Objective Bioactive borate glass (BG) has good biocompatibil ity and biodegradation. To investigate the feasibilty of bioactive borate glass as a carrier of the antibiotic controlled-releasing by implanting vancomycin-loaded BG (VBG)into the focus of tibia chronic osteomyel itis after debridement. Methods VBG and vancomycin-loaded calcium sulfate (VCS) were prepared with a vancomycin content of 80 mg/g. Sixty-five New Zealand white rabbits, weighing 2.12-3.91 kg (mean, 2.65 kg), were used. The tibia chronic osteomyel itis rabbit models were establ ished by injecting methicill in-resistant Staphylococcus aureus (MRSA, 0.1 mL, 1 × 109 cfu/mL) into the right tibia of 65 rabbits. After 3 weeks of injection, 54 rabbits of successful models were randomly divided into groups A (n=11), B (n=11), C (n=16), and D (n=16). Simple debridement was performed in group A; BG, VCS, and VBG were implanted into the infection sites of groups B, C, and D respectively after thorough debridement. A sample of the debrided tissues was harvested for bacterial examination. The vancomycin serum levels were determined in groups C and D at 1, 2, 4, 10, 24, and 48 hours after operation. The boron serum levels were determined in groups B and D at 10, 24, 48, 72, and 120 hours after operation. After 8 weeks, the effectiveness was assessed radiographically, bacteriologically, and histopathol ogically. Results Ten rabbits died after operation. No vancomycin was detected in group C; the vancomycin level increased gradually, reached the highest level at 4 hours after operation, and then decreased rapidly in group D. No boron was detected in group B; the boron reached the highest serum level at 10 hours after operation, and then decreased gradually in group D. At 8 weeks, calcium sulfate degraded in group C; BG degraded partially in group D; and no obvious degradation was observedin group B. The repair effect was better in group D than in group C. There was no significant difference in radiograph scoring between groups A, B, C and D (P gt; 0.05) before operation, but there was significant difference between group D and groups A, B, C (P lt; 0.05) at 8 weeks after operation. The bacterial culture showed that all the MRSA results were positive in 4 groups. At 8 weeks, the negative rates of MRSA examination were 36.36%, 18.18%, 73.33%, and 81.25% respectively in groups A, B, C, and D, showing significant differences between group D and groups A, B (P lt; 0.05). The histopathological observation showed that a large number of new bones formed and no foreign body reaction occurred in group D. The histopathologic scores of groups A, B, C, and D were 6.45 ± 3.62, 7.55 ± 3.36, 4.27 ± 2.91, and 3.81 ± 3.04 respectively, showing significant differences between group D and groups A, B, and between group C and group B (P lt; 0.05). Conclusion VBG can improve the repair of bone defect in the treatment of chronic osteomyel itis.
Objective To evaluate the tissue response induced by three kinds of bone transplantation materials implanted in rat so as to provide proper evidence for their cl inical appl ication. Methods Thirty-six healthy mature Sprague- Dawly mice, weighing from 229 g to 358 g, were randomly assigned to groups A and B (n=18). Three kinds of materials wereimplanted into muscles of rats. Calcium sulfate (CS) granular preparations and allogeneic demineral ized bone matrix (DBM) were transplanted into the left (group A1) and right (group A2) thigh muscle pouches of group A. Respectively, whereas xenogenic DBM were transplanted into the left (group B1) thigh muscle pouches of group B and the right (group B2) sites were taken as control without implant. The samples (n=6) were collected to make the observation of gross and histology and to analyze histological score after 2, 4, and 6 weeks. Results The gross observation: implanted materials were gradually absorbed at late stage in group A1. No obvious degradation and absorption, but fibrosis of tissues were observed in group A2 and B1. The inflammatory reactions were more severe in groups A2 and B1. In group B2, only the changes of scar were seen at operative site. The histological observation: no obvious inflammatory reactions were seen in group A1, CS were gradually absorbed and completely absorbed at 6 weeks, while fibrosis of tissues increased at late stage. Inflammatory reactions in group A2 and group B1 were alleviated gradually, no obvious absorption and degradation were observed. The different two DBM could induce granulation tissues and bone formation at different sites and secondary fibrosis with no obvious immune response was observed. In group B2, there was an increase in collagen fiber density and angiogenesis at late stage. The scores of inflammatory infiltration were significantly higher in groups A2, B1 than in groups A1, B2 (P lt; 0.05), and the scores of fibrosis was larger in groups A1, A2 and B1 than in group B2 (P lt; 0.05). Conclusion CS has rapid dissolution and good biocompatibil ity. It is a good replaceable packing materials of bone defects in some upper l imb’s or acute bone fracture. Both of two DBM have biocompatibil ity and osteoinductive potential, which dissolution are very slow. Due to these capacity, they can be served as an ideal materials in treatment of lower l imb’s bone defect and nonunion.
