1
|
Wang C, Liu J, Min S, Liu Y, Liu B, Hu Y, Wang Z, Mao F, Wang C, Ma X, Wen P, Zheng Y, Tian Y. The effect of pore size on the mechanical properties, biodegradation and osteogenic effects of additively manufactured magnesium scaffolds after high temperature oxidation: An in vitro and in vivo study. Bioact Mater 2023; 28:537-548. [PMID: 37457041 PMCID: PMC10344631 DOI: 10.1016/j.bioactmat.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/30/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
The effects of pore size in additively manufactured biodegradable porous magnesium on the mechanical properties and biodegradation of the scaffolds as well as new bone formation have rarely been reported. In this work, we found that high temperature oxidation improves the corrosion resistance of magnesium scaffold. And the effects of pore size on the mechanical characteristics and biodegradation of scaffolds, as well as new bone formation, were investigated using magnesium scaffolds with three different pore sizes, namely, 500, 800, and 1400 μm (P500, P800, and P1400). We discovered that the mechanical characteristics of the P500 group were much better than those of the other two groups. In vitro and in vivo investigations showed that WE43 magnesium alloy scaffolds supported the survival of mesenchymal stem cells and did not cause any local toxicity. Due to their larger specific surface area, the scaffolds in the P500 group released more magnesium ions within reasonable range and improved the osteogenic differentiation of bone mesenchymal stem cells compared with the other two scaffolds. In a rabbit femoral condyle defect model, the P500 group demonstrated unique performance in promoting new bone formation, indicating its great potential for use in bone defect regeneration therapy.
Collapse
Affiliation(s)
- Chaoxin Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Jinge Liu
- Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
| | - Shuyuan Min
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Yu Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Bingchuan Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Yuanyu Hu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Zhengguang Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| | - Fengbiao Mao
- Institute of Medicine Innovation and Research, Peking University Third Hospital, Beijing, 100191, China
| | - Caimei Wang
- Beijing AKEC Medical Co., Ltd., Beijing, 102200, China
| | - Xiaolin Ma
- Beijing AKEC Medical Co., Ltd., Beijing, 102200, China
| | - Peng Wen
- Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
| | - Yufeng Zheng
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, 100191, China
| |
Collapse
|
2
|
Zhang G, Zhen A, Chen J, Du B, Luo F, Li J, Tan H. In Vitro Effects of Waterborne Polyurethane 3D Scaffolds Containing Poly(lactic-co-glycolic acid)s of Different Lactic Acid/Glycolic Acid Ratios on the Inflammatory Response. Polymers (Basel) 2023; 15:polym15071786. [PMID: 37050400 PMCID: PMC10097270 DOI: 10.3390/polym15071786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/07/2023] Open
Abstract
The physical and chemical properties of tissue engineering scaffolds have considerable effects on the inflammatory response at the implant site in soft tissue repair. The development of inflammation-modulating polymer scaffolds for soft tissue repair is attracting increasing attention. In this study, in order to regulate the inflammatory response at the implant site, a series of waterborne polyurethane (WPU) scaffolds with different properties were synthesized using polyethylene glycol (PEG), polycaprolactone (PCL) and poly (lactic acid)–glycolic acid copolymers (PLGAs) with three lactic acid/glycolic acid (LA/GA) ratios as the soft segments. Then, scaffolds were obtained using freeze-drying. The WPU scaffolds exhibited a porous cellular structure, high porosity, proper mechanical properties for repairing nerve tissue and an adjustable degradation rate. In vitro cellular experiments showed that the degradation solution possessed high biocompatibility. The in vitro inflammatory response of C57BL/6 mouse brain microglia (immortalized) (BV2) cells demonstrated that the LA/GA ratio of the PLGA in WPU scaffolds can regulate the external inflammatory response by altering the secretion of IL-10 and TNF-α. Even the IL-10/TNF-α of PU5050 (3.64) reached 69 times that of the control group (0.053). The results of the PC12 culture on the scaffolds showed that the scaffolds had positive effects on the growth, proliferation and differentiation of nerve cells and could even promote the formation of synapses. Overall, these scaffolds, particularly the PU5050, indeed prevent BV2 cells from differentiating into a pro-inflammatory M1 phenotype, which makes them promising candidates for reducing the inflammatory response and repairing nerve tissue. Furthermore, PU5050 had the best effect on preventing the transformation of BV2 cells into the pro-inflammatory M1 phenotype.
