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Sharun K, Banu SA, El-Husseiny HM, Abualigah L, Pawde AM, Dhama K, Amarpal. Exploring the applications of platelet-rich plasma in tissue engineering and regenerative medicine: evidence from goat and sheep experimental research. Connect Tissue Res 2024:1-19. [PMID: 39246090 DOI: 10.1080/03008207.2024.2397657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 08/14/2024] [Accepted: 08/23/2024] [Indexed: 09/10/2024]
Abstract
Platelet-rich plasma (PRP) has emerged as a promising therapeutic approach in regenerative medicine. It contains various growth factors and bioactive molecules that play pivotal roles in tissue repair, regeneration, and inflammation modulation. This comprehensive narrative review delves into the therapeutic potential of PRP in experimental goat and sheep research, exploring recent advancements, challenges, and future prospects in the field. PRP has been explored for its application in musculoskeletal injuries, wound healing, and orthopedic conditions. Studies have demonstrated the ability of PRP to accelerate tissue healing, reduce inflammation, and improve the overall quality of healing. Recent advancements in PRP technology have led to the development of novel formulations and delivery methods to enhance its therapeutic efficacy. PRP has shown promise in tendon and ligament injuries, osteoarthritis, and bone fractures in experimental goat and sheep research. Despite these advancements, several challenges and opportunities exist to harness the full therapeutic potential of PRP in regenerative medicine. Standardizing PRP preparation protocols, including blood collection techniques, centrifugation parameters, and activation methods, is essential to ensure consistency and reproducibility of the findings. Moreover, further research is needed to elucidate the optimal dosing, frequency, and timing of PRP administration for different clinical indications. Research conducted in goat and sheep models provides evidence supporting the translational potential of PRP in tissue engineering and regenerative medicine. By harnessing the regenerative properties of PRP and leveraging insights from preclinical studies, researchers can develop innovative therapeutic strategies to address unmet clinical needs and improve patient outcomes in diverse medical specialties.
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Affiliation(s)
- Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan
| | - S Amitha Banu
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - Hussein M El-Husseiny
- Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Benha University, Toukh, Elqaliobiya, Egypt
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo, Fuchu-shi, Japan
| | - Laith Abualigah
- Artificial Intelligence and Sensing Technologies (AIST) Research Center, University of Tabuk, Tabuk, Saudi Arabia
- MEU Research Unit, Middle East University, Amman, Jordan
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Centre for Research Impact & Outcome, Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura, Punjab, India
| | - A M Pawde
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - Amarpal
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
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Bacevich BM, Smith RDJ, Reihl AM, Mazzocca AD, Hutchinson ID. Advances with Platelet-Rich Plasma for Bone Healing. Biologics 2024; 18:29-59. [PMID: 38299120 PMCID: PMC10827634 DOI: 10.2147/btt.s290341] [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: 10/05/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
Despite significant advances in the understanding and delivery of osteosynthesis, fracture non-union remains a challenging clinical problem in orthopaedic surgery. To bridge the gap, basic science characterization of fracture healing provides a platform to identify and target biological strategies to enhance fracture healing. Of immense interest, Platelet-rich plasma (PRP) is a point of care orthobiologic that has been extensively studied in bone and soft tissue healing given its relative ease of translation from the benchtop to the clinic. The aim of this narrative review is to describe and relate pre-clinical in-vitro and in-vivo findings to clinical observations investigating the efficacy of PRP to enhance bone healing for primary fracture management and non-union treatment. A particular emphasis is placed on the heterogeneity of PRP preparation techniques, composition, activation strategies, and delivery. In the context of existing data, the routine use of PRP to enhance primary fracture healing and non-union management cannot be supported. However, it is acknowledged that extensive heterogeneity of PRP treatments in clinical studies adds obscurity; ultimately, refinement (and consensus) of PRP treatments for specific clinical indications, including repetition studies are warranted.