ObjectiveTo observe the ability of osteogenesis in vivo using the injected absorbable polyamine acid/calcium sulfate (PAA/CS) composites and assess their ability to repair bone defects. MethodWe selected 48 New Zealand white rabbits, and half of them were male with a weight between 2.0 and 2.5 kg. Bone defect models were made at the rabbit femoral condyle using electric drill, and the rabbits were divided into two groups. One group accepted implantation of the material at the defect, while nothing was done for the control group. After four, eight, twelve and sixteen weeks, the animals were killed. The line X-ray and hard tissue slices histological examination (HE, MASSON staining) were observed to assess the situation of degradation, absorption and bone formation of the material. ResultsFour weeks after operation, bone defect of the experimental group had no obvious callus growth on X-ray imaging. Histology showed that the material began to degrade and new immature trabecular bone grew. The bone defect of the experimental group had a small amount of callus growth on X-ray imaging after eight weeks. And histology showed that the material continued to degrade and new immature trabecular bone grew continually. There was an obvious callus growth after twelve weeks, and the bone defect area had smaller residual low-density shadow on X-ray imaging. Histology showed that most of the materials degraded and parts of woven bone grew into lamellar bone. After sixteen weeks, the composites were absorbed completely, replaced by new bone tissues, and the new bone was gradually changed from woven bone into mature plate of bone. There was no significant change in bone defect in the control group within twelve weeks, and part of bone defect hole became smaller, and partial edge repair could be detected. ConclusionsThe PAA/CS composites can be completely degraded and absorbed, with a certain activity of bone formation, expected to be used as bone repair materials.
ObjectiveTo investigate the short-term effectiveness of balloon vertebroplasty combined with short-segment pedicle screw instrumentation for the treatment of thoracolumbar burst fractures. MethodsBetween June 2011 and December 2013, 22 patients with thoracolumbar burst fractures were included. There were 14 males and 8 females, aged 20-60 years (mean, 42.5 years). The fracture segments included T11 in 1 case, T12 in 4 cases, L1 in 10 cases, L2 in 6 cases, and L3 in 1 case. According to AO classification system, there were 13 cases of type A and 9 cases of type B. Spinal cord injury was classified as grade C in 2 cases, grade D in 3 cases, and grade E in 17 cases according to Frankel scale. The time from injury to operation was 3-10 days (mean, 5.5 days). All patients underwent posterior reduction and fixation via the injured vertebra, transpedicular balloon reduction of the endplate and calcium sulfate cement (CSC) injection. The ratio of anterior vertebral height, the ratio of central vertebral height, the sagittal Cobb angle, the restoration of nervous function, and internal fixation failure were analyzed. ResultsPrimary healing of incision was obtained in the others except 2 cases of poor healing, which was cured after dressing change or debridement. All the patients were followed up 9-40 months (mean, 15 months). CSC leakage occurred in 2 cases. Absorption of CSC was observed at 8 weeks after operation with complete absorption time of 12-16 weeks (mean, 13.2 weeks). The mean fracture healing time was 18.5 weeks (range, 16-20 weeks). The ratio of anterior vertebral height, ratio of central vertebral height, and sagittal Cobb angle were significantly improved at 1 week and 3 months after operation and last follow-up when compared with preoperative values (P<0.01), but no significant difference was found among 3 time points after operation (P>0.01). There was no internal fixation failure or Cobb angle loss more than 10°. Frankel scale was improved with no deterioration of neurologic function injury. ConclusionBalloon vertebroplasty combined with short-segment pedicle screw instrumentation is simple and safe for the treatment of thoracolumbar burst fractures, and it can improve the quality of reduction, restore vertebral mechanical performance effectively, and prevent the loss of correction and internal fixation failure.
Objective To extend its application in the field of bone repair by adding oxygen-carboxymethylated chitosan (O-CMC) and gentamicin for modification of the calcium sulfate cement (CSC). Methods The O-CMC/CSC was prepared by adding O-CMC with different concentrations (0.1wt%, 0.3wt%, 0.5wt%, 0.7wt%, and 1.0wt%) in the CSC liquid phase. The effect of O-CMC on the CSC was evaluated by testing the injectability, compressive strength, degradation rate, pH value, cytotoxicity and osteogenesis. After the optimal concentration of O-CMC was determined, gentamicin with different concentrations (0.5wt%, 1.5wt%, and 2.5wt%) was added in the O-CMC/CSC, and then the compressive strength and antibacterial properties were investigated. Results After adding O-CMC in the CSC liquid phase, the injection time of O-CMC/CSC was increased to more than 5 minutes; it significantly prolonged with increased concentration of O-CMC (P<0.05). The compressive strength of the modified bone cement was in the range of 11-18 MPa and it was the highest when the concentration of O-CMC was 0.5wt% (P<0.05). The degradation rate of O-CMC/CSC was not influenced obviously by O-CMC (P>0.05). The pH value was in the range of 7.2-7.4 and Ca2+ concentration was in the range of 6-8 mmol/L.In vitro mineralization experiment indicated that the induced mineralization ability of O-CMC/CSC was much higher than that of pure CSC. The 0.5wt% O-CMC/CSC had the best performance; the compressive strength of the composite bone cement was above 5 MPa after gentamicin was added, which had antibacterial effect. Conclusion O-CMC is able to effectively improve the injection, compressive strength, and osteogenic activity of CSC; in addition, antibacterial properties is obtained in the CSC after adding gentamicin.