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Zhao G, Jiang Z, Chen E, Ma T, Wu J, Song C, Li W. Biomechanical investigation of a customized interspinous spacer system in the treatment of degenerative disc diseases: A finite element analysis. Clin Biomech (Bristol, Avon) 2024; 116:106270. [PMID: 38776646 DOI: 10.1016/j.clinbiomech.2024.106270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND A novel interspinous fixation system based on anatomical parameters and incorporating transfacetopedicular screws, was developed to treat degenerative disc diseases. The biomechanical characteristics of the novel system were evaluated using finite element analysis in comparison to other classical interspinous spacers. METHODS The L1-S1 lumbar spine finite element models were surgically implanted with the novel system, Coflex and DIAM devices at the L4/L5 segment to assess the range of motion, the pression distribution of intervertebral disc, the peak stresses on the spinous process and implant during various motions. FINDINGS Range of motions of the L4/L5 surgical segment were reduced by 29.13%, 61.27%, 77.35%, 33.33%, and the peak stresses of intervertebral disc were decreased by 36.82%, 67.31%, 73.00%, 69.57% for the novel system in flexion, extension, lateral bending, and axial rotation when compared with the Coflex, and they were declined by 34.53%, 57.86%, 75.81%, 25.21%; 36.22%, 67.31%, 75.01%, 71.40% compared with DIAM. The maximum stresses of the spinous process were 29.93 MPa, 24.66 MPa, 14.45 MPa, 24.37 MPa in the novel system, and those of Coflex and DIAM were 165.3 MPa, 109 MPa, 84.79 MPa, 47.66 MPa and 52.59 MPa, 48.78 MPa, 50.27 MPa, 44.16 MPa during the same condition. INTERPRETATION Compared to other interspinous spacer devices, the novel interspinous fixation system demonstrated excellent stability, effectively distributing load on the intervertebral disc, and reducing the risk of spinous process fractures. The personalized design of the novel interspinous fixation system could be a viable option for treating degenerative disc diseases.
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Affiliation(s)
- Gaiping Zhao
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, PR China.
| | - Zhehua Jiang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, PR China
| | - Eryun Chen
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, Shanghai 200093, PR China
| | - Tong Ma
- Department of Bone and Joint Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai 200090, China.
| | - Jie Wu
- Key Laboratory of Hydrodynamics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chengli Song
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, PR China
| | - Weiqi Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, PR China
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Thirunavukarasu AJ, Morales-Wong F, Halim NSH, Han E, Koh SK, Zhou L, Kocaba V, Venkatraman S, Mehta JS, Riau AK. Nanohydroxyapatite Coating Attenuates Fibrotic and Immune Responses to Promote Keratoprosthesis Biointegration in Advanced Ocular Surface Disorders. ACS APPLIED MATERIALS & INTERFACES 2024; 16:25892-25908. [PMID: 38740379 PMCID: PMC11129699 DOI: 10.1021/acsami.4c04077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
Keratoprosthesis (KPro) implantation is frequently the only recourse for patients with severe corneal disease. However, problems arise due to inadequate biointegration of the KPro, particularly the PMMA optical cylinder, such as tissue detachment, tissue melting, or eye-threatening infection in the interface. Here, using the AuroKPro as a model prosthesis, a surface functionalization approach─coating the optical cylinder with nanohydroxyapatite (nHAp)─was trialed in rabbit eyes with and without a proceeding chemical injury. In chemically injured eyes, which simulated total limbal epithelial stem cell deficiency, clear benefits were conferred by the coating. The total modified Hackett-McDonald score and area of tissue apposition differences 12 weeks after implantation were 5.0 and 22.5%, respectively. Mechanical push-in tests revealed that 31.8% greater work was required to detach the tissues. These differences were less marked in uninjured eyes, which showed total score and tissue apposition differences of 2.5 and 11.5%, respectively, and a work difference of 23.5%. The improved biointegration could be contributed by the attenuated expression of fibronectin (p = 0.036), collagen 3A1 (p = 0.033), and α-smooth muscle actin (p = 0.045)─proteins typically upregulated during nonadherent fibrous capsule envelopment of bioinert material─adjacent to the optical cylinders. The coating also appeared to induce a less immunogenic milieu in the ocular surface tissue, evidenced by the markedly lower expression of tear proteins associated with immune and stimulus responses. Collectively, the level of these tear proteins in eyes with coated prostheses was 1.1 ± 13.0% of naïve eyes: substantially lower than with noncoated KPros (246.5 ± 79.3% of naïve, p = 0.038). Together, our results indicated that nHAp coating may reduce the risk of prosthesis failure in severely injured eyes, which are representative of the cohort of KPro patients.
