多孔钛合金支撑棒置入治疗早期距骨骨坏死

背景：国外最新的研究成果显示,与传统髓芯减压治疗比较,多孔钛合金支撑棒置入治疗距骨骨折的疗效有明显提升,同时降低了手术难度。 目的：对比多孔钛合金支撑棒与髓芯减压治疗早期距骨骨坏死的临床效果。 方法：纳入早期距骨骨坏死患者60例,其中男33例,女27例,年龄18-73岁,采取随机数表法均分为试验组与对照组,试验组进行多孔钛合金支撑棒置入治疗,对照组进行传统的髓芯减压治疗。对比两组治疗后12个月的坏死范围进展情况,治疗后24周内的感染率及踝关节肿胀情况,以及治疗12个月内的跛行发生率。 结果与结论：治疗后12个月,试验组骨坏死进展情况明显低于对照组(P < 0.05)。试验组治疗后即刻、治疗后2周、治疗后4周、治疗后12周、治疗后24周的感染率及踝关节肿胀率均低于对照组(P < 0.05),治疗后1,3,6,12个月的跛行发生率明显低于对照组(P < 0.05)。试验组未发生与植入材料相关的不良反应。表明以多孔钛合金支撑棒置入治疗早期距骨骨坏死有利于骨组织的再生,促进踝关节功能恢复。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

联合3D打印技术、载距突螺钉导向器治疗SandersⅢ、Ⅳ型跟骨骨折的临床疗效分析

目的 比较联合3D打印技术及载距突螺钉导向器的切开复位内固定手术方式与传统的单纯切开复位内固定方法在治疗Sanders Ⅲ、Ⅳ型跟骨骨折中的手术疗效。方法 选取2020年8月至2021年8月期间,广东医科大学附属东莞儿童医院收治的45例Sanders Ⅲ、Ⅳ型跟骨骨折患者病例资料进行回顾性分析,采用3D打印技术及载距突螺钉导向器的切开复位内固定23例（3D打印组）,采用传统的单纯切开复位内固定方法22例（传统组）,记录并比较两组患者的手术时间、术中出血量、术中透视次数,术前、术后跟骨长、宽、高及Böhler角、Gissane角变化,术前与术后3个月负重行走后AOFAS、Maryland评分,以及术后切口皮肤愈合优良率、并发症发生率、载距突螺钉置入精准率。结果 两组患者均获随访,平均随访时间（4.0±0.5）个月。3D打印组与传统组相比,具有手术时间短、术中出血少、术中透视次数少、载距突螺钉置入精准率高、术后切口愈合优良率高及术后并发症发生率低的优势,两组比较差异均有统计学意义（P＜0.05）。术后3个月AOFAS评分、Maryland评分,3D打印组优于传统组,差异有统计学意义（P＜0.05）。结论 联合3D打印技术、载距突螺钉导向器辅助治疗Sanders Ⅲ、Ⅳ型跟骨骨折的切开复位内固定手术方式比传统的单纯切开复位内固定手术方法具有手术时间短、术中出血少、术中透视次数少、术后切口愈合好及术后并发症少、复位精度高、愈后疗效佳的优势。     

微弧氧化陶瓷膜表面骨髓间充质干细胞生物相容性实验

目的观察微弧氧化（micro-arc,MAO）陶瓷膜表面骨髓间充质干细胞（mesenchymal stem cell,MSC）的黏附和增殖生长情况,通过MSC在三组不同表面处理材料表面的黏附和增殖情况评价微弧氧化陶瓷膜表面的生物相容性。方法贴壁法培养大鼠骨髓间充质干细胞,骨诱导培养后,做碱性磷酸酶染色和茜素红钙结节染色,鉴定其成骨潜能。取生长良好的第三代MSC,调整细胞密度为5×10^4/mL,接种到三组钛片表面。在接种细胞后第1、3、5、7天每组分别取出5枚钛片,一个做电镜扫描,另外4个细胞计数。观察MSC在不同材料表面的黏附增殖情况。电镜扫描MAO陶瓷膜表面形貌特征,EDX分析其表面主要元素含量。结果MSC具有良好的成骨特性,在MAO陶瓷膜表面的增殖优于光滑组和喷沙组。电镜下微弧氧化陶瓷膜表面有无数2～10m的微孔,并含有钙、磷成分。结论MAO陶瓷膜具有良好的生物相容性,大鼠骨髓间充质干细胞在其多孔,含有钙、磷元素表面的黏附及增殖均优于其它组。     