Collapse
Affiliation(s)
- Guanyu Zhang
- State Key Laboratory of Polymer Materials Engineering, College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Ao Zhen
- State Key Laboratory of Polymer Materials Engineering, College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Jinlin Chen
- State Key Laboratory of Polymer Materials Engineering, College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Bohong Du
- State Key Laboratory of Polymer Materials Engineering, College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Feng Luo
- State Key Laboratory of Polymer Materials Engineering, College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Jiehua Li
- State Key Laboratory of Polymer Materials Engineering, College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Hong Tan
- State Key Laboratory of Polymer Materials Engineering, College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, China
| |
Collapse
|
3
|
Open-porous magnesium-based scaffolds withstand in vitro corrosion under cyclic loading: A mechanistic study. Bioact Mater 2023; 19:406-417. [PMID: 35574056 PMCID: PMC9062748 DOI: 10.1016/j.bioactmat.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 01/05/2023] Open
Abstract
The successful application of magnesium (Mg) alloys as biodegradable bone substitutes for critical-sized defects may be comprised by their high degradation rate resulting in a loss of mechanical integrity. This study investigates the degradation pattern of an open-porous fluoride-coated Mg-based scaffold immersed in circulating Hanks' Balanced Salt Solution (HBSS) with and without in situ cyclic compression (30 N/1 Hz). The changes in morphological and mechanical properties have been studied by combining in situ high-resolution X-ray computed tomography mechanics and digital volume correlation. Although in situ cyclic compression induced acceleration of the corrosion rate, probably due to local disruption of the coating layer where fatigue microcracks were formed, no critical failures in the overall scaffold were observed, indicating that the mechanical integrity of the Mg scaffolds was preserved. Structural changes, due to the accumulation of corrosion debris between the scaffold fibres, resulted in a significant increase (p < 0.05) in the material volume fraction from 0.52 ± 0.07 to 0.47 ± 0.03 after 14 days of corrosion. However, despite an increase in fibre material loss, the accumulated corrosion products appear to have led to an increase in Young's modulus after 14 days as well as lower third principal strain (εp3) accumulation (−91000 ± 6361 με and −60093 ± 2414 με after 2 and 14 days, respectively). Therefore, this innovative Mg scaffold design and composition provide a bone replacement, capable of sustaining mechanical loads in situ during the postoperative phase allowing new bone formation to be initially supported as the scaffold resorbs. First report on in vitro cyclic loading of MgF2 coated open-porous Mg scaffolds in HBSS simulating 2–3 months in humans. Fluoride-coating slows down corrosion under cyclic loading in vitro. Entangled scaffold structure accumulates local corrosion debris which keeps the mechanical integrity over 14 days in vitro.
Collapse
|
4
|
Antoniac I, Manescu (Paltanea) V, Paltanea G, Antoniac A, Nemoianu IV, Petrescu MI, Dura H, Bodog AD. Additive Manufactured Magnesium-Based Scaffolds for Tissue Engineering. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8693. [PMID: 36500191 PMCID: PMC9739563 DOI: 10.3390/ma15238693] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Additive manufacturing (AM) is an important technology that led to a high evolution in the manufacture of personalized implants adapted to the anatomical requirements of patients. Due to a worldwide graft shortage, synthetic scaffolds must be developed. Regarding this aspect, biodegradable materials such as magnesium and its alloys are a possible solution because the second surgery for implant removal is eliminated. Magnesium (Mg) exhibits mechanical properties, which are similar to human bone, biodegradability in human fluids, high biocompatibility, and increased ability to stimulate new bone formation. A current research trend consists of Mg-based scaffold design and manufacture using AM technologies. This review presents the importance of biodegradable implants in treating bone defects, the most used AM methods to produce Mg scaffolds based on powder metallurgy, AM-manufactured implants properties, and in vitro and in vivo analysis. Scaffold properties such as biodegradation, densification, mechanical properties, microstructure, and biocompatibility are presented with examples extracted from the recent literature. The challenges for AM-produced Mg implants by taking into account the available literature are also discussed.