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Affiliation(s)
- Blake M Bacevich
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Richard David James Smith
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Alec M Reihl
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Augustus D Mazzocca
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
- Medical Director, Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Brigham, Boston, MA, USA
| | - Ian D Hutchinson
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
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3
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Yang YP, Gadomski BC, Bruyas A, Easley J, Labus KM, Nelson B, Palmer RH, Stewart H, McGilvray K, Puttlitz CM, Regan D, Stahl A, Lui E, Li J, Moeinzadeh S, Kim S, Maloney W, Gardner MJ. Investigation of a Prevascularized Bone Graft for Large Defects in the Ovine Tibia. Tissue Eng Part A 2021; 27:1458-1469. [PMID: 33858216 DOI: 10.1089/ten.tea.2020.0347] [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] [Indexed: 12/17/2022] Open
Abstract
In vivo bioreactors are a promising approach for engineering vascularized autologous bone grafts to repair large bone defects. In this pilot parametric study, we first developed a three-dimensional (3D) printed scaffold uniquely designed to accommodate inclusion of a vascular bundle and facilitate growth factor delivery for accelerated vascular invasion and ectopic bone formation. Second, we established a new sheep deep circumflex iliac artery (DCIA) model as an in vivo bioreactor for engineering a vascularized bone graft and evaluated the effect of implantation duration on ectopic bone formation. Third, after 8 weeks of implantation around the DCIA, we transplanted the prevascularized bone graft to a 5 cm segmental bone defect in the sheep tibia, using the custom 3D printed bone morphogenic protein 2 (BMP-2) loaded scaffold without prior in vivo bioreactor maturation as a control. Analysis by micro-computed tomography and histomorphometry found ectopic bone formation in BMP-2 loaded scaffolds implanted for 8 and 12 weeks in the iliac pouch, with greater bone formation occurring after 12 weeks. Grafts transplanted to the tibial defect supported bone growth, mainly on the periphery of the graft, but greater bone growth and less soft tissue invasion was observed in the avascular BMP-2 loaded scaffold implanted directly into the tibia without prior in vivo maturation. Histopathological evaluation noted considerably greater vascularity in the bone grafts that underwent in vivo maturation with an inserted vascular bundle compared with the avascular BMP-2 loaded graft. Our findings indicate that the use of an initial DCIA in vivo bioreactor maturation step is a promising approach to developing vascularized autologous bone grafts, although scaffolds with greater osteoinductivity should be further studied. Impact statement This translational pilot study aims at combining a tissue engineering scaffold strategy, in vivo prevascularization, and a modified transplantation technique to accelerate large segmental bone defect repair. First, we three-dimensional (3D) printed a 5 cm scaffold with a unique design to facilitate vascular bundle inclusion and osteoinductive growth factor delivery. Second, we established a new sheep deep circumflex iliac artery model as an in vivo bioreactor for prevascularizing the novel 3D printed osteoinductive scaffold. Subsequently, we transplanted the prevascularized bone graft to a clinically relevant 5 cm segmental bone defect in the sheep tibia for bone regeneration.
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Affiliation(s)
- Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Material Science and Engineering, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Benjamin C Gadomski
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Arnaud Bruyas
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Jeremiah Easley
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Kevin M Labus
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Brad Nelson
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Ross H Palmer
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Holly Stewart
- Department of Clinical Sciences, and Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Kirk McGilvray
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Christian M Puttlitz
- Department of Mechanical Engineering and School of Biomedical Engineering, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Dan Regan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Alexander Stahl
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Chemistry and Stanford University, Stanford, California, USA
| | - Elaine Lui
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Jiannan Li
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Seyedsina Moeinzadeh
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Sungwoo Kim
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - William Maloney
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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Rollo G, Bonura EM, Falzarano G, Bisaccia M, Ribes Iborra J, Grubor P, Filipponi M, Pichierri P, Hitov P, Leonetti D, Russi V, Daghino W, Meccariello L. Platet Rich Plasma or Hyperbaric Oxygen Therapy as callus accellerator in aseptic tibial non union. Evaluate of outcomes. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020188. [PMID: 33525281 PMCID: PMC7927478 DOI: 10.23750/abm.v91i4.8818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 05/16/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM OF THE WORK The incidence of long bone non-unions has been estimated to range between 5-10%. Nonunion of fracture is a delayed complication of fracture. A large bone resection, associated with Ilizarov's osteo-distraction technique, is commonly used in these cases. The war experience was very important for dealing with these injuries. The purpose of this study is to report whether the use of Platelet Rich of Plasma(PRP) or Hyperbric Oxygen Therapy(HOT) as an adjuvant to the osteogenic distraction of Ilizarov with respect to the classical method has advantages. METHODS From 183 tibial non union, we enrolled 50 patients suffering by Type B according ASAMI non union classification. We divided the patients into two groups. The first group was a retrospective group of patient treated by Ilizarov Tecnique plus PRP. Instead the second group, patients were treated by Ilizarov Tecnique associated with HOT. The chosen criteria to evaluate the two groups during the clinical and radiological follow-up were: the complication after the surgery in the two groups; the duration of surgery; the objective quality Bone results and functional results were evaluated according to ASAMI classification while the subjective quality of life correlated with Ilizarov frame function by the Short Form 12 Health Survey (SF-12); The correlation between bone regenerate/bone healing and X-rays. The evaluation endpoint was set at 12 months from the remotion of Ilizarov's frame for both groups. RESULTS In comparing the complications of the two populations, there were a significant statistically difference(p<0.05) in the local skin inflammation and Dockin Point Skin retraction for HOT group while in refracture p<0.05 was for group PRP. From the SF-12 we discovered not statistically differences p<0.05. The average correlation between Bone Regenerate-Bone Healing/ X-rays is absolutely in the PRP as in the HOT, p>0.05. The average Time for remove Ilizarov's Frame in months was 15.37(±7.34; range 9-32) in PRP while in HOT was15.22(± 7.83; range 9-31), p>0.05. CONCLUSIONS From our study we can conclude that the association of HOT and PRP with the Ilizarov technique does not improve the functional outcomes but allows a more rapid healing of the regenerated bone and therefore an early removal of the device and a corresponding improvement in the quality of life.