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Affiliation(s)
- Arun J. Thirunavukarasu
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
- Oxford
University Clinical Academic Graduate School, University of Oxford, Oxford OX3 9DU, United
Kingdom
| | - Fernando Morales-Wong
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
- Singapore
National Eye Centre, Singapore 168751, Singapore
- Autonomous
University of Nuevo Leon, San Nicolas
de los Garza, Nuevo Leon 66455, Mexico
| | | | - Evelina Han
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
| | - Siew Kwan Koh
- Ocular
Proteomics Group, Singapore Eye Research
Institute, Singapore 169856, Singapore
| | - Lei Zhou
- Department
of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Centre
for Eye and Vision Research, Shatin, Hong Kong
| | - Viridiana Kocaba
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
| | - Subramanian Venkatraman
- Department
of Materials Science and Engineering, National
University of Singapore, Singapore 117575, Singapore
- iHealthTech, National University of Singapore, Singapore 117599, Singapore
| | - Jodhbir S. Mehta
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
- Singapore
National Eye Centre, Singapore 168751, Singapore
- Ophthalmology
and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Andri K. Riau
- Tissue
Engineering and Cell Therapy Group, Singapore
Eye Research Institute, Singapore 169856, Singapore
- Ophthalmology
and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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Zhu W, Li W, Yao M, Wang Y, Zhang W, Li C, Wang X, Chen W, Lv H. Mineralized Collagen/Polylactic Acid Composite Scaffolds for Load-Bearing Bone Regeneration in a Developmental Model. Polymers (Basel) 2023; 15:4194. [PMID: 37896438 PMCID: PMC10610794 DOI: 10.3390/polym15204194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/23/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Repairing load-bearing bone defects in children remains a big clinical challenge. Mineralized collagen (MC) can effectively simulate natural bone composition and hierarchical structure and has a good biocompatibility and bone conductivity. Polylactic acid (PLA) is regarded as a gold material because of its mechanical properties and degradability. In this study, we prepare MC/PLA composite scaffolds via in situ mineralization and freeze-drying. Cell, characterization, and animal experiments compare and evaluate the biomimetic properties and repair effects of the MC/PLA scaffolds. Phalloidin and DAPI staining results show that the MC/PLA scaffolds are not cytotoxic. CCK-8 and scratch experiments prove that the scaffolds are superior to MC and hydroxyapatite (HA)/PLA scaffolds in promoting cell proliferation and migration. The surface and interior of the MC/PLA scaffolds exhibit rich interconnected pore structures with a porosity of ≥70%. The XRD patterns are typical HA waveforms. X-ray, micro-CT, and H&E staining reveal that the defect boundary disappears, new bone tissue grows into MC/PLA scaffolds in a large area, and the scaffolds are degraded after six months of implantation. The MC/PLA composite scaffold has a pore structure and composition similar to cancellous bone, with a good biocompatibility and bone regeneration ability.
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Affiliation(s)
- Wenbo Zhu
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China; (W.Z.); (W.L.); (M.Y.); (Y.W.); (C.L.)
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang 050051, China
- National Health Commission Key Laboratory of Intelligent Orthopaedic Equipment, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China
| | - Wenjing Li
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China; (W.Z.); (W.L.); (M.Y.); (Y.W.); (C.L.)
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang 050051, China
- National Health Commission Key Laboratory of Intelligent Orthopaedic Equipment, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China
| | - Mengxuan Yao
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China; (W.Z.); (W.L.); (M.Y.); (Y.W.); (C.L.)
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang 050051, China
- National Health Commission Key Laboratory of Intelligent Orthopaedic Equipment, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China
| | - Yan Wang
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China; (W.Z.); (W.L.); (M.Y.); (Y.W.); (C.L.)
