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Liu M, Liu B, Liu Z, Yang Z, Webster TJ, Zhou H, Yang L. High Strength and Shape Memory Spinal Fusion Device for Minimally Invasive Interbody Fusions. Int J Nanomedicine 2024; 19:5109-5123. [PMID: 38846643 PMCID: PMC11155384 DOI: 10.2147/ijn.s460339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/22/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Lumbar interbody fusion is widely employed for both acute and chronic spinal diseases interventions. However, large incision created during interbody cage implantation may adversely impair spinal tissue and influence postoperative recovery. The aim of this study was to design a shape memory interbody fusion device suitable for small incision implantation. Methods In this study, we designed and fabricated an intervertebral fusion cage that utilizes near-infrared (NIR) light-responsive shape memory characteristics. This cage was composed of bisphenol A diglycidyl ether, polyether amine D-230, decylamine and iron oxide nanoparticles. A self-hardening calcium phosphate-starch cement (CSC) was injected internally through the injection channel of the cage for healing outcome improvement. Results The size of the interbody cage is reduced from 22 mm to 8.8 mm to minimize the incision size. Subsequent NIR light irradiation prompted a swift recovery of the cage shape within 5 min at the lesion site. The biocompatibility of the shape memory composite was validated through in vitro MC3T3-E1 cell (osteoblast-like cells) adhesion and proliferation assays and subcutaneous implantation experiments in rats. CSC was injected into the cage, and the relevant results revealed that CSC is uniformly dispersed within the internal space, along with the cage compressive strength increasing from 12 to 20 MPa. Conclusion The results from this study thus demonstrated that this integrated approach of using a minimally invasive NIR shape memory spinal fusion cage with CSC has potential for lumbar interbody fusion.
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Affiliation(s)
- Min Liu
- School of Materials Science and Engineering, Hebei University of Technology, Tianjin, People’s Republic of China
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300131, People’s Republic of China
| | - Bo Liu
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300131, People’s Republic of China
| | - Ziyang Liu
- Department of Orthopedics, Tianjin Hospital, Tianjin, People’s Republic of China
| | - Zhen Yang
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300131, People’s Republic of China
| | | | - Huan Zhou
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300131, People’s Republic of China
| | - Lei Yang
- Center for Health Science and Engineering, Hebei Key Laboratory of Biomaterials and Smart Theranostics, School of Health Sciences and Biomedical Engineering, Hebei University of Technology, Tianjin, 300131, People’s Republic of China
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Yang G, Li Y, Zhang S, Wang Y, Yang L, Wan Q, Pei X, Chen J, Zhang X, Wang J. Double-Cross-Linked Hydrogel with Long-Lasting Underwater Adhesion: Enhancement of Maxillofacial In Situ and Onlay Bone Retention. ACS APPLIED MATERIALS & INTERFACES 2023; 15:46639-46654. [PMID: 37787379 DOI: 10.1021/acsami.3c09117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Bone retention is a usual clinical problem existing in a lot of maxillofacial surgeries involving bone reconstruction and bone transplantation, which puts forward the requirements for bone adhesives that are stable, durable, biosafe, and biodegradable in wet environment. To relieve the suffering of patients during maxillofacial surgery with one-step operation and satisfying repair, herein, we developed a double-cross-linked A-O hydrogel named by its two components: [(3-Aminopropyl) methacrylamide]-co-{[Tris(hydroxymethyl) methyl] acrylamide} and oxidated methylcellulose. With excellent bone adhesion ability, it can maintain long-lasting stable underwater bone adhesion for over 14 days, holding a maximum adhesion strength of 2.32 MPa. Schiff-base reaction and high-density hydrogen bonds endow the hydrogel with strong cohesion and adhesion performance as well as maneuverable properties such as easy formation and injectability. A-O hydrogel not only presents rarely reported long-lasting underwater adhesion of hard tissue but also owns inherent biocompatibility and biodegradation properties with a porous structure that facilitates the survival of bone graft. Compared to the commercial cyanoacrylate adhesive (3 M Vetbond Tissue Adhesive), the A-O hydrogel is confirmed to be safer, more stable, and more effective in calvarial in situ bone retention model and onlay bone retention model of rat, providing a practical solution for the everyday scenario of clinical bone retention.
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Affiliation(s)
- Guangmei Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yuanyuan Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Shu Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yuting Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Linxin Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Qianbing Wan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xibo Pei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Junyu Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xin Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jian Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Quan Q, Gongping X, Ruisi N, Shiwen L. New Research Progress of Modified Bone Cement Applied to Vertebroplasty. World Neurosurg 2023; 176:10-18. [PMID: 37087028 DOI: 10.1016/j.wneu.2023.04.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
Percutaneous vertebroplasty and percutaneous kyphoplasty are effective methods to treat acute osteoporotic vertebral compression fractures that can quickly provide patients with pain relief, prevent further height loss of the vertebral body, and help correct kyphosis. Many clinical studies have investigated the characteristics of bone cement. Bone cement is a biomaterial injected into the vertebral body that must have good biocompatibility and biosafety. The optimization of the characteristics of bone cement has become of great interest. Bone cement can be mainly divided into 3 types: polymethyl methacrylate, calcium phosphate cement, and calcium sulfate cement. Each type of cement has its own advantages and disadvantages. In the past 10 years, the performance of bone cement has been greatly improved via different methods. The aim of our review is to provide an overview of the current progress in the types of modified bone cement and summarize the key clinical findings.
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Affiliation(s)
- Qi Quan
- Department of Spine Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xu Gongping
- Department of Spine Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Na Ruisi
- Department of Gastrointestinal Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Li Shiwen
- Department of Spine Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China.