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Affiliation(s)
- Giuseppe Rollo
- Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
| | - Enrico Maria Bonura
- Department of Orthopaedics and Traumatology, Poliambulanza Foundation Hospital, Brescia, Italy..
| | - Gabriele Falzarano
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy.
| | - Michele Bisaccia
- Division of Orthopaedics and Trauma Surgery, University of Perugia, "S. Maria della Misericordia" Hospital, Perugia, Italy.
| | - Julio Ribes Iborra
- University of Valencia, "La Ribera" Hospital, Valencia, Spain Division of Orthopaedics and Trauma Surgery.
| | - Predrag Grubor
- Clinic of Traumatology, University Hospital Clinical Center Banja Luka, Bosnia and Herzegovina.
| | - Marco Filipponi
- Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
| | - Paolo Pichierri
- Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
| | - Philip Hitov
- 2nd Clinic of Orthopaedics and Traumatology, "N.I. Pirogov" University multiprofile Hospital, Sofia, Bulgaria.
| | - Danilo Leonetti
- Department of Orthopaedics and Traumatology, University Hospital "Gaetano Martino" Messina, Italy.
| | - Valentina Russi
- Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
| | - Walter Daghino
- Orthopaedic Clinic, CTO University Hospital, Turin, Italy..
| | - Luigi Meccariello
- Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
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The effect of platelet-rich plasma on fracture healing in long-bone pseudoarthrosis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1481-1486. [PMID: 32617687 DOI: 10.1007/s00590-020-02730-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to investigate the effects of platelet-rich plasma (PRP) on fracture union rate and fracture union time in pseudoarthrosis surgery and to evaluate the clinical and functional results of the patients. METHODS The patients who were undergone pseudoarthrosis surgery between 2011 and 2014 were evaluated retrospectively. Twenty-four patients were included in the study. Patients were divided into two groups with used PRP and not used PRP during surgery. There were 14 patients in the PRP group and 10 patients in the control group. The two groups were compared in terms of demographic characteristics, fracture union time, and functional scores of the Lower Extremity Functional Scale and Upper Extremity Functional Index. RESULTS Fractures were healed in both groups, and no complications were encountered. A statistically significant difference was found between the two groups in terms of fracture union time. The mean time of union was 5.3 months in the PRP group and 11.3 months in the control group (p: 0.000). There was no statistically significant difference between the two groups in terms of functional scores (p: 0.250). CONCLUSION As a result of our study, we concluded that PRP is an effective and safe method in pseudoarthrosis surgery that reduces fracture union time. Controlled studies with more patient numbers are needed.
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McEwan JK, Tribe HC, Jacobs N, Hancock N, Qureshi AA, Dunlop DG, Oreffo RO. Regenerative medicine in lower limb reconstruction. Regen Med 2018; 13:477-490. [PMID: 29985779 DOI: 10.2217/rme-2018-0011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Bone is a highly specialized connective tissue and has a rare quality as one of the few tissues that can repair without a scar to regain pre-injury structure and function. Despite the excellent healing capacity of bone, tumor, infection, trauma and surgery can lead to significant bone loss requiring skeletal augmentation. Bone loss in the lower limb poses a complex clinical problem, requiring reconstructive techniques to restore form and function. In the past, amputation may have been the only option; however, there is now an array of reconstructive possibilities and cellular therapies available to salvage a limb. In this review, we will evaluate current applications of bone tissue engineering techniques in limb reconstruction and identify potential strategies for future work.