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang 050051, China
- National Health Commission Key Laboratory of Intelligent Orthopaedic Equipment, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China
| | - Wei Zhang
- Department of Pathology, Hebei Medical University, No. 361 Zhongshan Road, Shijiazhuang 050017, China;
| | - Chao Li
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China; (W.Z.); (W.L.); (M.Y.); (Y.W.); (C.L.)
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang 050051, China
- National Health Commission Key Laboratory of Intelligent Orthopaedic Equipment, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, 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, China;
| | - Wei Chen
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China; (W.Z.); (W.L.); (M.Y.); (Y.W.); (C.L.)
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang 050051, China
- National Health Commission Key Laboratory of Intelligent Orthopaedic Equipment, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China
| | - Hongzhi Lv
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China; (W.Z.); (W.L.); (M.Y.); (Y.W.); (C.L.)
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang 050051, China
- National Health Commission Key Laboratory of Intelligent Orthopaedic Equipment, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang 050051, China
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Koch K, Szoverfi Z, Jakab G, Varga PP, Hoffer Z, Lazary A. Complication Pattern After Percutaneous Cement Discoplasty: Identification of Factors Influencing Reoperation and Length of Hospital Stay. World Neurosurg 2023; 178:e700-e711. [PMID: 37544606 DOI: 10.1016/j.wneu.2023.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Percutaneous cement discoplasty (PCD) was introduced to treat symptomatic vertical instability of the lumbar spine in a minimally invasive way. The aim of the present study was to analyze the complication pattern after PCD and to identify factors that predict the chance of cement leakage, reoperation, and length of hospital stay (LOS). METHODS patients were treated with PCD within the study period. Clinical features and complications were analyzed by applying descriptive statistics, whereas perioperative factors predictive of cement leakage, reoperation, and LOS were identified by regression models. RESULTS Cement leakage rate was 30.4% in the total cohort; however, only fifth of them were symptomatic. Cement leakage itself did not have a significant influence on clinical outcome. Other complications and nonsurgical adverse events were registered only in 2.0% of cases. Age, subcutaneous fat tissue thickness, low viscosity cement, lower level of surgeon's experience and the number of operated levels were identified as risk factors of cement leakage (P < 0.01; c-index = 0.836). Type of procedure, Charlson comorbidity score, reoperation, and nonsurgical adverse events significantly increased the LOS (P < 0.01). Cement leakage, early surgical practice, and increased subcutaneous fat tissue thickness were risk factors for reoperation (P < 0.01; c-index = 0.72). CONCLUSIONS PCD is a relatively safe and effective procedure for treating spinal instability caused by advanced-stage disc degeneration characterized by vacuum phenomenon. Cement leakage is not uncommon but is only a radiologic complication without clinical consequences in most cases. On the other hand, it can increase the LOS and is a significant risk factor for reoperation.
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Affiliation(s)
- Kristof Koch
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Zsolt Szoverfi
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gabor Jakab
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Peter Pal Varga
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Zoltan Hoffer
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Aron Lazary
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary.
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5
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Yang C, Wang F, Huang X, Zhang H, Zhang M, Gao J, Shi S, Wang F, Yang F, Yu X. Finite element analysis of biomechanical effects of mineralized collagen modified bone cement on adjacent vertebral body after vertebroplasty. Front Bioeng Biotechnol 2023; 11:1166840. [PMID: 37485322 PMCID: PMC10358328 DOI: 10.3389/fbioe.2023.1166840] [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: 02/15/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Objective: To investigate whether mineralized collagen modified polymethyl methacrylate (MC-PMMA) bone cement impacts the implanted vertebral body and adjacent segments and the feasibility of biomechanical properties compared with common bone cement in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: A healthy volunteer was selected to perform a three-dimensional reconstruction of the T11-L1 vertebral body to establish the corresponding finite element model of the spine, and the changes in the stress distribution of different types of cement were biomechanically analyzed in groups by applying quantitative loads. Results: The stress distribution of the T11-L1 vertebral body was similar between the two bone types of cement under various stress conditions. Conclusion: Mineralized collagen modified bone cement had the advantages of promoting bone regeneration, good biocompatibility, good transformability, and coupling, and had support strength not inferior to common PMMA bone cement, indicating it has good development prospects and potential.