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4
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Miao X, Yang S, Zhu J, Gong Z, Wu D, Hong J, Cai K, Wang J, Fang X, Lu J, Jiang G. Bioactive mineralized small intestinal submucosa acellular matrix/PMMA bone cement for vertebral bone regeneration. Regen Biomater 2023; 10:rbad040. [PMID: 37250976 PMCID: PMC10224805 DOI: 10.1093/rb/rbad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/30/2023] [Accepted: 04/15/2023] [Indexed: 05/31/2023] Open
Abstract
Polymethylmethacrylate (PMMA) bone cement extensively utilized for the treatment of osteoporotic vertebral compression fractures due to its exceptional handleability and mechanical properties. Nevertheless, the clinical application of PMMA bone cement is restricted by its poor bioactivity and excessively high modulus of elasticity. Herein, mineralized small intestinal submucosa (mSIS) was incorporated into PMMA to prepare a partially degradable bone cement (mSIS-PMMA) that provided suitable compressive strength and reduced elastic modulus compared to pure PMMA. The ability of mSIS-PMMA bone cement to promote the attachment, proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells was shown through cellular experiments carried out in vitro, and an animal osteoporosis model validated its potential to improve osseointegration. Considering these benefits, mSIS-PMMA bone cement shows promising potential as an injectable biomaterial for orthopedic procedures that require bone augmentation.
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Affiliation(s)
| | | | | | - Zhe Gong
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China
- Key Laboratory of Musculoskeletal System, Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, Zhejiang, China
| | - Dongze Wu
- Department of Spinal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315000, Zhejiang, China
| | - Juncong Hong
- Department of Anesthesiology, The First People’s Hospital of Linping District, Hangzhou 311100, Zhejiang, China
| | - Kaiwen Cai
- Department of Spinal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315000, Zhejiang, China
| | - Jiying Wang
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China
- Key Laboratory of Musculoskeletal System, Degeneration and Regeneration Translational Research of Zhejiang Province, Hangzhou 310016, Zhejiang, China
| | | | - Jiye Lu
- Correspondence address. E-mail: (G.J.); (J.L.); (X.F.)
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Application and translation of nano calcium phosphates in biomedicine. Nanomedicine (Lond) 2023. [DOI: 10.1016/b978-0-12-818627-5.00004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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6
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Vezenkova A, Locs J. Sudoku of porous, injectable calcium phosphate cements – Path to osteoinductivity. Bioact Mater 2022; 17:109-124. [PMID: 35386461 PMCID: PMC8964990 DOI: 10.1016/j.bioactmat.2022.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 12/16/2022] Open
Abstract
With the increase of global population, people's life expectancy is growing as well. Humans tend to live more active lifestyles and, therefore, trauma generated large defects become more common. Instances of tumour resection or pathological conditions and complex orthopaedic issues occur more frequently increasing necessity for bone substitutes. Composition of calcium phosphate cements (CPCs) is comparable to the chemical structure of bone minerals. Their ability to self-set and resorb in vivo secures a variety of potential applications in bone regeneration. Despite the years-long research and several products already reaching the market, finding the right properties for calcium phosphate cement to be osteoinductive and both injectable and suitable for clinical use is still a sudoku. This article is focused on injectable, porous CPCs, reviewing the latest developments on the path toward finding osteoinductive material, which is suitable for injection. Phase separation is an essential factor to be improved to obtain injectable material; several methods have been proposed. Osteoinductive bone substitutes – possible solution for bad mechanical performance of CPCs. Osteoinductivity of CPC could be attained even without the addition of different supplements. Less complex composition of CPC – potentially reduced price of the final product and wider availability on the market.
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Tzagiollari A, McCarthy HO, Levingstone TJ, Dunne NJ. Biodegradable and Biocompatible Adhesives for the Effective Stabilisation, Repair and Regeneration of Bone. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9060250. [PMID: 35735493 PMCID: PMC9219717 DOI: 10.3390/bioengineering9060250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/11/2022] [Accepted: 06/06/2022] [Indexed: 11/19/2022]
Abstract
Bone defects and complex fractures present significant challenges for orthopaedic surgeons. Current surgical procedures involve the reconstruction and mechanical stabilisation of complex fractures using metal hardware (i.e., wires, plates and screws). However, these procedures often result in poor healing. An injectable, biocompatible, biodegradable bone adhesive that could glue bone fragments back together would present a highly attractive solution. A bone adhesive that meets the many clinical requirements for such an application has yet to be developed. While synthetic and biological polymer-based adhesives (e.g., cyanoacrylates, PMMA, fibrin, etc.) have been used effectively as bone void fillers, these materials lack biomechanical integrity and demonstrate poor injectability, which limits the clinical effectiveness and potential for minimally invasive delivery. This systematic review summarises conventional approaches and recent developments in the area of bone adhesives for orthopaedic applications. The required properties for successful bone repair adhesives, which include suitable injectability, setting characteristics, mechanical properties, biocompatibility and an ability to promote new bone formation, are highlighted. Finally, the potential to achieve repair of challenging bone voids and fractures as well as the potential of new bioinspired adhesives and the future directions relating to their clinical development are discussed.
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Affiliation(s)
- Antzela Tzagiollari
- School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NA55 Dublin, Ireland; (A.T.); (T.J.L.)
- Centre for Medical Engineering Research, Dublin City University, D09 NA55 Dublin, Ireland
| | - Helen O. McCarthy
- School of Pharmacy, Queen’s University, Belfast BT9 7BL, UK;
- School of Chemical Sciences, Dublin City University, D09 NA55 Dublin, Ireland
- Biodesign Europe, Dublin City University, D09 NA55 Dublin, Ireland
| | - Tanya J. Levingstone
- School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NA55 Dublin, Ireland; (A.T.); (T.J.L.)
