Hydroxyapatite and carbon coatings for fixation of unloaded titanium implants

The aim of this study was to investigate the interaction between bone and pure titanium, titanium coated with hydroxyapatite (HA), and titanium coated with carbon in a rat femur model. In 25 rats, the medullary cavity of both femurs was entered by an awl from the trochanteric area. With steel burrs it was successively reamed to a diameter of 2.0 mm. Nails with a diameter of 2.0 mm and with a length of 34 mm were inserted in a random manner; either a pure titanium nail, a titanium nail entirely plasma-sprayed with a 75-100-microm layer of HA or a titanium nail coated with 2-10-microm carbon. The surface roughness of the pure titanium was characterized by Ra 2.6 microm and Rt 22 microm. Ra of HA was 7.5 microm and Rt 52 microm, and of carbon Ra was 0.4 microm and Rt 4.0 microm. Twelve rats were randomized to a follow up of 8 weeks, and the remaining 13 rats were followed for 16 weeks. At sacrifice both femora were dissected free from soft tissues and then immersed in fixative. A specimen slice of about 5 mm thickness was prepared from the subtrochanteric region with a water-cooled band-saw. Sample preparation for un-decalcified tissue followed the internal guidelines at the laboratories of Biomaterials/Handicap Research. At 8 weeks the median bone bonding contact of the implants was 43% (range 0-74) in the titanium group, 39% (0-75) in the HA group, and 3% (0-59) in the carbon group. At 16 weeks the corresponding figures were 58% (0-78) in the titanium group, 51% (15-75) in the HA group, and 8% (0-79) in the carbon group. In conclusion, we found great variability in bone bonding contact. In general, carbon-coated nails had reduced bone bonding contact both at 8 and at 16 weeks as compared to pure titanium or titanium coated with hydroxyapatite.     

Bone ingrowths to press-fit and loose-fit implants: comparisons between titanium and hydroxyapatite

The aim of this study was to investigate whether the coating of titanium (Ti) implants with hydroxyapatite (HA) might create a better fixation when titanium implants are implanted into a gap. In each of 16 rats, the medullary cavity of both femurs was entered by an awl from the trochanteric area. With steel burrs it was successively reamed to a diameter of 1.5 mm. In a random manner the proximal part of the cavity in half of the bones was reamed once again to a diameter of 2.0 mm. Nails with a diameter of 1.5 mm and a length of 34 mm were then inserted into the medullary cavity of these bones with press fit at the distal half and a gap to the bone in the proximal half. In the remaining bones the whole medullary canal was reamed to a diameter of 2.0 mm, and nails with a diameter of 2.0 mm and a length of 34 mm were introduced. In all cases, either a pure Ti nail or a Ti nail entirely plasma sprayed with HA was used in a random manner. The surface roughness of the pure Ti was characterized by Ra 2.6 microm and Rt 22 microm. Ra of HA was 7.5 microm and Rt 52 microm. At sacrifice after 16 weeks, both femurs were dissected free from soft tissues and then immersed in fixative. A specimen slice of about 5 mm in thickness was prepared from the subtrochanteric region with a water-cooled band saw. Sample preparation for undecalcified tissue followed the internal guidelines at the laboratories of the Department of Biomaterials/Handicap Research. Generally, bone contact to the nails with HA coating was more predictable than was bone contact to the Ti nails. But due to rather large variations in bone contact between the samples, statistical analyses revealed non-significant differences between the 4 groups (p = 0.083). There were no significant differences between Ti and HA coated nails of 2.0 mm (p = 0.633), nor between Ti and HA coated nails of 1.5 mm (p = 0.924). The pooled values for the 2.0 mm nails showed significantly higher bone bonding contact than the pooled values of the 1.5 mm nails (p = 0.011). Our results, then, indicate that bone bonding contact to implants with a loose fit insertion is less predictable than in press fit insertion, and HA coating seemed to be more predictable than pure Ti. However, due to large variations between the samples, the differences did not reach significant levels.     