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Affiliation(s)
- Josephine K McEwan
- Bone & Joint Research Group, Centre for Human Development, Stem Cell & Regeneration, Institute of Developmental Sciences, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Howard C Tribe
- Bone & Joint Research Group, Centre for Human Development, Stem Cell & Regeneration, Institute of Developmental Sciences, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Neal Jacobs
- Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Nicholas Hancock
- Trauma & Orthopaedic Department, University Hospital Southampton, Southampton, UK
| | - Amir A Qureshi
- Trauma & Orthopaedic Department, University Hospital Southampton, Southampton, UK
| | - Douglas G Dunlop
- Trauma & Orthopaedic Department, University Hospital Southampton, Southampton, UK
| | - Richard Oc Oreffo
- Bone & Joint Research Group, Centre for Human Development, Stem Cell & Regeneration, Institute of Developmental Sciences, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
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7
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Montes-Medina L, Hernández-Fernández A, Gutiérrez-Rivera A, Ripalda-Cemboráin P, Bitarte N, Pérez-López V, Granero-Moltó F, Prosper F, Izeta A. Effect of bone marrow stromal cells in combination with biomaterials in early phases of distraction osteogenesis: An experimental study in a rabbit femur model. Injury 2018; 49:1979-1986. [PMID: 30219381 DOI: 10.1016/j.injury.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 08/24/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023]
Abstract
Acceleration of the consolidation of the distracted bone is a relevant medical need. As a platform to improve in vivo bone engineering, we developed a novel distraction osteogenesis (DO) model in a rabbit large bone (femur) and tested if the application of cultured bone marrow stromal cells (BMSCs) immediately after the osteotomy promotes the formation of bone. This report consists of two components, an animal study to evaluate the quality of the regenerate following different treatments and an in vitro study to evaluate osteogenic potential of BMSC cultures. To illuminate the mechanism of action of injected cells, we tested stem cell cultures enriched in osteogenic-BMSCs (O-BMSCs) as compared with cultures enriched in non-osteogenic BMSCs (NO-BMSCs). Finally, we included a group of animals treated with biomaterials (fibrin and ground cortical bone) in addition to cells. Injection of O-BMSCs promoted the maturity of distracted callus and decreased fibrosis. When combined with biomaterials, O-BMSCs modified the ossification pattern from endochondral to intramembranous type. The use of NO-BMSCs not only did not increase the maturity but also increased porosity of the bone. These preclinical results indicate that the BMSC cultures must be tested in vitro prior to clinical use, since a number of factors may influence their outcome in bone formation. We hypothesize that the use of osteogenic BMSCs and biomaterials could be clinically beneficial to shorten the consolidation period of the distraction and the total period of bone lengthening.
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Affiliation(s)
- Laura Montes-Medina
- Department of Orthopaedic Surgery, Donostia University Hospital, San Sebastian, Spain
| | - Alberto Hernández-Fernández
- Department of Orthopaedic Surgery, Donostia University Hospital, San Sebastian, Spain; Department of Surgery, Radiology and Physical Medicine of the University of the Basque Country (UPV-EHU), San Sebastian, Spain
| | | | | | - Nerea Bitarte
- Tissue Engineering Group, Bioengineering Area, Instituto Biodonostia, San Sebastian, Spain
| | - Virginia Pérez-López
- Tissue Engineering Group, Bioengineering Area, Instituto Biodonostia, San Sebastian, Spain
| | - Froilán Granero-Moltó
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain; Cell Therapy Area, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Felipe Prosper
- Cell Therapy Area, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Ander Izeta
- Tissue Engineering Group, Bioengineering Area, Instituto Biodonostia, San Sebastian, Spain; Department of Biomedical Engineering and Science, School of Engineering, Tecnun-University of Navarra, San Sebastian, Spain.
