BIOMECHANICAL STUDY ON A NOVEL INJECTABLE CALCIUM PHOSPHATE CEMENT CONTAINING POLY (LATIC-CO-GLYCOLIC ACID) IN REPAIRING TIBIAL PLATEAU FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZOU Huazhang ¹ , MA Xiaochun ² , TANG Cheng ¹ , LI Chuang ¹ , CHEN Jianwei ³ , YE Jiandong ⁴

1Department of Orthopaedics, the Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 511447, P.R.China;;
2Department of Orthopaedics, Panyu Dashi People’s Hospital;;
3Orthopaedic Institute of Sun Yat-sen University;;
4Key Laboratory of Specially Functional Materials, South China University of Technology. Corresponding author: ZOU Huazhang, E-mail: zhz202@hotmail.com;

Corresponding author：

Keywords：

Tibial plateau fracture; Calcium phosphate cement; Biomechanics

DOI：

10.7507/1002-1892.20130187

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Objective To investigate the biomechanics of a novel injectable calcium phosphate cement (CPC) composited by poly (lactic-co-glycolic acid) (PLGA) combined with double-screw fixation in repairing Schatzker II type tibial plateau fracture, so as to provide the mechanical basis for the clinical minimally invasive treatment. Methods Ten matched pairs of proximal tibia specimens were harvested from 10 elderly cadavers to prepare Schatzker II type tibial plateau fracture model. Fracture was fixed by forcing injection of CPC (experimental group) or autologous cancellous bone (control group) combined with double-screw fixation. The samples underwent axial compression on MTS 858 material testing machine to measure the load-displacement, the maximum load, and compressive stiffness. Results The novel CPC had good injectable property at room temperature, which could fill in bone defect fully and permeated into the surrounding cancellous bone. The average bone mineral density of tibial metaphysis was (0.639 ± 0.081) g/cm2 in the experimental group and (0.668 ± 0.083) g/ cm2 in the control group, showing no significant difference (t=1.012, P=0.331). The maximum load in the experimental group [(4 101 ± 813) N] was significantly higher than that in the control group [(692 ± 138) N] (t=3.932, P=0.001). The compressive stiffness was (1 363 ± 362) N/mm in the experimental group and was (223 ± 54) N/mm in the control group, showing significant difference (t=3.023, P=0.013). Conclusion The novel CPC can effectively restore the biomechanical properties of tibilal plateau in repairing Schatzker II type tibial plateau fracture by means of forcing injection combining with double-screw fixation. It could be used as an effective bone substitute in the clinical application.

Citation： ZOU Huazhang,MA Xiaochun,TANG Cheng,LI Chuang,CHEN Jianwei,YE Jiandong. BIOMECHANICAL STUDY ON A NOVEL INJECTABLE CALCIUM PHOSPHATE CEMENT CONTAINING POLY (LATIC-CO-GLYCOLIC ACID) IN REPAIRING TIBIAL PLATEAU FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(7): 855-859. doi: 10.7507/1002-1892.20130187 Copy

1.	梁承伟, 朱炯, 沈海敏. 内固定治疗胫骨平台骨折64例分析. 中国矫形外科杂志, 2006, 14(18): 1393-1396.
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3.	Heini PF, Berlemann U. Bone substitutes in vertebroplasty. Eur Spine J, 2001, 10(2): S205-213.
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5.	van Lieshout EM, van Kralingen GH, El-Massoudi Y, et al. Microstructure and biomechanical characteristics of bone substitutes for trauma and orthopaedic surgery. BMC Musculoskelet Disord, 2011, 12: 34.
6.	Wang X, Ye J, Wang Y. Hydration mechanism of a novel PCCP + DCPA cement system. J Mater Sci Mater Med, 2008, 19(2): 813-816.
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10.	Ali AM, Saleh M, Bolongaro S, et al. The strength of different fixation techniques for bicondylar tibial plateau fractures: a biomechanical study. Clin biomech (Bristol, Avon), 2003, 18(9): 864-870.
11.	Yetkinler DN, McClellan RT, Reindel ES, et al. Biomechanical comparison of conventional open reduction and internal fixation versus calcium phosphate cement fixation of a central depressed tibial plateau fracture. J Orthop Trauma, 2001, 15(3): 197-206.
12.	Frankenburg EP, Goldstein SA, Bauer TW, et al. Biomeetumieal and histological evaluation of a calcium phosphate cement. J Bone Joint Surg (Am), 1998, 80(8): 1112-1124.
13.	叶建东, 王秀鹏, 白波, 等. 一种可注射可降解磷酸钙骨水泥的结构与性能. 功能材料, 2008, 39(2): 271-274, 278.
14.	邹华章, 廖威明, 段昕, 等. 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. 中华生物医学工程杂志, 2011, 17(2): 151-155.
15.	Fernández E, Vlad MD, Gel MM, et al. Modulation of porosity in apatitic cements by the use of alpha-tricalcium phosphate-calcium sulphate dihydrate mixtures. Biomaterials, 2005, 26(17): 3395-3404.
16.	Fernández E, Sarda S, Hamcerencu M, et al. High-strength apatitic cement by modification with superplasticizers. Biomaterials, 2005, 26(15): 2289-2296.
17.	廖红兴, 段昕, 邹华章, 等. 含聚乳酸-羟基乙酸共聚物的新型磷酸钙骨水泥体内降解性能研究. 中国修复重建外科杂志, 2012, 26(8): 934-938.
18.	Schipplein OD, Andreiacchi TP. Interaction between active and passive knee stabilizers during level walking. J Orthop Res, 1991, 9(1): 113-119.
19.	Mueller KL, Karunakar MA, Frankenburg EP, et al. Bicondylar tibial plateau fractures: a biomechanical study. Clin Orthop Relat Res, 2003, (412): 189-195.