富血小板血浆复合自体松质骨移植的生物重建治疗陈旧性腕舟状骨骨不连的临床效果分析

目的 观察富血小板血浆（platelet-rich plasma, PRP）复合自体松质骨移植治疗腕舟状骨骨不连的近期临床效果。方法 收集中国人民解放军联勤保障部队第989医院自2019年6月至2021年6月期间收治的30例陈旧性腕舟状骨骨不连的患者作为研究对象,按照随机数表分为观察组和对照组。观察组（15例）采用PRP复合自体松质骨移植的生物重建方法,对照组（15例）采用只采用自体松质骨移植并内固定的手术方式。对比两组的手术时间、住院时间、骨折愈合情况、骨痂等级评分、腕关节功能评估及术后并发症。结果 术后30例患者均得到随访,随访周期为12个月。观察组骨折愈合率为93.3%,对照组骨折愈合率为66.7%,两组比较差异具有统计学意义（P＜0.05）。观察组的手术时间为（1.83±0.23）h,对照组的手术时间为（1.73±0.30）h,两组比较差异无统计学意义（P＞0.05）;观察组骨折愈合时间［（16.54±0.74）周］少于对照组［（20.70±4.73）周］,术后住院时间［（14.27±2.43） d］少于对照组［（19.53±6.29） d］,两组比较差异具有统计学意义（P＜0.05）。观察组术后4、8、12周骨痂等级评分比较优于对照组,两组比较差异具有统计学意义（P＜0.05）;观察组术后16周骨痂等级评分比较优于对照组,两组比较差异无统计学意义（P＞0.05）。数据显示术后6个月,观察组的Mayo评分高于对照组,VAS评分低于对照组,两组比较差异具有统计学意义（P＜0.05）;术后12个月,两组间Mayo评分及VAS评分比较,差异无统计学意义（P＞0.05）。观察组术后并发症共2例,对照组术后并发症共6例,两组比较差异具有统计学意义（P＜0.05）。结论 富血小板血浆（PRP）复合自体松质骨移植治疗腕舟状骨骨不连可促进腕舟状骨骨折愈合,减少手术相关并发症,利于腕关节功能恢复,近期临床效果较好。     

3D打印技术辅助单一前入路治疗累及双柱的复杂髋臼骨折

目的 探讨3D打印技术辅助单一前入路治疗累及双柱的复杂髋臼骨折的有效性及可行性。方法 回顾性分析2018年1月至2021年5月安徽医科大学第一附属医院获得完整随访的单一前入路手术治疗累及双柱的复杂髋臼骨折患者33例,其中10例术前行3D打印技术辅助进行虚拟复位、模型打印及钢板预弯（3D打印组）,23例常规单一前入路行髋臼骨折切开复位内固定手术治疗（经验手术组）,比较两组患者的手术时间、术中出血量、透视次数、后柱螺钉置入时间等术中指标,以及术后愈合时间、住院时间、术后复位质量和Merle D′Aubigné-Postel功能评分。结果 33例患者得到完整随访,随访6 ～ 36个月,平均（25.00±9.94）个月。其中,3D打印组患者在手术时间、后柱螺钉置入时间及住院时间方面较经验手术组缩短,在术中出血量、术中透视次数方面较经验手术组减少,差异具有统计学意义（P＜0.05）。两组在复位质量、术后功能及并发症方面比较,差异无统计学意义（P＞0.05）。结论 应用3D打印辅助术前规划治疗复杂髋臼骨折,在减少手术时间、术中出血量及住院时间的同时,还能减少医务人员及患者暴露射线的次数,其方法安全可靠,有利于髋臼骨折患者快速康复的实现。     

3D打印技术辅助切开复位内固定与常规手术治疗髋臼骨折疗效的Meta分析

目的 通过Meta分析比较3D打印技术辅助切开复位内固定（ORIF）与常规手术治疗髋臼骨折的临床疗效差异。方法 通过计算机检索建库至2022年7月1日PubMed、EMBASE、Cochrane Library、知网、万方和维普数据库中3D打印技术辅助ORIF与常规手术治疗髋臼骨折的相关文献,根据纳入与排除标准筛选符合的临床对照试验,利用Cochrane评价手册和渥太华纽卡斯尔量表（NOS）对纳入研究进行质量评价,采用RevMan 5.3软件对两组术式临床疗效结果进行统计分析。结果 共纳入6篇随机对照试验,14篇非随机对照试验,研究对象821例（3D打印手术组372例,常规手术组449例）。Meta分析结果显示：在手术时间［MD=-43.41,95%CI（-56.19,-30.62）,P＜0.000 01］、术中出血量［MD=-216.47,95%CI（-298.39,-134.56）,P＜0.000 01］、术中透视次数［MD=-5.43,95%CI（-7.71,-3.15）,P＜0.000 01］、术中器械安装时间［MD=-27.31,95%CI（-31.29,-23.33）,P＜0.000 01］、术后CT上残余位移［MD=-0.67,95%CI（-1.12,-0.22）,P=0.004］、并发症发生率［OR=0.51,95%CI（0.34,0.76）,P=0.001］及创伤性关节炎发生率［OR=0.43,95%CI（0.20,0.94）,P=0.03］方面,3D打印手术组优于常规手术组;而在术后骨折复位质量Matta评分优良率、末次随访时髋关节Merle D''Aubigne & Postel评分及Harris评分优良率方面两组相比差异无统计学意义（P=0.07、P=0.11和P=0.69）。结论 3D打印技术辅助ORIF治疗髋臼骨折,可缩短手术时间及术中器械安装时间,减少术中出血量、术中透视次数、术后残余位移及术后并发症发生率,是髋臼骨折的一种有效治疗方式。     