- Centre for Medical Engineering Research, Dublin City University, D09 NA55 Dublin, Ireland
- Biodesign Europe, Dublin City University, D09 NA55 Dublin, Ireland
- Tissue, Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, D02 PN40 Dublin, Ireland
- Advanced Manufacturing Research Centre (I-Form), School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NA55 Dublin, Ireland
- Advanced Processing Technology Research Centre, Dublin City University, D09 NA55 Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Nicholas J. Dunne
- School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NA55 Dublin, Ireland; (A.T.); (T.J.L.)
- Centre for Medical Engineering Research, Dublin City University, D09 NA55 Dublin, Ireland
- Biodesign Europe, Dublin City University, D09 NA55 Dublin, Ireland
- Advanced Manufacturing Research Centre (I-Form), School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NA55 Dublin, Ireland
- Advanced Processing Technology Research Centre, Dublin City University, D09 NA55 Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Trinity College Dublin, D02 PN40 Dublin, Ireland
- Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Correspondence: ; Tel.: +353-(0)1-7005712
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Karpiński R, Szabelski J, Krakowski P, Jojczuk M, Jonak J, Nogalski A. Evaluation of the Effect of Selected Physiological Fluid Contaminants on the Mechanical Properties of Selected Medium-Viscosity PMMA Bone Cements. MATERIALS 2022; 15:ma15062197. [PMID: 35329650 PMCID: PMC8951357 DOI: 10.3390/ma15062197] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 02/06/2023]
Abstract
Revision surgeries several years after the implantation of the prosthesis are unfavorable from the patient’s point of view as they expose him to additional discomfort, to risk of complications and are expensive. One of the factors responsible for the aseptic loosening of the prosthesis is the gradual degradation of the cement material as a result of working under considerable loads, in an aggressive environment of the human body. Contaminants present in the surgical field may significantly affect the durability of the bone cement and, consequently, of the entire bone-cement-prosthesis system. The paper presents the results of an analysis of selected mechanical properties of two medium-viscosity bone cements DePuy CMW3 Gentamicin and Heraeus Palamed, for the samples contaminated with saline and blood in the range of 1–10%. The results obtained for compressive strength and modulus of elasticity were subjected to statistical analysis, which estimated the nature of changes in these parameters depending on the amount and type of contamination and their statistical significance.
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Affiliation(s)
- Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland;
- Correspondence: (R.K.); (J.S.)
| | - Jakub Szabelski
- Section of Biomedical Engineering, Department of Computerization and Production Robotization, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
- Correspondence: (R.K.); (J.S.)
| | - Przemysław Krakowski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland; (P.K.); (M.J.); (A.N.)
- Orthopaedic Department, Łęczna Hospital, Krasnystawska 52, 21-010 Leczna, Poland
| | - Mariusz Jojczuk
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland; (P.K.); (M.J.); (A.N.)
| | - Józef Jonak
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland;
| | - Adam Nogalski
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland; (P.K.); (M.J.); (A.N.)
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Zhang M, Liu J, Zhu T, Le H, Wang X, Guo J, Liu G, Ding J. Functional Macromolecular Adhesives for Bone Fracture Healing. ACS APPLIED MATERIALS & INTERFACES 2022; 14:1-19. [PMID: 34939784 DOI: 10.1021/acsami.1c17434] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Compared with traditional internal fixation devices, bone adhesives are expected to exhibit remarkable advantages, such as improved fixation of comminuted fractures and maintained spatial location of fractured scattered bone pieces in treating bone injuries. In this review, different bone adhesives are summarized from the aspects of bone tissue engineering, and the applications of bone adhesives are emphasized. The concepts of "liquid scaffold" and "liquid plate" are proposed to summarize two different research directions of bone adhesives. Furthermore, significant advances of bone adhesives in recent years in mechanical strength, osseointegration, osteoconductivity, and osteoinductivity are discussed. We conclude this topic by providing perspectives on the state-of-the-art research progress and future development trends of bone adhesives. We hope this review will provide a comprehensive summary of bone adhesives and inspire more extensive and in-depth research on this subject.
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Affiliation(s)
- Mingran Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130033, People's Republic of China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, People's Republic of China
| | - Jiaxue Liu
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, People's Republic of China
- Jilin Collaborative Innovation Center for Antibody Engineering, Jilin Medical University, 5 Jilin Street, Jilin 132000, People's Republic of China
| | - Tongtong Zhu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130033, People's Republic of China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, People's Republic of China
| | - Hanxiang Le
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, People's Republic of China
- Orthopaedic Medical Center, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun 130041, People's Republic of China
| | - Xukai Wang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130033, People's Republic of China
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, People's Republic of China
| | - Jinshan Guo
- Department of Histology and Embryology, School of Basic Medical Sciences; Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, The Third Affiliated Hospital of Southern Medical University, Southern Medical University, 1023 Southern Shatai Road, Guangzhou 510515, People's Republic of China
| | - Guangyao Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130033, People's Republic of China
| | - Jianxun Ding
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, People's Republic of China
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Chen MM, Jia P, Tang H. Cortical bone trajectory fixation in cemented vertebrae in lumbar degenerative disease: A case report. World J Clin Cases 2021; 9:8609-8615. [PMID: 34754875 PMCID: PMC8554437 DOI: 10.12998/wjcc.v9.i28.8609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/27/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) has been widely used in osteoporotic vertebral compression fracture (OVCF). Following surgery, the bone cement would be positioned permanently. However, in some cases of lumbar degenerative disease, the cemented vertebrae needs to be fixed after decompression and fusion procedure. It is difficult to implant traditional pedicle screws into the cemented vertebrae because of the bone cement filling. At present, the main treatment strategy is to skip the cemented vertebra and conduct a long segment fixation. This article presents a cortical bone trajectory (CBT) fixation technique for cemented vertebrae.
