCs)成骨活性的差异,探讨融合基因BMP-4/7的生物学活性。 方法：经脂质体转染分离培养的兔BMSCs,G418筛选出稳定表达株,利用RT-PCR法证明目的基因在BMSCs中的表达情况;以BMP-4和BMP4/7融合基因修饰的AAV载体,转染兔BMSCs,MTT法检测不同基因转染细胞的增殖能力;以BMP-4单基因和BMP-4/7融合基因修饰的AAV载体转染兔BMSCs 7 d后,测定两组细胞内碱性磷酸酶及骨钙素水平,观察成骨活性的变化。 结果与结论：实验成功构建高滴度的分别携带BMP-4单基因、BMP-4/7融合基因的重组腺相关病毒载体AAV-BMP-4、AAV-BMP-4/7;RT-PCR结果证明目的基因能够在BMSCs中得到稳定表达。AAV-BMP-4及AAV-BMP-4/7载体转染效率分别为68.20%、72.18%;转染BMSCs后,细胞增殖能力均明显提高,BMP-4/7融合基因的细胞增殖能力活性高于BMP-4单基因。以BMP-4和BMP-4/7融合基因修饰的AAV转染细胞7 d后,细胞内碱性磷酸酶活性明显上调,骨钙素水平升高,成骨活性均增强;两种基因比较,BMP-4/7融合基因成骨活性强于BMP-4单基因(P < 0.01)。提示BMP-4、BMP-4/7修饰的AAV载体转染效率高,对BMSCs均有成骨活性,其中BMP-4/7融合基因成骨活性强于BMP-4单基因。