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Shibata M, Takagi G, Kudo M, Kurita J, Kawamoto Y, Miyagi Y, Kanazashi M, Sakatani T, Naito Z, Tabata Y, Miyamoto M, Nitta T. Enhanced Sternal Healing Through Platelet-Rich Plasma and Biodegradable Gelatin Hydrogel. Tissue Eng Part A 2018; 24:1406-1412. [DOI: 10.1089/ten.tea.2017.0505] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Masafumi Shibata
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Gen Takagi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Mitsuhiro Kudo
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Jiro Kurita
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Yoko Kawamoto
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Yasuo Miyagi
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mikimoto Kanazashi
- Kanagawa Dental University, Graduate School of Dentistry, Department of Oral Functional & Restoration, Division of Periodontology, Kanagawa, Japan
| | - Takashi Sakatani
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Zenya Naito
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Yasuhiko Tabata
- Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
| | - Masaaki Miyamoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
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Mokhtari H, Montaseri A, Mojaddadi A, Mokhtari Zonouzi HR, Karimiyan N, Arami S. Effect of Platelet-Rich Plasma on Differentiation of Osteoblasts and Osteoclasts in the Presence of Three-Dimensional Scaffold. PHARMACEUTICAL SCIENCES 2018. [DOI: 10.15171/ps.2018.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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10
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Marcazzan S, Taschieri S, Weinstein RL, Del Fabbro M. Efficacy of platelet concentrates in bone healing: A systematic review on animal studies - Part B: Large-size animal models. Platelets 2017; 29:338-346. [PMID: 29206070 DOI: 10.1080/09537104.2017.1384537] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the presence of large bone defects, delayed bone union, or nonunion and fractures, bone reconstruction may be necessary. Different strategies have been employed to enhance bone healing among which the use of autologous platelet concentrates (APCs). Due to the high content of platelets and platelet-derived bioactive molecules (e.g., growth factors, antimicrobial peptides), they are promising candidates to enhance bone healing. However, both preclinical and clinical studies produced contrasting results, mainly due to a high heterogeneity in study design, objectives, techniques adopted, and outcomes assessed. The aim of the present systematic review was to evaluate the efficacy of APCs in animal models of bone regeneration, considering the possible factors that might affect the outcome. An electronic search was performed on MEDLINE and Scopus databases. Comparative animal studies with a minimum follow up of 2 weeks, at least five subjects per group and using APCs for regeneration of bone defects were included. Articles underwent risk of bias assessment and quality evaluation. Fifty studies performed on six animal species (rat, rabbit, dog, sheep, goat, mini-pig) were included. The present part of the review considers studies performed on small ruminants, dogs, and mini-pigs (14 articles). The majority of the studies were considered at low risk of bias. In general, APCs' adjunct positively affected bone regeneration. Animal species, platelet and growth factors concentration, type of bone defect and of platelet concentrate used seemed to influence their efficacy in bone healing. However, sound conclusions were not drawn since too few studies for each large-size animal model were included. In addition, characterization of APCs' content was performed only in a few studies. Further studies with a standardized protocol including characterization of the final products will provide useful information for translating the results to clinical application of APCs in bone surgery.
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Affiliation(s)
- Sabrina Marcazzan
- a Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche , Università degli Studi di Milano , Milan , Italy.,b Department of Nanomedicine, Houston Methodist Research Institute , Houston, TX, USA
| | - Silvio Taschieri
- a Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche , Università degli Studi di Milano , Milan , Italy.,c Dental Clinic, IRCCS (Scientific Institute for Care and Clinical Research) Istituto Ortopedico Galeazzi, Milan , Italy
| | | | - Massimo Del Fabbro
- a Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche , Università degli Studi di Milano , Milan , Italy
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Oryan A, Alidadi S, Bigham-Sadegh A, Moshiri A. Effectiveness of tissue engineered based platelet gel embedded chitosan scaffold on experimentally induced critical sized segmental bone defect model in rat. Injury 2017; 48:1466-1474. [PMID: 28460883 DOI: 10.1016/j.injury.2017.04.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/21/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Healing and regeneration of large bone defects are a challenging problem for reconstructive orthopedic surgeons. PURPOSE This study investigated the effectiveness of chitosan scaffold (CS), platelet gel (PG) and their combination (CS-PG) on healing process of an experimentally induced critical sized segmental bone defect model in rat. METHODS Fifty bilateral defects were created in the mid diaphysis of the radial bones of 25 Sprague-Dawley rats. The animals were randomly divided into five equal groups. The bone defects were either left untreated or treated with corticomedullary autograft, CS, PG or CS-PG. Plain radiographs were provided from the radial bones on weeks 2, 5, and 8 after injury. In addition, clinical examinations were done for the healing radial bones. The animals were euthanized after 8 weeks of injury, and their harvested samples were evaluated by gross morphology, histopathology, scanning electron microscopy, CT-scan, and biomechanical testing. RESULTS Compared with the defect group, the PG and autograft treated bone defects had significantly superior radiological scored values, bone volume and biomechanical performance which had positive correlation with their superior gross pathological, histopathological and ultra-structural features. Compared with the untreated defects, the PG and CS-PG treated defects showed significantly superior structural and functional properties so that PG had the highest value. In addition, CS had low value in bone regeneration. Although combination of CS and PG improved the healing efficacy of the CS, this strategy reduced the ability of PG to increase osteoconduction and osteoinduction during bone regeneration. CONCLUSION Application of PG alone enhanced bone healing and can be regarded as a promising option for bone tissue engineering in clinical settings. Chitosan was not effective in bone reconstruction surgery and further investigations should be conducted to find a suitable carrier for PG.