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Affiliation(s)
- Cunheng Yang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Fumin Wang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xingxing Huang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Hao Zhang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Meng Zhang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Junxiao Gao
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Shengbo Shi
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Fuyang Wang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Fangjun Yang
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xiaobing Yu
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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6
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Computational assessment of growth of connective tissues around textured hip stem subjected to daily activities after THA. Med Biol Eng Comput 2023; 61:525-540. [PMID: 36534373 DOI: 10.1007/s11517-022-02729-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Longer-term stability of uncemented femoral stem depends on ossification at bone-implant interface. Although attempts have been made to assess the amount of bone growth using finite element (FE) analysis in combination with a mechanoregulatory algorithm, there has been little research on tissue differentiation patterns on hip stems with proximal macro-textures. The primary goal of this investigation is to qualitatively compare the formation of connective tissues around a femoral implant with/without macro-textures on its proximal surfaces. This study also predicts formation of different tissue phenotypes and their spatio-temporal distribution around a macro-textured femoral stem under routine activities. Results from the study show that non-textured implants (80 to 94%) encourage fibroplasia compared to that in textured implants (71 to 85.38%) under similar routine activity, which might trigger aseptic loosening of implant. Formation of bone was more on medio-lateral sides and towards proximal regions of Gruen zones 2 and 6, which was found to be in line with clinical observations. Fibroplasia was higher under stair climbing (85 to 91%) compared to that under normal walking (71 to 85.38%). This study suggests that stair climbing, although falls under recommended activity, might be detrimental to patient compared to normal walking in the initial rehabilitation period.
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Cao D, Ding J. Recent advances in regenerative biomaterials. Regen Biomater 2022; 9:rbac098. [PMID: 36518879 PMCID: PMC9745784 DOI: 10.1093/rb/rbac098] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 07/22/2023] Open
Abstract
Nowadays, biomaterials have evolved from the inert supports or functional substitutes to the bioactive materials able to trigger or promote the regenerative potential of tissues. The interdisciplinary progress has broadened the definition of 'biomaterials', and a typical new insight is the concept of tissue induction biomaterials. The term 'regenerative biomaterials' and thus the contents of this article are relevant to yet beyond tissue induction biomaterials. This review summarizes the recent progress of medical materials including metals, ceramics, hydrogels, other polymers and bio-derived materials. As the application aspects are concerned, this article introduces regenerative biomaterials for bone and cartilage regeneration, cardiovascular repair, 3D bioprinting, wound healing and medical cosmetology. Cell-biomaterial interactions are highlighted. Since the global pandemic of coronavirus disease 2019, the review particularly mentions biomaterials for public health emergency. In the last section, perspectives are suggested: (i) creation of new materials is the source of innovation; (ii) modification of existing materials is an effective strategy for performance improvement; (iii) biomaterial degradation and tissue regeneration are required to be harmonious with each other; (iv) host responses can significantly influence the clinical outcomes; (v) the long-term outcomes should be paid more attention to; (vi) the noninvasive approaches for monitoring in vivo dynamic evolution are required to be developed; (vii) public health emergencies call for more research and development of biomaterials; and (viii) clinical translation needs to be pushed forward in a full-chain way. In the future, more new insights are expected to be shed into the brilliant field-regenerative biomaterials.
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Affiliation(s)
- Dinglingge Cao
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
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Zhao X, Ma H, Han H, Zhang L, Tian J, Lei B, Zhang Y. Precision medicine strategies for spinal degenerative diseases: Injectable biomaterials with in situ repair and regeneration. Mater Today Bio 2022; 16:100336. [PMID: 35799898 PMCID: PMC9254127 DOI: 10.1016/j.mtbio.2022.100336] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 11/23/2022]
Abstract
As the population ages, spinal degeneration seriously affects quality of life in middle-aged and elderly patients, and prevention and treatment remain challenging for clinical surgeons. In recent years, biomaterials-based injectable therapeutics have attracted much attention for spinal degeneration treatment due to their minimally invasive features and ability to perform precise repair of irregular defects. However, the precise design and functional control of bioactive injectable biomaterials for efficient spinal degeneration treatment remains a challenge. Although many injectable biomaterials have been reported for the treatment of spinal degeneration, there are few reviews on the advances and effects of injectable biomaterials for spinal degeneration treatment. This work reviews the current status of the design and fabrication of injectable biomaterials, including hydrogels, bone cements and scaffolds, microspheres and nanomaterials, and the current progress in applications for treating spinal degeneration. Additionally, registered clinical trials were also summarized and key challenges and clinical translational prospects for injectable materials for the treatment of spinal degenerative diseases are discussed.