CASE SUMMARY PVP involving the L3 and L4 was performed in an 82-year-old man due to OVCF. During the surgery, bone cement leakage occurred, resulting in compression of the root of the right L3 nerve. We performed a partial facetectomy to retrieve the leaked bone cement and to relieve the patient’s neurological symptoms. After 3 mo, the patient developed lumbar disc herniation in L3/4, potentially due to instability caused by the previous surgery. Therefore, it was necessary to perform intervertebral fusion and fixation. It was difficult to implant traditional trajectory pedicle screws in L3 and L4 because of the bone cement filling. Hence, we implanted CBT screws in the L3 and L4 vertebrae. As a result, the patient’s symptoms resolved and he reported satisfaction with the surgery at follow-up after 8 mo.
CONCLUSION It is feasible to utilize CBT in cemented vertebrae for the treatment of lumbar degenerative disease.
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Affiliation(s)
- Meng-Meng Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Pu Jia
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hai Tang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Wu X, Tang Z, Wu K, Bai Y, Lin X, Yang H, Yang Q, Wang Z, Ni X, Liu H, Yang L. Strontium-calcium phosphate hybrid cement with enhanced osteogenic and angiogenic properties for vascularised bone regeneration. J Mater Chem B 2021; 9:5982-5997. [PMID: 34139000 DOI: 10.1039/d1tb00439e] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vascularized bone tissue engineering is regarded as one of the optimal treatment options for large bone defects. The lack of angiogenic properties and unsatisfactory physicochemical performance restricts calcium phosphate cement (CPC) from application in vascularized bone tissue engineering. Our previous studies have developed a starch and BaSO4 incorporated calcium phosphate hybrid cement (CPHC) with improved mechanical strength and handling properties. However, the bioactivity-especially the angiogenic ability-is still absent and requires further improvement. Herein, based on the reported CPHC and the osteogenic and angiogenic properties of strontium (Sr) ions, a strontium-enhanced calcium phosphate hybrid cement (Sr-CPHC) was developed to improve both biological and physicochemical properties of CPC. Compared to CPC, the initial setting time of Sr-CPHC was prolonged from 2.2 min to 20.7 min. The compressive strength of Sr-CPHC improved from 11.21 MPa to 45.52 MPa compared with CPC as well. Sr-CPHC was biocompatible and showed promotion of alkaline phosphatase (ALP) activity, calcium nodule formation and osteogenic relative gene expression, suggesting high osteogenic-inductivity. Sr-CPHC also facilitated the migration and tube formation of human umbilical vein endothelial cells (HUVECs) in vitro and up-regulated the expression of the vascular endothelial growth factor (VEGF) and Angiopoietin-1 (Ang-1). In vivo evaluation showed marked new bone formation in a rat calvarial defect model with Sr-CPHC implanted. Sr-CPHC also exhibited enhancement of neovascularization in subcutaneous connective tissue in a rat subcutaneous implantation model. Thus, the Sr-CPHC with the dual effects of osteogenesis and angiogenesis shows great potential for clinical applications such as the repair of ischemic osteonecrosis and critical-size bone defects.
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Affiliation(s)
- Xiexing Wu
- Institute of Orthopedics and Department of Orthopedics, The First Affiliated Hospital, Soochow University, No. 708 Renmin Road, Suzhou 215006, P. R. China
| | - Ziniu Tang
- Institute of Orthopedics and Department of Orthopedics, The First Affiliated Hospital, Soochow University, No. 708 Renmin Road, Suzhou 215006, P. R. China
| | - Kang Wu
- Institute of Orthopedics and Department of Orthopedics, The First Affiliated Hospital, Soochow University, No. 708 Renmin Road, Suzhou 215006, P. R. China
| | - Yanjie Bai
- School of Public Health, Medical College, Soochow University, Suzhou 215006, P. R. China
| | - Xiao Lin
- Institute of Orthopedics and Department of Orthopedics, The First Affiliated Hospital, Soochow University, No. 708 Renmin Road, Suzhou 215006, P. R. China
| | - Huilin Yang
- Institute of Orthopedics and Department of Orthopedics, The First Affiliated Hospital, Soochow University, No. 708 Renmin Road, Suzhou 215006, P. R. China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin 300211, P. R. China
| | - Zheng Wang
- Department of Orthopedics, PLA General Hospital, Beijing 100853, P. R. China
| | - Xinye Ni
- Second People's Hospital of Changzhou, Nanjing Medical University, No. 68 Gehu Road, Changzhou 213003, P. R. China.
| | - Huiling Liu
- Institute of Orthopedics, Medical College, Soochow University, Suzhou 215006, P. R. China.
| | - Lei Yang
- Institute of Orthopedics and Department of Orthopedics, The First Affiliated Hospital, Soochow University, No. 708 Renmin Road, Suzhou 215006, P. R. China and Center for Health Science and Engineering (CHSE), School of Materials Science and Engineering, Hebei University of Technology, No. 8 Guangrong Road, Tianjin 300130, P. R. China.
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Effect of Physiological Saline Solution Contamination on Selected Mechanical Properties of Seasoned Acrylic Bone Cements of Medium and High Viscosity. MATERIALS 2020; 14:ma14010110. [PMID: 33383870 PMCID: PMC7796448 DOI: 10.3390/ma14010110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/29/2022]
Abstract
Bone cements play a key role in present-day surgery, including the implantation of hip and knee joint endoprostheses. The correct and durable bonding of the prosthesis to the bone is affected by both the static strength characteristics determined in accordance with ISO 5833:2002 and the resistance to long-term exposure to an aggressive environment of the human body and the impurities that may be introduced into the cement during implementation. The study attempts to demonstrate statistically significant degradation of cement as a result of the seasoning of cement samples in Ringer’s solution with simultaneous contamination of the material with saline solution, which is usually present in the surgical field (e.g., during the fixing of endoprostheses). The results of statistical analysis showed the nature of changes in compressive strength and microhardness due to seasoning time and degree of contamination.