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Affiliation(s)
- Ahmad Oryan
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
| | - Soodeh Alidadi
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Amin Bigham-Sadegh
- Department of Clinical Sciences, School of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
| | - Ali Moshiri
- Razi Drug Research Center, Iran University of Medical Sciences, Tehran, Iran
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Role of platelet gel embedded within gelatin scaffold on healing of experimentally induced critical-sized radial bone defects in rats. INTERNATIONAL ORTHOPAEDICS 2017; 41:805-812. [DOI: 10.1007/s00264-016-3393-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/27/2016] [Indexed: 02/07/2023]
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Platelet-rich plasma for the treatment of bone defects: from pre-clinical rational to evidence in the clinical practice. A systematic review. INTERNATIONAL ORTHOPAEDICS 2016; 41:221-237. [PMID: 27888295 DOI: 10.1007/s00264-016-3342-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE The treatment of large bone defects represents a significant challenge for orthopaedic surgeons. In recent years, biologic agents have also been used to further improve bone healing. Among these, platelet-rich plasma (PRP) is the most exploited strategy. The aim of the present study was to systematically review the available literature to identify: 1) preclinical in-vivo results supporting the rational of PRP use for bone healing; 2) evidence from the clinical practice on the actual clinical benefit of PRP for the treatment of fractures and complications such as delayed unions and non-unions. METHODS A systematic review of the literature was performed on the application of PRP in bone healing, using the following inclusion criteria: pre-clinical and clinical reports of any level of evidence, written in English language, published in the last 20 years (1996-2016), on the use of PRP to stimulate long-bone defect treatment, with focus on fracture and delayed/non-unions healing. RESULTS The search in the Pubmed database identified 64 articles eligible for inclusion: 45 were preclinical in-vivo studies and 19 were clinical studies. Despite the fact that the overall pre-clinical results seem to support the benefit of PRP in 91.1 % of the studies, a more in depth analysis underlined a lower success rate, with a positive outcome of 84.4 % in terms of histological analysis, and even lower values considering radiological and biomechanical results (75.0 % and 72.7 % positive outcome respectively). This was also mirrored in the clinical literature, where the real benefit of PRP use to treat fractures and non-unions is still under debate. CONCLUSION Overall, the available literature presents major limitations in terms of low quality and extreme heterogeneity, which hamper the possibility to optimize PRP treatment and translate it into a real clinical benefit despite positive preclinical findings on its biological potential to favour bone healing.
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Zedda M, Palombo MR, Brits D, Carcupino M, Sathé V, Cacchioli A, Farina V. Differences in femoral morphology between sheep (Ovis aries) and goat (Capra hircus): macroscopic and microscopic observations. ZOOMORPHOLOGY 2016. [DOI: 10.1007/s00435-016-0329-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wang X, Luo Y, Masci PP, Crawford R, Xiao Y. Influence of Interleukin-1 Beta on Platelet-Poor Plasma Clot Formation: A Potential Impact on Early Bone Healing. PLoS One 2016; 11:e0149775. [PMID: 26909757 PMCID: PMC4766092 DOI: 10.1371/journal.pone.0149775] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/22/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Hematoma quality (especially the fibrin matrix) plays an important role in the bone healing process. Here, we investigated the effect of interleukin-1 beta (IL-1β) on fibrin clot formation from platelet-poor plasma (PPP). METHODS Five-milliliter of rat whole-blood samples were collected from the hepatic portal vein. All blood samples were firstly standardized via a thrombelastograph (TEG), blood cell count, and the measurement of fibrinogen concentration. PPP was prepared by collecting the top two-fifths of the plasma after centrifugation under 400 × g for 10 min at 20°C. The effects of IL-1β cytokines on artificial fibrin clot formation from PPP solutions were determined by scanning electronic microscopy (SEM), confocal microscopy (CM), turbidity, and clot lysis assays. RESULTS The lag time for protofibril formation was markedly shortened in the IL-1β treatment groups (243.8 ± 76.85 in the 50 pg/mL of IL-1β and 97.5 ± 19.36 in the 500 pg/mL of IL-1β) compared to the control group without IL-1β (543.8 ± 205.8). Maximal turbidity was observed in the control group. IL-1β (500 pg/mL) treatment significantly decreased fiber diameters resulting in smaller pore sizes and increased density of the fibrin clot structure formed from PPP (P < 0.05). The clot lysis assay revealed that 500 pg/mL IL-1β induced a lower susceptibility to dissolution due to the formation of thinner and denser fibers. CONCLUSION IL-1β can significantly influence PPP fibrin clot structure, which may affect the early bone healing process.