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Fusini F, Girardo M, Aprato A, Massè A, Lorenzi A, Messina D, Colò G. Percutaneous Cement Discoplasty in Degenerative Spinal Disease: Systematic Review of Indications, Clinical Outcomes, and Complications. World Neurosurg 2022; 168:219-226. [DOI: 10.1016/j.wneu.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022]
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10
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Wu Y, Yang L, Chen L, Geng M, Xing Z, Chen S, Zeng Y, Zhou J, Sun K, Yang X, Shen B. Core-Shell Structured Porous Calcium Phosphate Bioceramic Spheres for Enhanced Bone Regeneration. ACS APPLIED MATERIALS & INTERFACES 2022; 14:47491-47506. [PMID: 36251859 DOI: 10.1021/acsami.2c15614] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Adequate new bone regeneration in bone defects has always been a challenge as it requires excellent and efficient osteogenesis. Calcium phosphate (CaP) bioceramics, including hydroxyapatite (HA) and biphasic calcium phosphates (BCPs), have been extensively used in clinical bone defect filling due to their good osteoinductivity and biodegradability. Here, for the first time, we designed and fabricated two porous CaP bioceramic granules with core-shell structures, named in accordance with their composition as BCP@HA and HA@BCP (core@shell). The spherical shape and the porous structure of these granules were achieved by the calcium alginate gel molding technology combined with a H2O2 foaming process. These granules could be stacked to build a porous structure with a porosity of 65-70% and a micropore size distribution between 150 and 450 μm, which is reported to be good for new bone ingrowth. In vitro experiments confirmed that HA@BCP bioceramic granules could promote the proliferation and osteogenic ability when cocultured with bone marrow mesenchymal stem cells, while inhibiting the differentiation of RAW264.7 cells into osteoclasts. In vivo, 12 weeks of implantation in a critical-sized femoral bone defect animal model showed a higher bone volume fraction and bone mineral density in the HA@BCP group than in the BCP@HA or pure HA or BCP groups. From histological analysis, we discovered that the new bone tissue in the HA@BCP group was invading from the surface to the inside of the granules, and most of the bioceramic phase was replaced by the new bone. A higher degree of vascularization at the defect region repaired by HA@BCP was revealed by 3D microvascular perfusion angiography in terms of a higher vessel volume fraction. The current study demonstrated that the core-shell structured HA@BCP bioceramic granules could be a promising candidate for bone defect repair.
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Affiliation(s)
- Yuangang Wu
- Orthopedic Research Institute, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Long Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Li Chen
- Analytical & Testing Center, Sichuan University, No. 29 Jiuyanqiao Wangjiang Road, Chengdu 610064, China
| | - Mengyu Geng
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Zhengyi Xing
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Siyu Chen
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Yi Zeng
- Orthopedic Research Institute, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jinhan Zhou
- Core Facilities of West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kaibo Sun
- Orthopedic Research Institute, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Bin Shen
- Orthopedic Research Institute, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, China
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11
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Biomechanical analysis of a customized lumbar interspinous spacer based on transfacetopedicular screw fixation: A finite element study. Med Eng Phys 2022; 107:103850. [DOI: 10.1016/j.medengphy.2022.103850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 07/03/2022] [Accepted: 07/10/2022] [Indexed: 11/23/2022]
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12
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Techens C, Eltes PE, Lazary A, Cristofolini L. Critical Review of the State-of-the-Art on Lumbar Percutaneous Cement Discoplasty. Front Surg 2022; 9:902831. [PMID: 35620196 PMCID: PMC9127498 DOI: 10.3389/fsurg.2022.902831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Interbody fusion is the gold standard surgery to treat lumbar disc degeneration disease but can be a high-risk procedure in elderly and polymorbid patients. Percutaneous Cement Discoplasty (PCD) is a minimally invasive technique developed to treat advanced stage of disc degeneration exhibiting a vacuum phenomenon. A patient-specific stand-alone spacer is created by filling the disc with polymethylmethacrylate cement, allowing to recover the disc height and improve the patient’s conditions. As it has recently been introduced in the lumbar spine, this review aims to present a transversal state-of-the-art of the surgery from its clinical practice and outcome to biomechanical and engineering topics. The literature was searched across multiple databases using predefined keywords over no limited period of time. Papers about vertebroplasty were excluded. Among 466 identified papers, the relevant ones included twelve clinical papers reporting the variations of the surgical technique, follow-up and complications, four papers reporting biomechanical ex vivo and numerical tests, and four letters related to published clinical papers. Papers presenting the operative practice are reported, as well as follow-ups up to four years. The papers found, consistently reported that PCD significantly improved the clinical status of the patients and maintained it after two years. Spine alignment was impacted by PCD: the sacral slope was significantly reduced, and disc height increased. The foramen opening correlated to the volume of injected cement. Substitutes to the acrylic cement exhibited better osteointegration and mechanical properties closer to bone tissue. Finally, limitations and risks of the surgery are discussed as well as potential improvements such as the development of new filling materials with better mechanical properties and biological integration or the investigation of the inner disc.