Collapse
Affiliation(s)
- Iulian Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 54 Splaiul Independentei, 050094 Bucharest, Romania
| | - Veronica Manescu (Paltanea)
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Gheorghe Paltanea
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Iosif Vasile Nemoianu
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Mircea Ionut Petrescu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Horatiu Dura
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Alin Danut Bodog
- Faculty of Medicine and Pharmacy, University of Oradea, 10 P-ta 1 December Street, 410073 Oradea, Romania
| |
Collapse
|
5
|
Nasr Azadani M, Zahedi A, Bowoto OK, Oladapo BI. A review of current challenges and prospects of magnesium and its alloy for bone implant applications. Prog Biomater 2022; 11:1-26. [PMID: 35239157 DOI: 10.1007/s40204-022-00182-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/29/2022] [Indexed: 02/08/2023] Open
Abstract
Medical application materials must meet multiple requirements, and the designed implant must mimic the bone structure in shape and support the formation of bone tissue (osteogenesis). Magnesium (Mg) alloys, as a "smart" biodegradable material and as "the green engineering material in the twenty-first century", have become an outstanding bone implant material due to their natural degradability, smart biocompatibility, and desirable mechanical properties. Magnesium is recognised as the next generation of orthopaedic appliances and bioresorbable scaffolds. At the same time, improving the mechanical properties and corrosion resistance of magnesium alloys is an urgent challenge to promote the application of magnesium alloys. Nevertheless, the excessively quick deterioration rate generally results in premature mechanical integrity disintegration and local hydrogen build-up, resulting in restricted clinical bone restoration applicability. The condition of Mg bone implants is thoroughly examined in this study. The relevant approaches to boost the corrosion resistance, including purification, alloying treatment, surface coating, and Mg-based metal matrix composite, are comprehensively revealed. These characteristics are reviewed to assess the progress of contemporary Mg-based biocomposites and alloys for biomedical applications. The fabricating techniques for Mg bone implants also are thoroughly investigated. Notably, laser-based additive manufacturing fabricates customised forms and complicated porous structures based on its distinctive additive manufacturing conception. Because of its high laser energy density and strong controllability, it is capable of fast heating and cooling, allowing it to modify the microstructure and performance. This review paper aims to provide more insight on the present challenges and continued research on Mg bone implants, highlighting some of the most important characteristics, challenges, and strategies for improving Mg bone implants.
Collapse
Affiliation(s)
- Meysam Nasr Azadani
- School of Engineering and Sustainable Development, De Montfort University, Leicester, LE1 9BH, UK.
| | - Abolfazl Zahedi
- School of Engineering and Sustainable Development, De Montfort University, Leicester, LE1 9BH, UK
| | - Oluwole Kingsley Bowoto
- School of Engineering and Sustainable Development, De Montfort University, Leicester, LE1 9BH, UK
| | - Bankole Ibrahim Oladapo
- School of Engineering and Sustainable Development, De Montfort University, Leicester, LE1 9BH, UK
| |
Collapse
|
6
|
Li C, Lv H, Du Y, Zhu W, Yang W, Wang X, Wang J, Chen W. Biologically modified implantation as therapeutic bioabsorbable materials for bone defect repair. Regen Ther 2021; 19:9-23. [PMID: 35024389 PMCID: PMC8732753 DOI: 10.1016/j.reth.2021.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022] Open
Abstract
For decades, researches have concentrated on the mechanical properties, biodegradation, and biocompatibility of implants used in the therapy of large size bone defect. In vivo studies demonstrate that bioabsorbable bone substitute materials can reduce the risk of common symptoms such as inflammation and osteonecrosis caused by bio-inert materials after long-term implantation. Several organic, inorganic, and composite materials have been approved for clinical application, based on their unique characteristics and advantages. Although some artificial bioabsorbable bone substitute materials have been used for years, there are still some disadvantages existing, such as low mechanical strength, high brittleness, and low degradation rate. Therefore, novel bioabsorbable composite materials biomaterials have been developed for bone defect repair. In this review, we provide an overview of the development of artificial bioabsorbable bone substitute materials and highlight the advantages and disadvantages. Furthermore, recent advances in bioabsorbable bone substitute materials used in bone defect repair are outlined. Finally, we discuss current challenges and further developments in the clinical application of bioabsorbable bone substitute materials.
