Abstract An experiment was carried out to investigate the possibility of the establishment of an osteoblasts bank which could supply osteoblasts in repairing bone defect. Osteoblasts were isolated from thetibial periosteum of eight New-Zealand rabbits and cultured in votro. A bone defect, 1.5cm in length was made in both radii of each of the 8 rabbits. The cultivated osteoblasts, gelfoam as a carrier were randomly implanted into the defects of the radii of rabbits. Accordingly, the contralateral radial defects wereimplanted with gelfoam absorbed with the Hanks solution as control. The healing of bone defects was evaluated by roentgenographic examination at 2, 4, 8 and 12 weeks after operation, respectively. It was shown that the implanted cells had osteogenetic capability and could be possible to promote healing of the bone defects. It was suggested that further study needed to be carried out in this field.
OBJECTIVE To investigate a good method for repairing the long bone defect of tibia combined with soft tissue defect. METHODS From 1988-1998, sixteen patients with long bone defect of tibia were admitted. There were 12 males, 4 females and aged from 16 to 45 years. The length of tibia defect ranged from 7 cm to 12 cm, the area of soft tissue defect ranged from 5 cm x 3 cm to 12 cm x 6 cm. Free fibula grafting was adopted in repairing. During operation, the two ends of fibular artery were anastomosised with the anterior tibial artery of the recipient, and the composited fibular flap were transplanted. RESULTS All grafted fibula unioned and the flap survived completely. Followed up for 6 to 111 months, 14 patients acquired the normal function while the other 2 patients received arthrodesis of the tibial-talus joint. In all the 16 patients, the unstable ankle joint could not be observed. CONCLUSION The modified method is characterized by the clear anatomy, the less blood loss and the reduced operation time. Meanwhile, the blood supply of the grafted fibula can be monitored.
Objective To investigate the clinical application of self-settingcalcium phosphate cement (CPC) in bone defect repair of extremities. Methods From May 1998 to January 2000, 32 cases of bone defect, in 36 sites, were repairedand reviewed, aged from 4 to 59 years old (24.7 years old on average), with bone defect 2 to 125 cm2 in size (13.1 cm2 on average). The causes of the bone defect werefracture, bone cyst, iliac bone harvesting, fibrous dysplasia, enchondroma and bone tuberculosis, which involved femur, iliac, tibia, humerus, phalanx, fibula, calcaneus, talus and acetabulum. All of the cases were followed up for 1 to 23 months, 15.3 months on average, before radiographic examination. Results All operations were successful and no general response was observed in all of the cases. X-ray examination showed an integrity interface between CPC and bone. And CT showed no gap existed. There was no increase of serum calcium and phosphate levels. Conclusion CPC is applicable in the low- or non-weight-bearing site of the extremities.
Objective To study the effect of direct bone morphogenetic protein 2 (BMP-2) gene therapy mediated by adenovirus on repairing bone defect. Methods The radial defect models were made on 60 rabbits, which were evenly divided into 4 groups randomly. The 4 groups were treated with different materials: group A, adenovirus carrying BMP-2 gene (AdBMP-2) plus bovine cancellous bone (BCB); group B, reconstructed BMP-2 plus BCB; group C, AdLacz plus BCB; and group D, only BCB scaffolds. The X-ray, histological examination, biomechanics analysis, and immunohistochemical staining were made 4, 8, and 12 weeks after the operation. Results Group A gained better effect in the volume of new bones, the anti-bending intensity of the healing bone, and the expression of BMP-2 than those of group B. The defect in group A was healed. No new bones were observed in group C and group D. Conclusion Direct BMP-2 gene therapy is easy to perform and has veryb osteoinduction ability. It is a good method to repair segmental bone defects.
Objective To investigate the effect of anti-infective reconstitutedbone xenograft (ARBX) as primary grafting on repair of a segmental contaminateddefect in canine radius. Methods The contaminated segmentaldefects of 1.5 cm were made in both radius of 8 canine and 1 ml of staphylococal suspension was injected into the defect region at a concentration of 5×106 CFU/ml. ARBX(experimental side) or RBX(control side) was implanted into the two sides of the defects respectively as primary grafting followed by internal fixation. The results were compared between the two grafting materials in repairing the contaminated segmental defect. Results In ARBX side, the defects were repaired completely in 5 cases and partially in 1 case, and there existed no osteomyelitis in all cases; while in RBX side, the defects were repaired partially in 1 case and were not repaired in 5 cases after 6 months of operation, and there existed osteomyelitis in all cases. Conclusion Besides its b osteoinductive and osteoconductive activity, ARBX is highly antibacterial and can be used as primary grafting in repairing contaminated segmental defects.
Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
Objective To study efficiency of vascularized bone graft combining with reconstituted bone xenograft (RBX) in repairing bone defect and the expression of the vascular endothelial growth factor (VEGF) in serum. Methods From January 1998 to December 2002, 27 cases of bones defects were treated and randomly divided into 3 groups according to different repair materials: group A (the vascularized bone graft-RBX group, n=9), group B (the vascularized bone graft group, n=10)and group C(the RBX group, n=8). The bone defect repair, the bone healing time and the bone graft resorption were observed by radiograph after 3 months, 6 months and 12 months of operation, and the expression of VEGF in serum was assayed with lumino-enzyme immunoassay before operation and after operative 2 weeks, 4 weeks, 6 weeks and 8 weeks respectively. Results The X-ray films showed that the bonehealing was achieved in 8 cases of group A, in 6 cases of group B and in 3 cases of group C after 3 months; in 1 case of group A, respectively in 3 cases of both group B and group C after 6 months. The bone graft resorption was observed in1 case of group B and in 2 cases of group C after 12 months. The serum VEGF values after operative 2 weeks and 4 weeks were higher than those before operation in all of 3 groups(Plt;0.05), and the VEGF values of groups A and B were higher than that group C(Plt;0.05) after 4 weeks. There were no significant differences (Pgt;0.05) in serum VEGF level between postoperative 6, 8 weeks and preoperation in 3 groups. Conclusion The expression of serum VEGF obviously increase in the early period of bone transplanting, it is value of clinical evaluation of reparative efficiency of bone defect.
Since 1979, 13 different types of vascularized bone or periosteal flaps were used to repair bone defects following resection of skeletal neoplasms in 109 cases. The result was satisfactory. In this article, the main points in discussion werethe operative indication, how to design the flap and the technique used to repair the defect.
Objective To evaluate the osteogenesis of three bio-bone derived materials in repairing segmental bone defects. Methods Sixty Japanese rabbits were made 10 mm radius segmental defects and divided into 5 groups(groups A, B, C ,D and E,n=12). Composite fully deproteinised bone(CFDB, group A), partially deproteinised bone(PDPB, group B), partially decalcified bone(PDCB, group C), autogenous iliac bone graft(group D) and no implant(group E) were implanted into the radius segmental bone defects of rabbits. The specimens were examined after 4, 8, 12 and 24 weeks; the osteogenesis was evaluated through X-ray radiograph and undecalcified solid tissue histological examination.Results The border between the material and host’s bone was distinct after 4 weeks and blurred after 8 weeks; the density of partial edge of the material was similar to that of radii after 12 weeks. The medullary cavity of bone reopened in group B; the density of most defect area was similar to that of the host bone and there was a few high density shadow in group C; the density of most defect area was higher than that of host bone in group A after 24 weeks. There was no significant difference in radiograph scoring between groups A, B and C after 4 weeks and 8 weeks(P＞0.05); the scores of group B and C were higher than that of group A after 12 weeks(P＜0.05); and the scores were arranged as follow: group Dgt;group Bgt; group Cgt;group A after24 weeks(P＜0.05). Bone callusgrew toward defect area and new bone adhered to the material after 4 weeks and 8 weeks; more new bone formed, and the materials were absorbed and degraded with time. The quantity of bone formation was more in group D than in group B andin group B than in group C and in group C than in group A after 24 weeks(P＜0.05).Conclusion PDPB had good osteogenesis in repairing the segmental bone defect, PDCB was inferior to it, both PDPB and PDCB are fit to repair segmental bone defect. Both of them were inferior to autogenous bone.
Objective To study the effect of autogenous bone marrow on guided bone regeneration (GBR),and evaluate the repairing ability of GBR in bone defect with autogenous bone marrow. Methods Ten mm segmental defects were produced in both radii of 18 rabbits. The defect was bridged with a silicon tube. Autogenous bone marrow was injected into the tube on the experimental group at 0, 2,4 weeks after operation, and peripheralblood into the control group at thesame time. The X-ray, gross, histological and biochemical examinations were observed invarious times. Results The new bone formation of experimental group was prior to that of control group; calcium and alkaline phosphatase of experimental groupwere higher than those of control group. The experimental group had all been healed at the tenth week, but no one healed in control group. Conclusion It can be conclude that autogenous bone marrow can stimulate bone formation and facilitate GBR in bone defect.