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Enhancing effects of radiopaque agent BaSO4 on mechanical and biocompatibility properties of injectable calcium phosphate composite cement. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 116:110904. [DOI: 10.1016/j.msec.2020.110904] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/08/2020] [Accepted: 03/27/2020] [Indexed: 12/20/2022]
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Wang D, Li Z, Yin S, Liu R, Sun F, Hu Y, Li C, Xu R. Modified kyphoplasty with controllable balloon dilatation for treatment of thoracolumbar osteoporotic vertebral compression fractures. INTERNATIONAL ORTHOPAEDICS 2020; 44:1401-1408. [PMID: 32418017 DOI: 10.1007/s00264-020-04592-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the surgical effects of modified kyphoplasty with controllable balloon dilatation for treatment of thoracolumbar osteoporotic vertebral compression fractures (OVCF). METHODS From April 2013 to October 2017, a total of 53 patients with thoracolumbar OVCF were treated with controllable balloon percutaneous kyphoplasty (C-PKP). Peri-operative parameters including days from injury to operation, operation time, injected cement volume, cement leakage and complications were collected. Visual analogue scale (VAS) and Cobb angle before and after operation were applied to evaluate surgical effects. Moreover, a total of 53 cases treated with traditional balloon of percutaneous kyphoplasty were retrospectively analyzed and compared with C-PKP in above parameters. RESULTS C-PKP achieved significant fewer events of cement leakage (type C) than that of traditional PKP (5/53 vs 13/53, p < 0.01). The patients were followed up for 10.8 ± 4.2 months; VAS and Cobb angle of the injured vertebra in both two groups at three days and final follow-up were significantly improved compared with that before surgery (p < 0.05), while there were no significant differences between the two groups regarding the VAS and Cobb angle at corresponding time points (p > 0.05). CONCLUSIONS C-PKP technology is a safe and efficient way for the treatment of thoracolumbar OVCF, and it can reduce cement leakage.
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Affiliation(s)
- Dexin Wang
- Department of Orthopaedics, Haishu Branch of Ningbo First Hospital, Zhejiang University, Ningbo, 315012, Zhejiang, China
| | - Zheng Li
- Spinal Surgery Department, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China
| | - Shaomeng Yin
- Spinal Surgery Department of AoYoung Hospital, Suzhou, 215600, Jiangsu, China.
| | - Rui Liu
- Department of Orthopaedics, Mingzhou Hospital of Zhejiang University, 168 Taian West Road, Ningbo, 315100, Zhejiang Province, China
| | - Fanggui Sun
- Department of Orthopaedics, Mingzhou Hospital of Zhejiang University, 168 Taian West Road, Ningbo, 315100, Zhejiang Province, China
| | - Yutong Hu
- Department of Orthopaedics, Mingzhou Hospital of Zhejiang University, 168 Taian West Road, Ningbo, 315100, Zhejiang Province, China
| | - Chunzhi Li
- Department of Orthopaedics, Mingzhou Hospital of Zhejiang University, 168 Taian West Road, Ningbo, 315100, Zhejiang Province, China
| | - Rongming Xu
- Department of Orthopaedics, Mingzhou Hospital of Zhejiang University, 168 Taian West Road, Ningbo, 315100, Zhejiang Province, China.
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15
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Zhu J, Yang S, Cai K, Wang S, Qiu Z, Huang J, Jiang G, Wang X, Fang X. Bioactive poly (methyl methacrylate) bone cement for the treatment of osteoporotic vertebral compression fractures. Theranostics 2020; 10:6544-6560. [PMID: 32483469 PMCID: PMC7255031 DOI: 10.7150/thno.44428] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/05/2020] [Indexed: 12/14/2022] Open
Abstract
Rationale: Poly (methyl methacrylate) (PMMA) bone cement is one of the most commonly used biomaterials for augmenting/stabilizing osteoporosis-induced vertebral compression fractures (OVCFs), such as percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP). However, its clinical applications are limited by its poor performance in high compressive modulus and weak bonding to bone. To address these issues, a bioactive composite bone cement was developed for the treatment of osteoporotic vertebral compression fractures, in which mineralized collagen (MC) was incorporated into the PMMA bone cement (MC-PMMA). Methods: The in vitro properties of PMMA and MC-PMMA composite bone cement were determined, including setting time, compressive modulus, adherence, proliferation, and osteogenic differentiation of rat bone mesenchymal stem cells. The in vivo properties of both cements were evaluated in an animal study (36 osteoporotic New Zealand female rabbits divided equally between the two bone cement groups; PVP at L5) and a small-scale and short-term clinical study (12 patients in each of the two bone cement groups; follow-up: 2 years). Results: In terms of value for PMMA bone cement, the handling properties of MC-PMMA bone cement were not significantly different. However, both compressive strength and compressive modulus were found to be significantly lower. In the rabbit model study, at 8 and 12 weeks post-surgery, bone regeneration was more significant in MC-PMMA bone cement (cortical bone thickness, osteoblast area, new bone area, and bone ingrowth %; each significantly higher). In the clinical study, at a follow-up of 2 years, both the Visual Analogue Score and Oswestry Disability Index were significantly reduced when MC-PMMA cement was used. Conclusions: MC-PMMA bone cement demonstrated good adaptive mechanical properties and biocompatibility and may be a promising alternative to commercial PMMA bone cements for the treatment of osteoporotic vertebral fractures in clinical settings. While the present results for MC-PMMA bone cement are encouraging, further study of this cement is needed to explore its viability as an ideal alternative for use in PVP and BKP.