Collapse
Affiliation(s)
- Chao Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China
| | - Hongzhi Lv
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China
| | - Yawei Du
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, PR China
| | - Wenbo Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China
| | - Weijie Yang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China
| | - Xiumei Wang
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, No.30 Shuangqing Road, Beijing 100084, PR China
| | - Juan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Corresponding author. No.139 Ziqiang Road, Shjiazhuang 050051, PR China. Fax: +86-311-87023626.
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, PR China,Corresponding author. No.139 Ziqiang Road, Shjiazhuang 050051, PR China. Fax: +86-311-87023626.
| |
Collapse
|
7
|
Post-corrosion mechanical properties of absorbable open cell iron foams with hollow struts. J Mech Behav Biomed Mater 2021; 117:104413. [PMID: 33640846 DOI: 10.1016/j.jmbbm.2021.104413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/06/2021] [Accepted: 02/17/2021] [Indexed: 11/21/2022]
Abstract
In-depth analyses of post-corrosion mechanical properties and architecture of open cell iron foams with hollow struts as absorbable bone scaffolds were carried out. Variations in the architectural features of the foams after 14 days of immersion in a Hanks' solution were investigated using micro-computed tomography and scanning electron microscope images. Finite element Kelvin foam model was developed, and the numerical modeling and experimental results were compared against each other. It was observed that the iron foam samples were mostly corroded in the periphery regions. Except for quasi-elastic gradient, other mechanical properties (i.e. compressive strength, yield strength and energy absorbability) decreased monotonically with immersion time. Presence of adherent corrosion products enhanced the load-bearing capacity of the open cell iron foams at small strains. The finite element prediction for the quasi-elastic response of the 14-day corroded foam was in an agreement with the experimental results. This study highlights the importance of considering corrosion mechanism when designing absorbable scaffolds; this is indispensable to offer desirable mechanical properties in porous materials during degradation in a biological environment.
Collapse
|
8
|
Yang X, Chen S, Liu X, Yu M, Liu X. Drug Delivery Based on Nanotechnology for Target Bone Disease. Curr Drug Deliv 2020; 16:782-792. [PMID: 31530265 DOI: 10.2174/1567201816666190917123948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/03/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023]
Abstract
Bone diseases are a serious problem in modern human life. With the coming acceleration of global population ageing, this problem will become more and more serious. Due to the specific physiological characteristics and local microenvironment of bone tissue, it is difficult to deliver drugs to the lesion site. Therefore, the traditional orthopedic medicine scheme has the disadvantages of high drug frequency, large dose and relatively strong side effects. How to target deliver drugs to the bone tissue or even target cells is the focus of the development of new drugs. Nano drug delivery system with a targeting group can realize precise delivery of orthopedic drugs and effectively reduce the systemic toxicity. In addition, the application of bone tissue engineering scaffolds and biomedical materials to realize in situ drug delivery also are research hotspot. In this article, we briefly review the application of nanotechnology in targeted therapies for bone diseases.
Collapse
Affiliation(s)
- Xiaosong Yang
- Orthopedic Department, Peking University Third Hospital, Beijing 100191, China
| | - Shizhu Chen
- Laboratory for Biological Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Xiao Liu
- Orthopedic Department, Peking University Third Hospital, Beijing 100191, China
| | - Miao Yu
- Orthopedic Department, Peking University Third Hospital, Beijing 100191, China
| | - Xiaoguang Liu
- Orthopedic Department, Peking University Third Hospital, Beijing 100191, China
| |
Collapse
|