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Affiliation(s)
- Chloé Techens
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
- In silico Biomechanics Laboratory, National Center for Spinal Disorders, Budapest, Hungary
- Department of Orthopaedics, Department of Spine Surgery, Semmelweis University, Budapest, Hungary
| | - Peter Endre Eltes
- In silico Biomechanics Laboratory, National Center for Spinal Disorders, Budapest, Hungary
- Department of Orthopaedics, Department of Spine Surgery, Semmelweis University, Budapest, Hungary
| | - Aron Lazary
- In silico Biomechanics Laboratory, National Center for Spinal Disorders, Budapest, Hungary
- Department of Orthopaedics, Department of Spine Surgery, Semmelweis University, Budapest, Hungary
- Correspondence: Aron Lazary Luca Cristofolini
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
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Alkharsawi M, Shousha M, Boehm H, Alhashash M. Cement discoplasty for managing lumbar spine pseudarthrosis in elderly patients: a less invasive alternative approach for failed posterior lumbar spine interbody fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1728-1735. [PMID: 35347424 DOI: 10.1007/s00586-022-07186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/29/2022] [Accepted: 03/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE A retrospective cohort study was performed to evaluate pseudoarthrosis treatment results by injection of cement in disc space of failed fusion in posterior lumbar interbody fusion in patients above 65 years. METHODS Forty-five patients above 65 years with symptomatic pseudarthrosis after lumbar spine fusion were treated by cement injection in the affected disc space. RESULTS There were 30 females and 15 males. The mean age at the operation was 74 ± 6.5 years (range 65-89). Discoplasty was performed after the primary fusion operations after a mean of 14 ± 1.3 months (range 12-24). The mean preoperative VAS was 7.5 (range 6-9), and ODI was 36 (range 30-45). Cement injection was done at one level in most of the cases (35 patients). In seven cases, two injection levels were done, and in three cases, three levels. Twenty-three patients had discoplasty only, while 22 had discoplasty and screws change, including 14 cases of extension of the instrumentation. The mean postoperative follow-up was 32 ± 6.5 months. The VAS improved to 3.5 (range 2-5) (p = 0.02) and ODI to 12.3 (range 5-35) (p = 0.001). Reoperation was indicated in two (4%) patients by screws loosening. Asymptomatic cement leakage occurred in the paravertebral space in seven cases (15.5%). CONCLUSION Cement discoplasty offers a less invasive reliable surgical solution in elderly patients with symptomatic lumbar pseudarthrosis in the elderly patients. In cases with screw loosening, discoplasty should be combined with screw revision.
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Affiliation(s)
- Mahmoud Alkharsawi
- Department of Spine Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 7, 99437, Bad Berka, Germany.
- Department of Orthopedic Surgery, Tanta University, Tanta, Egypt.