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Affiliation(s)
- Jinjin Zhu
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine & Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
- Department of Spinal Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, China
| | - Shuhui Yang
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Kaiwen Cai
- Department of Spinal Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, China
| | - Shuo Wang
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Zhiye Qiu
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Junfei Huang
- Shimadzu (China) Co., Ltd. Shenzhen Branch, Shenzhen 518042, China
| | - Guoqiang Jiang
- Department of Spinal Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, China
| | - Xiumei Wang
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Xiangqian Fang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine & Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
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Karpiński R, Szabelski J, Maksymiuk J. Effect of Physiological Fluids Contamination on Selected Mechanical Properties of Acrylate Bone Cement. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E3963. [PMID: 31795371 PMCID: PMC6926979 DOI: 10.3390/ma12233963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/27/2022]
Abstract
This study analyses the degradation rate of selected mechanical properties of bone cement contaminated with human blood and saline solution. During the polymerisation stage, the PMMA cement specimens were supplemented with the selected physiological fluids in a range of concentrations from 0% to 10%. The samples were then subjected to the standardised compression tests, as per ISO 5833: 2002, and hardness tests. The obtained results were analysed statistically to display the difference in the degradation of the material relative to the degree of contamination. Subsequently, numerical modelling was employed to determine the mathematical relationship between the degree of contamination and the material strength degradation rate. The introduction of various concentrations of contaminants into the cement mass resulted in a statistically significant change in their compressive strength. It was shown that the addition of more than 4% of saline and more than 6% of blood (by weight) causes that the specimens exhibit lower strength than the minimum critical value of 70 MPa, specified in the abovementioned International Standard. It was further revealed that the cement hardness characteristics degraded accordingly. The mathematical models showed a very good fit with the results from the experiments: The coefficient of determination R2 was 0.987 in the case of the linear hardness model for blood and 0.983 for salt solution; secondly, the values of R2 for the third-degree polynomial model of compressive strength were 0.88 for blood and 0.92 for salt. From the results, it can be seen that there is a quantitative/qualitative relationship between the contamination rate and the drop in the tested mechanical characteristics. Therefore, great effort must be taken to minimise the contact of the bone cement with physiological fluids, which naturally occur in the operative field, particularly when the material cures, in order to prevent the cement material strength declining below the minimum threshold specified in the ISO standard.
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Affiliation(s)
- Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Jakub Szabelski
- Section of Biomedical Engineering, Department of Computerization and Production Robotization, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Jacek Maksymiuk
- Orthopaedic Department, Łęczna Hospital, Krasnystawska 52, 21-010 Łęczna, Poland
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Biomechanical evaluation of calcium phosphate-based nanocomposite versus polymethylmethacrylate cement for percutaneous kyphoplasty. Spine J 2019; 19:1871-1884. [PMID: 31202837 DOI: 10.1016/j.spinee.2019.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Polymethylmethacrylate (PMMA) is the most commonly used filling material when performing percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures. However, there are some inherent and unavoidable drawbacks with the clinical use of PMMA. PMMA bone cement tends to leak during injection, which can lead to injury of the spinal nerves and spinal cord. Moreover, the mechanical strength of PMMA-augmented vertebral bodies is extraordinary and this high level of mechanical strength might predispose to adjacent vertebral fractures. A novel biodegradable calcium phosphate-based nanocomposite (CPN) for PKP augmentation has recently been developed to potentially avoid these issues. PURPOSE By comparison with PMMA, the leakage characteristics, biomechanical properties, and dispersion of CPN were evaluated when used for PKP. STUDY DESIGN Biomechanical evaluation and studies on the dispersion and anti-leakage properties of CPN and PMMA cements were performed and compared using cadaveric vertebral fracture model, sheep vertebral fracture model, and simulated rigid foam model. METHODS Sheep vertebral bodies were decalcified by ethylenediaminetetraacetic acid disodium salt (EDTA-Na2) to simulate osteoporosis in vitro. After compression to create wedge-shaped fractures using a self-designed fracture creation tool, human cadaveric vertebrae and decalcified sheep vertebrae were augmented by PKP. In addition, three L5 vertebral bodies from human cadavers were used in a contrast vertebroplasty (VP) augmentation experiment. Occurrence of cement leakage was observed and compared between CPN and PMMA during the process of vertebral augmentation. Open-cell rigid foam model (Sawbones#1522-507) was used to create a simulated leakage model for the evaluation of the leakage characteristics of CPN and PMMA with different viscosities. The augmentation effects of CPN and PMMA were evaluated in human cadaveric and decalcified sheep vertebral models and then compared to the results from solid rigid foam model (Sawbones#1522-23). The dispersion abilities of CPN and PMMA were evaluated via three methods as follows. The dispersion volume and dispersion ratio were calculated by three-dimensional reconstruction using human vertebral body CT scans; the ratio of cement area to injection volume was calculated from three-dimensional sections of micro-CT scans of a sheep vertebra; and the micro-CT images of cement dispersion in open-cell rigid foam model (Sawbones#1522-507) were compared between CPN and PMMA. This study was funded by the National Natural Science Foundation of China (No. 81622032, 190,000 dollars and No. 51672184, 90,600 dollars), Principal Project of Natural Science Research of Jiangsu Higher Education Institutions (No. 17KJA180011, 22,000 dollars), and Jiangsu Innovation and Entrepreneurship Program (146,000 dollars). RESULTS There was no significant