1. 梁承伟, 朱炯, 沈海敏. 内固定治疗胫骨平台骨折64例分析. 中国矫形外科杂志, 2006, 14(18): 1393-1396.
2. Lim TH, Brebach GT, Renner SM, et al. Biomechanical evaluation of an injectable calcium phosphate cement for vertebroplasty. Spine (Phila Pa 1976), 2002, 27(12): 1297-1302.
3. Heini PF, Berlemann U. Bone substitutes in vertebroplasty. Eur Spine J, 2001, 10(2): S205-213.
4. Kruyt MC, Persson C, Johansson G, et al. Towards injectable cell-based tissue-engineered bone: the effect of different calcium phosphate microparticles and pre-culturing. Tissue Eng, 2006, 12(2): 309-317.
5. van Lieshout EM, van Kralingen GH, El-Massoudi Y, et al. Microstructure and biomechanical characteristics of bone substitutes for trauma and orthopaedic surgery. BMC Musculoskelet Disord, 2011, 12: 34.
6. Wang X, Ye J, Wang Y. Hydration mechanism of a novel PCCP + DCPA cement system. J Mater Sci Mater Med, 2008, 19(2): 813-816.
7. Trenholm A, Landry S, McLaughlin K, et al. Comparative fixation of tibial plateau fractures using alpha-BSM, a calcium phosphate cement, versus cancellous bone graft. J Orthop Trauma, 2005, 19(10): 698-702.
8. Stuart MJ, Beachy AM, Grabowski JJ, et al. Biomechanical evaluation of a proximal tibial opening-wedge osteotomy plate. Am J Knee Surg, 1999, 12(3): 148-154.
9. Wu CC, Tai CL. Plating treatment for tibial plateau fractures: a biomechanical comparison of buttress and tension band positions. Arch Orthop Trauma Surg, 2007, 127(1): 19-24.
10. Ali AM, Saleh M, Bolongaro S, et al. The strength of different fixation techniques for bicondylar tibial plateau fractures: a biomechanical study. Clin biomech (Bristol, Avon), 2003, 18(9): 864-870.
11. Yetkinler DN, McClellan RT, Reindel ES, et al. Biomechanical comparison of conventional open reduction and internal fixation versus calcium phosphate cement fixation of a central depressed tibial plateau fracture. J Orthop Trauma, 2001, 15(3): 197-206.
12. Frankenburg EP, Goldstein SA, Bauer TW, et al. Biomeetumieal and histological evaluation of a calcium phosphate cement. J Bone Joint Surg (Am), 1998, 80(8): 1112-1124.
13. 叶建东, 王秀鹏, 白波, 等. 一种可注射可降解磷酸钙骨水泥的结构与性能. 功能材料, 2008, 39(2): 271-274, 278.
14. 邹华章, 廖威明, 段昕, 等. 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. 中华生物医学工程杂志, 2011, 17(2): 151-155.
15. Fernández E, Vlad MD, Gel MM, et al. Modulation of porosity in apatitic cements by the use of alpha-tricalcium phosphate-calcium sulphate dihydrate mixtures. Biomaterials, 2005, 26(17): 3395-3404.
16. Fernández E, Sarda S, Hamcerencu M, et al. High-strength apatitic cement by modification with superplasticizers. Biomaterials, 2005, 26(15): 2289-2296.
17. 廖红兴, 段昕, 邹华章, 等. 含聚乳酸-羟基乙酸共聚物的新型磷酸钙骨水泥体内降解性能研究. 中国修复重建外科杂志, 2012, 26(8): 934-938.
18. Schipplein OD, Andreiacchi TP. Interaction between active and passive knee stabilizers during level walking. J Orthop Res, 1991, 9(1): 113-119.
19. Mueller KL, Karunakar MA, Frankenburg EP, et al. Bicondylar tibial plateau fractures: a biomechanical study. Clin Orthop Relat Res, 2003, (412): 189-195.

Chinese Journal of Reparative and Reconstructive Surgery

BIOMECHANICAL STUDY ON A NOVEL INJECTABLE CALCIUM PHOSPHATE CEMENT CONTAINING POLY (LATIC-CO-GLYCOLIC ACID) IN REPAIRING TIBIAL PLATEAU FRACTURES

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