仿生电活性涂层钛植入材料促进骨结合的实验研究

目的评价仿生电活性钛酸钡(BaTiO3,BTO)/聚偏氟乙烯-三氟乙烯P(VDF-TrFE)涂层钛植入材料促进骨结合性能的效果。方法首先将直径为2 mm、长度为5 mm的医用纯钛圆柱进行表面喷砂-酸蚀处理,然后将BaTiO3/P(VDF-TrFE)溶液均匀涂覆在钛柱表面。待烘干后对涂层表面进行电晕极化处理。采用扫描电镜、能谱分析、原子力显微镜、水接触角测量仪分别对材料表面形貌、元素组成、表面粗糙度和亲疏水性进行表征检测,PLLA涂层钛柱作为对照材料。选取实验兔4只,在双侧胫骨位置各制备3个间隔为1 cm的圆形缺损,在左侧胫骨植入PLLA涂层钛柱,右侧胫骨植入仿生电活性涂层钛柱,术后4周和12周分别取材进行硬组织的骨形态检测分析。采用SPSS15.0软件对数据进行统计分析。结果理化性能表征检测显示,BaTiO3/P(VDF-TrFE)涂层和PLLA涂层均匀附着在钛柱表面,涂层厚度约50μm,且表面结构致密。电活性涂层可见钛酸钡纳米颗粒均匀分布在P(VDF-TrFE)基体内。两种涂层表面的粗糙度和水接触角无明显差异。电活性涂层具有稳定的压电性能,且压电常数接近生理量级。动物实验显示,术后4周,仿生电活性涂层材料表面和新骨结合紧密,涂层材料稳定无降解;而PLLA涂层材料表面由于材料有部分降解导致新骨结合较差,电活性涂层的骨结合率明显高于PLLA涂层。术后12周,两组的新骨成熟程度均增加,骨陷窝明显,仿生电活性涂层仍然保持稳定状态;而PLLA涂层进一步发生降解,和新骨结合程度弱于电活性涂层组。结论仿生电活性BaTiO3/P(VDF-TrFE)涂层钛可能作为一种具有促进骨整合功能的种植体涂层材料。     

Morphometric examination of straight, tapered titanium stems: a retrieval study.

Cementless straight, tapered rectangular cross section titanium stems have been used by the senior author since 1979. Thirty-four stems retrieved postmortem, after between 10 days and 15.2 years in situ, were studied morphometrically and histologically. Nineteen stems were first generation (1979-1986), with an incomplete sagittal taper and a mean surface roughness of 1 microm (Ra 1.23 +/- 0.3 microm); 15 stems were second generation after 1986, with a full biplane taper and a mean surface roughness of 4 microm (Ra 4.14 +/- 0.36 microm). Implant surface bony coverage was determined morphometrically in 10 segments of the stems, and expressed as a bone implant contact index. Histologically, there were no differences between implants with different levels of roughness. Morphometrically, the first-generation stems showed significant differences in coverage (distal > proximal); second-generation stems had a more uniform pattern. Stems retrieved early after arthroplasty had a mean bone implant contact index of 10%. The mean bone implant contact index showed attainment of maximum coverage by 5 years after arthroplasty, without additional apposition or loss thereafter. Patients younger than 65 years at arthroplasty had similar bone implant contact indices to patients 65 years or older; coverage in the six patients 80 years of age at retrieval did not differ from the rates in the other patients. Morphometry was able to provide objective evidence of design change effects. No differences in coverage were found in terms of times in situ, patient age at arthroplasty and at retrieval, and degree of stem surface roughness.     

Comparative in vitro analysis of vacuum plasma-sprayed titanium implants--evaluation of OPG, Osteokalzin and AP expression