difference in vertebral height between CPN and PMMA during PKP augmentation and both cements restored the vertebral height after augmentation. In PKP augmentation experiment, posterior wall cement leakage occurred in 75% of human vertebrae augmented with PMMA; however, no leakage occurred in human vertebrae augmented with CPN. Anterior leakage occurred in all vertebrae augmented by PMMA, while in only 75% of vertebra augmented by CPN. Furthermore, CPN and PMMA had completely different leakage patterns in the simulated rigid foam model whether administered at the same injection speed or under the same injection force, suggesting that CPN has anti-leakage characteristics. The augmentation in human cadaveric vertebrae was lower with CPN compared to PMMA (1,668±816 N vs. 2,212±813 N, p=.459, respectively), but this difference was not significant. The augmentation force in sheep vertebral bodies reached 1,393±433 N when augmented with PMMA, but 1,108±284 N when augmented with CPN. The dispersion of CPN was better, and the dispersion volume and ratio were greater, with CPN than with PMMA. Imaging of the open-cell rigid foam model showed completely different dispersion modes for CPN and PMMA. After injection, the PMMA cement formed a contracted clump in the open-cell rigid foam model. However, the CPN cement extended many antennae outward, appearing to spread to the surrounding area. The surface areas of the CPN cement blocks with different liquid-to-solid ratios were significantly larger than the surface area of the PMMA cement in the open-cell rigid foam model (p<.05). CONCLUSIONS CPN has anti-leakage properties, which might be related to its high viscosity and viscoplasticity. CPN had a slightly lower augmentation force than PMMA when used in cadaveric vertebrae, decalcified sheep vertebrae, and in the standard rigid foam model. However, CPN diffused more easily into cancellous bone than did PMMA and encapsulated bone tissue during the dispersion process. The excellent dispersion of CPN generated better interdigitation with cancellous bone, which may be why the augmentation effect of CPN is similar to that of PMMA. CLINICAL SIGNIFICANCE Biodegradable CPN is a potential alternative to PMMA cement in PKP surgery, in which CPN is likely to reduce the cement leakage during the surgery and avoid the post-surgery complications caused by excessive strengths and nondegradability of PMMA cement.
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18
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Effect of surgical factors on the augmentation of cement-injectable cannulated pedicle screw fixation by a novel calcium phosphate-based nanocomposite. Front Med 2019; 13:590-601. [PMID: 31555965 DOI: 10.1007/s11684-019-0710-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/25/2019] [Indexed: 10/25/2022]
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Sun H, Liu C, Li X, Liu H, Zhang W, Yang H, Li C, Yang L. A novel calcium phosphate-based nanocomposite for the augmentation of cement-injectable cannulated pedicle screws fixation: A cadaver and biomechanical study. J Orthop Translat 2019; 20:56-66. [PMID: 31908934 PMCID: PMC6938802 DOI: 10.1016/j.jot.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/03/2019] [Accepted: 08/07/2019] [Indexed: 12/26/2022] Open
Abstract
Background/objective Both polymethylmethacrylate (PMMA) and traditional calcium phosphate–based cements have some deficiencies as augmentation materials for pedicle screw fixation. Here, a novel calcium phosphate–based nanocomposite (CPN) for the augmentation of pedicle screw fixation was developed based on previous study, and the handling properties, biomechanical performance, and biodegradation behaviour of CPN were evaluated and compared with clinical PMMA by means of a cadaver study and animal tests. Methods Bone mineral density of the lumbar vertebrae was tested. Pedicle screws were placed into the lumbar vertebrae under the guidance of three dimensionally printed templates; each of which was designed based on computed tomography (CT) reconstruction of each vertebrae and augmented with either PMMA or CPN. X-ray and CT scan were used to evaluate the accuracy of screw placement and dispersion as well as interdigitation of bone cement. The axial pull-out strength and maximum torque were tested using a mechanical testing machine. Degradation behaviour of CPN was evaluated by in vitro immersion tests for 8 weeks and in vivo rabbit femur defect model for up to 6 months, respectively. Results Standard mechanical tests revealed that PMMA was much stronger than CPN after setting (compressive strength 95 vs. 49 MPa, respectively, p < 0.001). Results of the projection area and volume distribution of cement along the distal end of the screws revealed that CPN exhibited unique dispersing and interdigitation abilities compared with PMMA. Specifically, CPN dispersed uniformly and symmetrically along the screw, while PMMA was limited to the proximal part of the screw. Axial pull-out test results showed that the axial pull-out strengths of CPN- and PMMA-augmented pedicle screws were similar (1199 ± 225 N vs 1337 ± 483 N, respectively) and not significantly different (p = 0.47), although CPN was an intrinsically weaker material than PMMA. Similarly, CPN showed average torque values of 0.72 ± 0.31 N·m slightly lower than those of PMMA (0.96 ± 0.23 N·m), but statistically there was no significant difference between CPN and PMMA (p = 0.21). In a rabbit model of femoral bone defect, the implanted CPN maintained its clear boundary and there is no disintegration in the cement clump after 20 days and 24 weeks, and there was moderate bioabsorption of CPN and clearly new bone ingrowth at the absorbed sites after 24 weeks. Conclusion A new nanocomposite cement CPN, designed for replacing the nondegradable PMMA cement and overcoming the mechanical inferiority of calcium phosphate cement, was evaluated for its biomechanical and biodegradation behaviours in cement-injectable cannulated pedicle screws (CICPS) application. Although CPN is a mechanically weaker material than PMMA, CPN demonstrates similar biomechanical properties to PMMA in the application of augmentation for CICPS fixation in cadaveric vertebrae. This improvement in biomechanical property is attributed to a better dispersion and interdigitation mode of CPN. In addition, the animal study results suggest the in vivo absorption of CPN is slow enough and matches the bone ingrowth. The translational potential of this article This work reports a cadaveric and biomechanical study of novel CPN for the application in the augmentation of CICPS. The results suggest that CPN has equivalent or better biomechanical and interdigitation performance compared with PMMA. Together with the biodegradability and ossointegration capability, CPN reveals high translational potential as a new bone cements for load-bearing bone fixation and repair.