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Affiliation(s)
- Xin Wang
- Department of Spine, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou Province, China
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane, Queensland, Australia
- Translational Research Institute, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Yan Luo
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Paul P. Masci
- Translational Research Institute, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ross Crawford
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Yin Xiao
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane, Queensland, Australia
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Abstract
BACKGROUND Low-dose biplanar radiography (EOS) is an appealing imaging modality for use in children given its low radiation and ease of use. The goal of this study was to determine the accuracy and reliability of EOS compared with CT scanogram for measurement of leg length and to assess interrater and intrarater reliability of measured interbead distances for EOS and CT scanogram after insertion of tantalum beads into lamb femurs. METHODS Tantalum beads (0.8 mm) were inserted into the cortex on both the medial and lateral sides of 10 skeletally immature lamb femurs. CT scanogram and EOS imaging were obtained. Measurements of total length and distance between bead pairs were recorded on anteroposterior and lateral views by 2 orthopaedic surgeons on 2 separate occasions. Pearson correlations were performed for statistical comparisons. RESULTS EOS measurements showed near-perfect correlation to those of CT scanogram (r>0.96, P<0.001). Intrarater reliability was excellent for all measurements with EOS (r>0.98, P<0.001) and CT scanogram (r>0.99, P<0.001) as was interrater reliability for EOS (r>0.98, P<0.001) and CT scanogram (r>0.99, P<0.001). CONCLUSIONS EOS is comparable with CT scanogram in the assessment of limb length and the distance between 2 radiopaque markers. Reliability was excellent for all measurements. The combination of EOS imaging and tantalum bead implantation may be an effective way to evaluate physeal growth following procedures such as epiphysiodesis and physeal bar resection. LEVEL OF EVIDENCE Level II—diagnostic
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Oryan A, Alidadi S, Moshiri A. Platelet-rich plasma for bone healing and regeneration. Expert Opin Biol Ther 2015; 16:213-32. [DOI: 10.1517/14712598.2016.1118458] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Gianakos A, Zambrana L, Savage-Elliott I, Lane JM, Kennedy JG. Platelet-Rich Plasma in the Animal Long-Bone Model: An Analysis of Basic Science Evidence. Orthopedics 2015; 38:e1079-90. [PMID: 26652328 DOI: 10.3928/01477447-20151120-04] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/20/2015] [Indexed: 02/03/2023]
Abstract
Platelet-rich plasma (PRP) has been suggested as an adjunct to aid in long-bone healing. The purpose of this study was to systematically review the basic science in vivo evidence for the use of PRP in the treatment of bone pathology. The PubMed/MEDLINE and EMBASE databases were screened using the following search criteria: "(Platelet-rich plasma OR PRP OR autologous conditioned plasma OR ACP) AND (bone OR osteocytes OR osteogenesis OR nonunion OR delayed union)." Studies were included if they fulfilled the following criteria: (1) studied the effect of PRP or a similar concentrated platelet product, defined as a blood product with platelet concentration elevated to higher than baseline; (2) established a control with which to compare PRP; (3) were published in a peer-reviewed journal; and (4) looked specifically at animal long-bone models. All review articles and clinical studies, including randomized controlled trials and case series, were excluded from the review. Studies examining the effects of PRP on bones of animals with confounding pathology were excluded. In studies that contained additional treatment variables, only the portion of the experiment that compared PRP directly with the control were evaluated. Data were then extracted with a standardized table. The search yielded 29 articles for inclusion. Seventy-two percent of the studies reported platelet concentrations. Eighty-nine percent of studies reported significant improvement in earlier bone healing on histologic/histomorphometric assessment. One hundred percent showed significant increase in bone formation on radiographs in the PRP group. Eighty percent of studies reported a significant increase in bone area on microcomputed tomography. One hundred percent of studies showed a higher torsional stiffness for the PRP-treated defects. In the in vivo studies evaluated, PRP confers several beneficial effects on animal long-bone models. Proof of concept for PRP as a biologic adjunct in long-bone models has been determined.