| | - Mootaz Shousha
- Department of Spine Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 7, 99437, Bad Berka, Germany
- Department of Orthopedic Surgery, Alexandria University, Alexandria, Egypt
| | - Heinrich Boehm
- Department of Spine Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 7, 99437, Bad Berka, Germany
| | - Mohamed Alhashash
- Department of Spine Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 7, 99437, Bad Berka, Germany
- Department of Orthopedic Surgery, Alexandria University, Alexandria, Egypt
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Madruga LYC, Kipper MJ. Expanding the Repertoire of Electrospinning: New and Emerging Biopolymers, Techniques, and Applications. Adv Healthc Mater 2022; 11:e2101979. [PMID: 34788898 DOI: 10.1002/adhm.202101979] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/09/2021] [Indexed: 12/20/2022]
Abstract
Electrospinning has emerged as a versatile and accessible technology for fabricating polymer fibers, particularly for biological applications. Natural polymers or biopolymers (including synthetically derivatized natural polymers) represent a promising alternative to synthetic polymers, as materials for electrospinning. Many biopolymers are obtained from abundant renewable sources, are biodegradable, and possess inherent biological functions. This review surveys recent literature reporting new fibers produced from emerging biopolymers, highlighting recent developments in the use of sulfated polymers (including carrageenans and glycosaminoglycans), tannin derivatives (condensed and hydrolyzed tannins, tannic acid), modified collagen, and extracellular matrix extracts. The proposed advantages of these biopolymer-based fibers, focusing on their biomedical applications, are also discussed to highlight the use of new and emerging biopolymers (or new modifications to well-established ones) to enhance or achieve new properties for electrospun fiber materials.
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Affiliation(s)
- Liszt Y. C. Madruga
- Department of Chemical and Biological Engineering Colorado State University Fort Collins CO 80526 USA
| | - Matt J. Kipper
- Department of Chemical and Biological Engineering Colorado State University Fort Collins CO 80526 USA
- School of Advanced Materials Discovery Colorado State University Fort Collins CO 80526 USA
- School of Biomedical Engineering Colorado State University Fort Collins CO 80526 USA
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Yang L, Chen S, Shang T, Zhao R, Yuan B, Zhu X, Raucci MG, Yang X, Zhang X, Santin M, Ambrosio L. Complexation of Injectable Biphasic Calcium Phosphate with Phosphoserine-Presenting Dendrons with Enhanced Osteoregenerative Properties. ACS APPLIED MATERIALS & INTERFACES 2020; 12:37873-37884. [PMID: 32687309 DOI: 10.1021/acsami.0c09004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Injectable biphasic calcium phosphates have been proposed as a solution in the treatment of a range of clinical applications including as fillers in the augmentation of osteoporotic bone. To date, various biodegradable natural or synthetic organics have been used as a polymer component of bone materials to increase their cohesiveness. Herein, a novel bone material was developed combining osteoconductive biphasic calcium phosphate (BCP) nanoparticles with phosphoserine-tethered generation 3 poly(epsilon-lysine) dendron (G3-K PS), a class of hyperbranched peptides previously shown to induce biomineralization and stem cell osteogenic differentiation. Strontium was also incorporated into the BCP nanocrystals (SrBCP) to prevent bone resorption. Within 24 h, an antiwashout behavior was observed in G3-K PS-integrated pure BCP group (BCPG3). Moreover, both in vitro tests by relevant cell phenotypes and an in vivo tissue regeneration study by an osteoporotic animal bone implantation showed that the integration of G3-K PS would downregulate Cxcl9 gene and protein expressions, thus enhancing bone regeneration measured as bone mineral density, new bone volume ratio, and trabecular microarchitectural parameters. However, no synergistic effect was found when Sr was incorporated into the BCPG3 bone pastes. Notably, results indicated a concomitant reduction of bone regeneration potential assessed as reduced Runx2 and PINP expression when bone resorptive RANKL and CTX-I levels were reduced by Sr supplementation. Altogether, the results suggest the potential of injectable BCPG3 bone materials in the treatment of osteoporotic bone defects.
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Affiliation(s)
- Long Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Siyu Chen
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Tieliang Shang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Rui Zhao
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Bo Yuan
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Xiangdong Zhu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Maria Grazia Raucci
- Institute of Polymers, Composites and Biomaterials (IPCB)-National Research Council of Italy (CNR), 80125 Naples, Italy
| | - Xiao Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Xingdong Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Matteo Santin
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Huxley Building Lewes Road, Brighton BN2 4GJ, U.K
| | - Luigi Ambrosio
- Institute of Polymers, Composites and Biomaterials (IPCB)-National Research Council of Italy (CNR), 80125 Naples, Italy
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Zaokari Y, Persaud A, Ibrahim A. Biomaterials for Adhesion in Orthopedic Applications: A Review. ENGINEERED REGENERATION 2020. [DOI: 10.1016/j.engreg.2020.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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