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Affiliation(s)
- Haolin Sun
- Department of Orthopedics, Peking University First Hospital, China
| | - Chun Liu
- Institute of Orthopedics, Department of Orthopedics, Soochow University, China
| | - Xuwen Li
- Department of Orthopedics, Peking University First Hospital, China
| | - Huiling Liu
- Institute of Orthopedics, Department of Orthopedics, Soochow University, China
| | - Weiguang Zhang
- Department of Human Anatomy, School of Basic Medical Sciences, Peking University, China
| | - Huilin Yang
- Institute of Orthopedics, Department of Orthopedics, Soochow University, China
| | - Chunde Li
- Department of Orthopedics, Peking University First Hospital, China
| | - Lei Yang
- Institute of Orthopedics, Department of Orthopedics, Soochow University, China.,Center for Health Science and Engineering, Tianjin Key Laboratory of Materials Laminating Fabrication and Interface Control Technology, School of Materials Science and Engineering, Hebei University of Technology, China
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Cohn D, Sloutski A, Elyashiv A, Varma VB, Ramanujan R. In Situ Generated Medical Devices. Adv Healthc Mater 2019; 8:e1801066. [PMID: 30828989 DOI: 10.1002/adhm.201801066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/25/2018] [Indexed: 12/19/2022]
Abstract
Medical devices play a major role in all areas of modern medicine, largely contributing to the success of clinical procedures and to the health of patients worldwide. They span from simple commodity products such as gauzes and catheters, to highly advanced implants, e.g., heart valves and vascular grafts. In situ generated devices are an important family of devices that are formed at their site of clinical function that have distinct advantages. Among them, since they are formed within the body, they only require minimally invasive procedures, avoiding the pain and risks associated with open surgery. These devices also display enhanced conformability to local tissues and can reach sites that otherwise are inaccessible. This review aims at shedding light on the unique features of in situ generated devices and to underscore leading trends in the field, as they are reflected by key developments recently in the field over the last several years. Since the uniqueness of these devices stems from their in situ generation, the way they are formed is crucial. It is because of this fact that in this review, the medical devices are classified depending on whether their in situ generation entails chemical or physical phenomena.
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Affiliation(s)
- Daniel Cohn
- Casali Center of Applied ChemistryInstitute of ChemistryHebrew University of Jerusalem Jerusalem 91904 Israel
| | - Aaron Sloutski
- Casali Center of Applied ChemistryInstitute of ChemistryHebrew University of Jerusalem Jerusalem 91904 Israel
| | - Ariel Elyashiv
- Casali Center of Applied ChemistryInstitute of ChemistryHebrew University of Jerusalem Jerusalem 91904 Israel
| | - Vijaykumar B. Varma
- School of Materials Science and EngineeringNanyang Technological University 639798 Singapore Singapore
| | - Raju Ramanujan
- School of Materials Science and EngineeringNanyang Technological University 639798 Singapore Singapore
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Sangeetha R, Madheswari D, Priya G. Fabrication of poly (methyl methacrylate)/Ce/Cu substituted apatite/Egg white (Ovalbumin) biocomposite owning adjustable properties: Towards bone tissue rejuvenation. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2018; 187:162-169. [DOI: 10.1016/j.jphotobiol.2018.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 01/25/2023]
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Kirillova A, Kelly C, Windheim N, Gall K. Bioinspired Mineral-Organic Bioresorbable Bone Adhesive. Adv Healthc Mater 2018; 7:e1800467. [PMID: 29938916 DOI: 10.1002/adhm.201800467] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/29/2018] [Indexed: 12/17/2022]
Abstract
Bioresorbable bone adhesives have potential to revolutionize the clinical treatment of the human skeletal system, ranging from the fixation and osteointegration of permanent implants to the direct healing and fusion of bones without permanent fixation hardware. Despite an unmet need, there are currently no bone adhesives in clinical use that provide a strong enough bond to wet bone while possessing good osteointegration and bioresorbability. Inspired by the sandcastle worm that creates a protective tubular shell around its body using a proteinaceous adhesive, a novel bone adhesive is introduced, based on tetracalcium phosphate and phosphoserine, that cures in minutes in an aqueous environment and provides high bone-to-bone adhesive strength. The new material is measured to be 10 times more adhesive than bioresorbable calcium phosphate cement and 7.5 times more adhesive than non-resorbable poly(methyl methacrylate) bone cement, both of which are standard of care in the clinic today. The bone adhesive also demonstrates chemical adhesion to titanium approximately twice that of its adhesion to bone, unlocking the potential for adherence to metallic implants during surrounding bony incorporation. Finally, the bone adhesive is shown to demonstrate osteointegration and bioresorbability over a 52-week period in a critically sized distal femur defect in rabbits.
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Affiliation(s)
- Alina Kirillova
- Department of Mechanical Engineering and Materials Science Edmund T. Pratt Jr., School of Engineering Duke University Durham NC 27708 USA
| | - Cambre Kelly
- Department of Mechanical Engineering and Materials Science Edmund T. Pratt Jr., School of Engineering Duke University Durham NC 27708 USA
| | - Natalia Windheim
- Department of Mechanical Engineering and Materials Science Edmund T. Pratt Jr., School of Engineering Duke University Durham NC 27708 USA
| | - Ken Gall
- Department of Mechanical Engineering and Materials Science Edmund T. Pratt Jr., School of Engineering Duke University Durham NC 27708 USA
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