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Dehghan MM, Baghaban Eslaminejad M, Motallebizadeh N, Ashrafi Halan J, Tagiyar L, Soroori S, Nikmahzar A, Pedram M, Shahverdi A, Kazemi Mehrjerdi H, Izadi S. Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells with Platelet-Rich Plasma Accelerate Distraction Osteogenesis in A Canine Model. CELL JOURNAL 2015. [PMID: 26199903 PMCID: PMC4503838 DOI: 10.22074/cellj.2016.3724] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective Distraction osteogenesis (DO) is a surgical procedure used to generate large
volumes of new bone for limb lengthening.
Materials and Methods In this animal experimental study, a 30% lengthening of the left
tibia (mean distraction distance: 60.8 mm) was performed in ten adult male dogs by callus
distraction after osteotomy and application of an Ilizarov fixator. Distraction was started on
postoperative day seven with a distraction rate of 0.5 mm twice per day and carried out at
a rate of 1.5 mm per day until the end of the study. Autologous bone marrow mesenchymal stem cells (BM-MSCs) and platelet-rich plasma (PRP) as the treatment group (n=5)
or PRP alone (control group, n=5) were injected into the distracted callus at the middle
and end of the distraction period. At the end of the consolidation period, the dogs were
sacrificed after which computerized tomography (CT) and histomorphometric evaluations
were performed.
Results Radiographic evaluationsrevealed that the amount and quality of callus formations were significantly higher in the treatment group (P<0.05). As measured by
CT scan, the healing parametersin dogs of the treatment group were significantly
greater (P<0.05). New bone formation in the treatment group was significantly higher
(P<0.05).
Conclusion The present study showed that the transplantation of BM-MSCs positively
affects early bony consolidation in DO. The use of MSCs might allow a shortened period
of consolidation and therefore permit earlier device removal.
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Affiliation(s)
- Mohammad Mehdi Dehghan
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Mohamadreza Baghaban Eslaminejad
- Department of Stem Cells and Developmental Biology at Cell Sciences Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | | | - Javad Ashrafi Halan
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Tabriz University, Tabriz, Iran
| | - Leila Tagiyar
- Department of Stem Cells and Developmental Biology at Cell Sciences Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Sarang Soroori
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Agbibi Nikmahzar
- Department of Stem Cells and Developmental Biology at Cell Sciences Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mirsepehr Pedram
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Abdolhossein Shahverdi
- Department of Stem Cells and Developmental Biology at Cell Sciences Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Hossein Kazemi Mehrjerdi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Sadra Izadi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
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Malhotra A, Pelletier M, Oliver R, Christou C, Walsh WR. Platelet-Rich Plasma and Bone Defect Healing. Tissue Eng Part A 2014; 20:2614-33. [DOI: 10.1089/ten.tea.2013.0737] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Angad Malhotra
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, The University of New South Wales, Prince of Wales Hospital, Randwick, Australia
| | - Matthew Pelletier
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, The University of New South Wales, Prince of Wales Hospital, Randwick, Australia
| | - Rema Oliver
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, The University of New South Wales, Prince of Wales Hospital, Randwick, Australia
| | - Chris Christou
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, The University of New South Wales, Prince of Wales Hospital, Randwick, Australia
| | - William R. Walsh
- Surgical and Orthopedic Research Laboratories, Prince of Wales Clinical School, The University of New South Wales, Prince of Wales Hospital, Randwick, Australia
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The Experimental Study on Promoting the Ilizarov Distraction Osteogenesis by the Injection of Liquid Alg/nHAC Biocomposites. INT J POLYM SCI 2014. [DOI: 10.1155/2014/238247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Limb lengthening is frequently utilized in treating limb length inequalities, angulation deformities, nonunions, complex fractures, and deficiencies after tumor resection in more recent year. The procedure of limb lengthening pioneered by Ilizarov is now a widely accepted method for correcting limb length inequality and short stature as well as for bridging large defects in long bones. In order to promote bone healing during distraction osteogenesis and reduce the complications caused by limb lengthening pioneered, an alginate/nanohydroxyapatite/collagen (Alg/nHAC) composite was fabricated. General observation, histologically morphological observations, X-ray examination, biomechanical test, bone density, and the percentage area of bone trabecula were used to assay the ability of Alg/nHAC composite to promote bone healing. The present study demonstrates that the injection of liquid Alg/nHAC composites can significantly promote distraction osteogenesis. Alg/nHAC composite is promising for clinical application, solving the healing problem of backbone osteotomy and the fixing problem of metaphyseal backbone.
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