INTRODUCTION: The purpose of this study was to evaluate the influence of different surface topographies on the expression of bone cell-associated proteins, such as osteoprotegerin (OPG), osteocalcin and alkaline phosphatase (AP), and the production of the extracellular matrix (ECM) in vitro. Another aspect was the question as to whether a hydroxyapatite (HA) coating offers additional advantages. Vacuum plasma-sprayed (VPS) pure titanium was used to generate different surface topographies. MATERIALS AND METHODS: The in vitro response of human bone marrow cells to VPS implants (porosity ranging from 25 to 50%, pore size ranging from 50 to 200 microm and roughness ranging from 0.191 to 0.547 mm) and cancellous structured titanium (cs-Ti) as a reference material (55% porosity, pore size of 500 microm, roughness 0.836 mm) were compared. The expression of bone cell-associated proteins, such as OPG, osteocalcin and alkaline phosphatase (AP), was evaluated. Scanning electron microscopy (SEM) was used to judge the production of ECM. RESULTS: All implant materials induced the release of OPG, osteocalcin and AP. Significant differences were evident between the cs-Ti and the different VPS-Ti surface structures. There was no difference in the response between the VPS-Ti surfaces. SEM showed a dense and increased production of ECM on the VPS-Ti surfaces. An additional HA coating caused a faster production of ECM and higher levels of OPG. CONCLUSIONS: The in vitro data presented here demonstrate the superiority of VPS-Ti surfaces over cs-Ti, which is already in clinical use. Differences between the VPS-Ti surfaces were not evident. Presumably, VPS-Ti surfaces offer good prerequisites for a successful integration of the implant in the surrounding tissue. An additional HA coating could influence these events positively.     

The unreamed femoral and tibial nail-design and insertion behavior

Summary Background: The insertion of locking nails into the medullary cavity without previous reaming of the latter has come to meet most prerequisites desirable for biological osteosynthesis. The present experimental study, which was performed on cadaver bones is based on the measurement of the intramedullary pressure exercised by solid titanium nails of different profiles and diameters inserted in the medullary cavity of femora and tibia. Methods: In all, 132 pressure measurements were carried out in 4 cadaver femora after insertion of 5 different solid nails of 9 mm diameter, and 6 solid nails of 10 mm diameter. Our examinations were carried out in 4 cadaver tibia, using nails of 8 to 10 mm diameter and 84 pressure measurements were done. All of these nails were mad of titanium alloy but differed in profile and surface conditions. Results: Femur: With implants of 9 mm diameter, maximum insertion forces of 234 to 327 N and maximum pressure values between 5 and 11 bar were measured, whereas with nails of 8 to 10 implants of 10 mm diameter the respective values were 191 to 285 N and 3 to 12 bar. Tibia: With implants of 8 to 10 mm diameter, maximum insertion forces of 103 to 340 N and pressure values of 0.43 to 8.05 bar were measured, whereas with nails of 9 and 10 mm diameter, insertion forces amounted to 226 to 325 N, and pressure values to 0.77 to 12.27 bar. Conclusions: Our experimental model confirmed the influence of the shape of the nail on its insertion behavior. Proper selection of the nail diameter is thus decisive for unproblematic implantation. The pressure developed during insertion is on average higher with nails of smaller diameters, as rapid insertion will increase pressure and the marrow substitute cannot flow off fast enough on account of its viscosity. Thus it is not only the diameter of the nail that is decisive for pressure development in the medullary cavity but also the shape of its cross-section.      

蹲甲皮瓣移植再造拇指术后再造拇指指甲的远期随访

目的 探讨游离甲皮瓣移植再造拇指术后再造拇指指甲的远期改变.方法 对行 甲皮瓣移植再造拇指的患者进行随访,观察再造拇指指甲外观,测量其宽度及长度,并与健侧拇指及供趾健侧趾进行对比,并进行统计学分析.结果 19例患者获得随访,随访时间7～182个月,平均40个月.所有患者行拇指再造时均未作甲床修整.随访发现再造拇指指甲虽然均无畸形,外观佳,但指甲长度和宽度均有缩小,曲度增大.健侧趾甲床宽度为[(19.3±2.4)mm,x±s,下同],再造拇指甲床宽度缩小为(17.1±2.3)mm,两者差异有高度统计学意义(t=5.95,P＜0.01);再造拇指的甲床宽度接近健侧拇指甲床宽度(17.1±1.7)mm,两者差异无统计学意义(t=0.00,P＞0.05),但由于再造拇指甲床曲度明显增大,因而显得比健侧拇指甲床更小.再造拇指的甲床长度缩减更加明显,其测量值为(12.2±2.2)mm,与健侧趾甲床长度(14.7±2.4)mm和健侧拇指甲床长度(15.4±3.2)mm相比,差异均有高度统计学意义(t分别=5.72和4.27,P均＜0.01).采用原套脱伤拇指指骨或髂骨植骨作为骨性支撑的两组再造拇指的甲床大小差异无统计学意义.结论 游离甲皮瓣移植再造拇指术后再造拇指的甲床长度和宽度均会发生明显的萎缩,且由于指甲曲度增大,显得比健侧拇指指甲还小,因此术中无需对供趾甲床进行修剪.     

AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨骨囊肿

目的 探讨AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨单纯性骨囊肿的疗效及特点.方法 肱骨、股骨单纯性骨囊肿患儿18例,男11例,女7例;年龄6～12岁,平均8.1岁;肱骨近端12例,股骨近端5例,股骨中段1例;按Neer等标准,活动期12例,静止期6例.使用AO钛制弹性髓内钉结合自体骨髓囊腔注射进行治疗.测量治疗后3、6、12、18个月的X线片示囊肿残留静止透光区面积并进行统计学分析,评估骨囊肿的愈合情况.结果 18例患儿均获得随访,随访时间11～23个月,平均16个月.骨囊肿愈合时间3～6个月,平均4.8个月.囊肿愈合6例(33.3%),缺损愈合12例(66.7%),愈合率100%.3、6、12、18个月X线片示囊肿残留静止透光区面积逐渐减小,各时间点比较差异有统计学意义.术后除1例患儿因钉尾刺激引起轻度皮肤激惹症状外,余均未发现其他并发症及病理性骨折.结论 AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童骨囊肿不仅囊肿愈合快,愈合率高,而且病灶骨能即刻获得力学稳定,同时可有效预防病理性骨折的发生.     

AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨骨囊肿

目的 探讨AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨单纯性骨囊肿的疗效及特点.方法 肱骨、股骨单纯性骨囊肿患儿18例,男11例,女7例;年龄6～12岁,平均8.1岁;肱骨近端12例,股骨近端5例,股骨中段1例;按Neer等标准,活动期12例,静止期6例.使用AO钛制弹性髓内钉结合自体骨髓囊腔注射进行治疗.测量治疗后3、6、12、18个月的X线片示囊肿残留静止透光区面积并进行统计学分析,评估骨囊肿的愈合情况.结果 18例患儿均获得随访,随访时间11～23个月,平均16个月.骨囊肿愈合时间3～6个月,平均4.8个月.囊肿愈合6例(33.3%),缺损愈合12例(66.7%),愈合率100%.3、6、12、18个月X线片示囊肿残留静止透光区面积逐渐减小,各时间点比较差异有统计学意义.术后除1例患儿因钉尾刺激引起轻度皮肤激惹症状外,余均未发现其他并发症及病理性骨折.结论 AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童骨囊肿不仅囊肿愈合快,愈合率高,而且病灶骨能即刻获得力学稳定,同时可有效预防病理性骨折的发生.     

金属与羟基磷灰石微孔表面股骨植入体与骨结合强度的比较研究

目的比较金属与羟基磷灰石(hydroxyapatite,HA)微孔表面股骨植入体与骨的结合强度.方法用等离子喷涂技术,分别喷涂HA微粒和钴铬钼合金微粒于不锈钢三棱针表面,配对植入15只成年家兔的股骨,饲养2个月作拔出试验,并比较手术当日与2个月后的X线改变.结果HA与钴铬钼合金涂层三棱针平均剪切强度分别为(0.98±0.12)MPa和(0.65±0.15)MPa,二者有显著性差异(P＜0.05).X线片HA涂层三棱针周围有较多的成骨反应,透明区较金属涂层三棱针要少而窄.结论植入兔的股骨短时间内,HA微孔表面植入体较金属微孔表面植入体更为稳定.     

AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨骨囊肿

目的 探讨AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨单纯性骨囊肿的疗效及特点.方法 肱骨、股骨单纯性骨囊肿患儿18例,男11例,女7例;年龄6～12岁,平均8.1岁;肱骨近端12例,股骨近端5例,股骨中段1例;按Neer等标准,活动期12例,静止期6例.使用AO钛制弹性髓内钉结合自体骨髓囊腔注射进行治疗.测量治疗后3、6、12、18个月的X线片示囊肿残留静止透光区面积并进行统计学分析,评估骨囊肿的愈合情况.结果 18例患儿均获得随访,随访时间11～23个月,平均16个月.骨囊肿愈合时间3～6个月,平均4.8个月.囊肿愈合6例(33.3%),缺损愈合12例(66.7%),愈合率100%.3、6、12、18个月X线片示囊肿残留静止透光区面积逐渐减小,各时间点比较差异有统计学意义.术后除1例患儿因钉尾刺激引起轻度皮肤激惹症状外,余均未发现其他并发症及病理性骨折.结论 AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童骨囊肿不仅囊肿愈合快,愈合率高,而且病灶骨能即刻获得力学稳定,同时可有效预防病理性骨折的发生.     

AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨骨囊肿

目的 探讨AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨单纯性骨囊肿的疗效及特点.方法 肱骨、股骨单纯性骨囊肿患儿18例,男11例,女7例;年龄6～12岁,平均8.1岁;肱骨近端12例,股骨近端5例,股骨中段1例;按Neer等标准,活动期12例,静止期6例.使用AO钛制弹性髓内钉结合自体骨髓囊腔注射进行治疗.测量治疗后3、6、12、18个月的X线片示囊肿残留静止透光区面积并进行统计学分析,评估骨囊肿的愈合情况.结果 18例患儿均获得随访,随访时间11～23个月,平均16个月.骨囊肿愈合时间3～6个月,平均4.8个月.囊肿愈合6例(33.3%),缺损愈合12例(66.7%),愈合率100%.3、6、12、18个月X线片示囊肿残留静止透光区面积逐渐减小,各时间点比较差异有统计学意义.术后除1例患儿因钉尾刺激引起轻度皮肤激惹症状外,余均未发现其他并发症及病理性骨折.结论 AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童骨囊肿不仅囊肿愈合快,愈合率高,而且病灶骨能即刻获得力学稳定,同时可有效预防病理性骨折的发生.     

AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨骨囊肿

目的 探讨AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨单纯性骨囊肿的疗效及特点.方法 肱骨、股骨单纯性骨囊肿患儿18例,男11例,女7例;年龄6～12岁,平均8.1岁;肱骨近端12例,股骨近端5例,股骨中段1例;按Neer等标准,活动期12例,静止期6例.使用AO钛制弹性髓内钉结合自体骨髓囊腔注射进行治疗.测量治疗后3、6、12、18个月的X线片示囊肿残留静止透光区面积并进行统计学分析,评估骨囊肿的愈合情况.结果 18例患儿均获得随访,随访时间11～23个月,平均16个月.骨囊肿愈合时间3～6个月,平均4.8个月.囊肿愈合6例(33.3%),缺损愈合12例(66.7%),愈合率100%.3、6、12、18个月X线片示囊肿残留静止透光区面积逐渐减小,各时间点比较差异有统计学意义.术后除1例患儿因钉尾刺激引起轻度皮肤激惹症状外,余均未发现其他并发症及病理性骨折.结论 AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童骨囊肿不仅囊肿愈合快,愈合率高,而且病灶骨能即刻获得力学稳定,同时可有效预防病理性骨折的发生.     

AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨骨囊肿

目的 探讨AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨单纯性骨囊肿的疗效及特点.方法 肱骨、股骨单纯性骨囊肿患儿18例,男11例,女7例;年龄6～12岁,平均8.1岁;肱骨近端12例,股骨近端5例,股骨中段1例;按Neer等标准,活动期12例,静止期6例.使用AO钛制弹性髓内钉结合自体骨髓囊腔注射进行治疗.测量治疗后3、6、12、18个月的X线片示囊肿残留静止透光区面积并进行统计学分析,评估骨囊肿的愈合情况.结果 18例患儿均获得随访,随访时间11～23个月,平均16个月.骨囊肿愈合时间3～6个月,平均4.8个月.囊肿愈合6例(33.3%),缺损愈合12例(66.7%),愈合率100%.3、6、12、18个月X线片示囊肿残留静止透光区面积逐渐减小,各时间点比较差异有统计学意义.术后除1例患儿因钉尾刺激引起轻度皮肤激惹症状外,余均未发现其他并发症及病理性骨折.结论 AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童骨囊肿不仅囊肿愈合快,愈合率高,而且病灶骨能即刻获得力学稳定,同时可有效预防病理性骨折的发生.     

AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨骨囊肿

目的 探讨AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨单纯性骨囊肿的疗效及特点.方法 肱骨、股骨单纯性骨囊肿患儿18例,男11例,女7例;年龄6～12岁,平均8.1岁;肱骨近端12例,股骨近端5例,股骨中段1例;按Neer等标准,活动期12例,静止期6例.使用AO钛制弹性髓内钉结合自体骨髓囊腔注射进行治疗.测量治疗后3、6、12、18个月的X线片示囊肿残留静止透光区面积并进行统计学分析,评估骨囊肿的愈合情况.结果 18例患儿均获得随访,随访时间11～23个月,平均16个月.骨囊肿愈合时间3～6个月,平均4.8个月.囊肿愈合6例(33.3%),缺损愈合12例(66.7%),愈合率100%.3、6、12、18个月X线片示囊肿残留静止透光区面积逐渐减小,各时间点比较差异有统计学意义.术后除1例患儿因钉尾刺激引起轻度皮肤激惹症状外,余均未发现其他并发症及病理性骨折.结论 AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童骨囊肿不仅囊肿愈合快,愈合率高,而且病灶骨能即刻获得力学稳定,同时可有效预防病理性骨折的发生.     

AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨骨囊肿

目的 探讨AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨单纯性骨囊肿的疗效及特点.方法 肱骨、股骨单纯性骨囊肿患儿18例,男11例,女7例;年龄6～12岁,平均8.1岁;肱骨近端12例,股骨近端5例,股骨中段1例;按Neer等标准,活动期12例,静止期6例.使用AO钛制弹性髓内钉结合自体骨髓囊腔注射进行治疗.测量治疗后3、6、12、18个月的X线片示囊肿残留静止透光区面积并进行统计学分析,评估骨囊肿的愈合情况.结果 18例患儿均获得随访,随访时间11～23个月,平均16个月.骨囊肿愈合时间3～6个月,平均4.8个月.囊肿愈合6例(33.3%),缺损愈合12例(66.7%),愈合率100%.3、6、12、18个月X线片示囊肿残留静止透光区面积逐渐减小,各时间点比较差异有统计学意义.术后除1例患儿因钉尾刺激引起轻度皮肤激惹症状外,余均未发现其他并发症及病理性骨折.结论 AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童骨囊肿不仅囊肿愈合快,愈合率高,而且病灶骨能即刻获得力学稳定,同时可有效预防病理性骨折的发生.     

AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨骨囊肿

目的 探讨AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨单纯性骨囊肿的疗效及特点.方法 肱骨、股骨单纯性骨囊肿患儿18例,男11例,女7例;年龄6～12岁,平均8.1岁;肱骨近端12例,股骨近端5例,股骨中段1例;按Neer等标准,活动期12例,静止期6例.使用AO钛制弹性髓内钉结合自体骨髓囊腔注射进行治疗.测量治疗后3、6、12、18个月的X线片示囊肿残留静止透光区面积并进行统计学分析,评估骨囊肿的愈合情况.结果 18例患儿均获得随访,随访时间11～23个月,平均16个月.骨囊肿愈合时间3～6个月,平均4.8个月.囊肿愈合6例(33.3%),缺损愈合12例(66.7%),愈合率100%.3、6、12、18个月X线片示囊肿残留静止透光区面积逐渐减小,各时间点比较差异有统计学意义.术后除1例患儿因钉尾刺激引起轻度皮肤激惹症状外,余均未发现其他并发症及病理性骨折.结论 AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童骨囊肿不仅囊肿愈合快,愈合率高,而且病灶骨能即刻获得力学稳定,同时可有效预防病理性骨折的发生.     

AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨骨囊肿

目的 探讨AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨单纯性骨囊肿的疗效及特点.方法 肱骨、股骨单纯性骨囊肿患儿18例,男11例,女7例;年龄6～12岁,平均8.1岁;肱骨近端12例,股骨近端5例,股骨中段1例;按Neer等标准,活动期12例,静止期6例.使用AO钛制弹性髓内钉结合自体骨髓囊腔注射进行治疗.测量治疗后3、6、12、18个月的X线片示囊肿残留静止透光区面积并进行统计学分析,评估骨囊肿的愈合情况.结果 18例患儿均获得随访,随访时间11～23个月,平均16个月.骨囊肿愈合时间3～6个月,平均4.8个月.囊肿愈合6例(33.3%),缺损愈合12例(66.7%),愈合率100%.3、6、12、18个月X线片示囊肿残留静止透光区面积逐渐减小,各时间点比较差异有统计学意义.术后除1例患儿因钉尾刺激引起轻度皮肤激惹症状外,余均未发现其他并发症及病理性骨折.结论 AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童骨囊肿不仅囊肿愈合快,愈合率高,而且病灶骨能即刻获得力学稳定,同时可有效预防病理性骨折的发生.     

AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨骨囊肿

目的 探讨AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童长骨单纯性骨囊肿的疗效及特点.方法 肱骨、股骨单纯性骨囊肿患儿18例,男11例,女7例;年龄6～12岁,平均8.1岁;肱骨近端12例,股骨近端5例,股骨中段1例;按Neer等标准,活动期12例,静止期6例.使用AO钛制弹性髓内钉结合自体骨髓囊腔注射进行治疗.测量治疗后3、6、12、18个月的X线片示囊肿残留静止透光区面积并进行统计学分析,评估骨囊肿的愈合情况.结果 18例患儿均获得随访,随访时间11～23个月,平均16个月.骨囊肿愈合时间3～6个月,平均4.8个月.囊肿愈合6例(33.3%),缺损愈合12例(66.7%),愈合率100%.3、6、12、18个月X线片示囊肿残留静止透光区面积逐渐减小,各时间点比较差异有统计学意义.术后除1例患儿因钉尾刺激引起轻度皮肤激惹症状外,余均未发现其他并发症及病理性骨折.结论 AO钛制弹性髓内钉结合自体骨髓囊腔注射治疗儿童骨囊肿不仅囊肿愈合快,愈合率高,而且病灶骨能即刻获得力学稳定,同时可有效预防病理性骨折的发生.     

Interfacial shear strength of bioactive‐coated carbon fiber reinforced polyetheretherketone after in vivo implantation

Despite the excellent osseointegration of carbon‐fiber‐reinforced polyetheretherketone (CFR/PEEK) with a surface hydroxyapatite (HA) coating, the bone‐implant interfacial shear strength of HA‐coated CFR/PEEK after osseointegration is unclear. We examined the interfacial shear strength of HA‐coated CFR/PEEK implants after in vivo implantation in a rabbit femur‐implant pull‐out test model. HA coating was performed by a newly developed method. Uncoated CFR/PEEK, HA‐coated blasted titanium alloy, and uncoated blasted titanium alloy were used as control implants. The implants were inserted into drilled femoral cortex, and pull‐out tests were conducted after 6 and 12 weeks of implantation to determine maximum interfacial shear strength. The HA‐coated CFR/PEEK (15.7 ± 4.5 MPa) and HA‐coated titanium alloy (14.1 ± 6.0 MPa) exhibited significantly larger interfacial shear strengths than the uncoated CFR/PEEK (7.7 ± 1.8 MPa) and the uncoated titanium alloy (7.8 ± 2.1 MPa) at 6 weeks. At 12 weeks, only the uncoated CFR/PEEK (8.3 ± 3.0 MPa) exhibited a significantly smaller interfacial shear strength, as compared to the HA‐coated CFR/PEEK (17.4 ± 3.6 MPa), HA‐coated titanium alloy (14.2 ± 4.8 MPa), and uncoated titanium alloy (15.0 ± 2.6 MPa). Surface analysis of the removed implants revealed detachment of the HA layer in both the HA‐coated CFR/PEEK and titanium alloy implants. The proposed novel HA coating method of CFR/PEEK significantly increased interfacial shear strength between bone and CFR/PEEK. The achieved interfacial shear strength of the HA‐coated CFR/PEEK implant is of the same level as that of grit‐blasted titanium alloy with HA. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1618–1625, 2012