改性3D打印钛支架对脂肪间充质干细胞成骨分化的影响北大核心

背景:3D打印钛支架克服了传统钛支架内部结构可控性差及外形不匹配等缺陷,但由于钛的生物惰性较大,使其在植入体内后难以与周围组织快速稳定地结合。目的:采用喷砂酸蚀和阳极氧化方法改性3D打印钛支架表面,观察其对脂肪间充质干细胞黏附、增殖和成骨分化能力的影响。方法:采用喷砂酸蚀联合阳极氧化方法在3D打印钛支架表面构建微纳米多孔结构,扫描电镜观察其表面特征。将第3代大鼠脂肪间充质干细胞分别接种于3D打印钛支架组(A组)、3D打印钛支架+成骨诱导液(B组)、改性3D打印钛支架(C组)上,通过细胞骨架与CCK-8实验检测细胞的黏附和增殖能力,碱性磷酸酶与茜素红染色观察细胞的成骨分化能力,实时定量PCR分析细胞成骨相关基因的表达,免疫荧光染色观察细胞骨钙素与骨桥蛋白的表达。结果与结论:①扫描电镜下可见,改性后的3D打印钛支架表面出现微米及亚微米级凹坑和沟槽,内部有直径为70-100 nm的纳米级孔隙,孔隙之间相互连通;②共聚焦显微镜下可见,A、B组细胞伪足及触角较少,尚未铺展;C组细胞完全铺展在材料表面,可见大量明显的细胞伪足和触角,紧密附着于材料表面;CCK-8实验显示,改性3D打印钛支架可促进脂肪间充质干细胞的增殖;③碱性磷酸酶与茜素红染色显示,B、C组碱细胞性磷酸酶活性与矿化水平高于A组(P<0.05);④B、C组细胞骨钙素、RUNX2、碱性磷酸酶及Ⅰ型胶原mRNA表达均高于A组(P<0.05),骨桥蛋白与骨钙素蛋白表达均高于A组(P<0.05);⑤结果表明,喷砂酸蚀联合阳极氧化改性3D打印钛支架具有良好的生物相容性,可促进脂肪间充质干细胞的黏附、增殖和成骨分化。     

负载rh-BMP2的羟基磷灰石人工骨治疗胫骨平台骨折骨缺损的临床疗效研究

目的 通过与羟基磷灰石生物陶瓷人工骨对比，评估负载rh-BMP2的羟基磷灰石人工骨对胫骨平台骨折骨缺损修复的临床疗效。方法 回顾性分析2014年10月至2019年9月中国人民解放军联勤保障部队第九二〇医院骨科收治的53例Schatzker Ⅴ、Ⅵ型胫骨平台骨折骨缺损患者，所有患者均进行骨折切开复位内固定术并予术中植骨，其中27例患者术中予负载rh-BMP2的羟基磷灰石人工骨植骨（研究组），另26例患者予羟基磷灰石生物陶瓷人工骨植骨（对照组）。对比两组患者骨折愈合时间、膝关节HSS功能评分、Rasmussen影像学评分及术后并发症发生情况。结果 所有患者获得随访，平均随访时间为（10.45±2.31）个月，所有患者最终均骨性愈合。研究组的骨折愈合时间［（13.46±3.38）周］明显短于对照组［（16.67±6.51）周］（P＜0.05）；术后6个月时研究组HSS评分［（85.53±5.30）分］优于对照组［（80.58±6.40）分］（P＜0.05）。术后6个月时两组的Rasmussen影像学评分比较，差异无统计学意义（P＞0.05），同时两组患者随访期间出现并发症情况比较，差异无统计学意义（P＞0.05）。结论 相较于羟基磷灰石人工骨治疗胫骨平台骨折骨缺损，负载rh-BMP2的羟基磷灰石人工骨植入后骨折愈合时间更短，膝关节功能恢复更佳，同时未增加并发症发生风险。其可视为一种良好的人工骨修复材料。     

可注射、组织黏附性PVA/淀粉水凝胶对力学失稳条件下关节软骨退变抑制作用的研究

目的 制备一种仿生正常关节滑液流变学特征的组织黏附性可注射水凝胶,并研究该水凝胶抑制膝关节创伤后软骨退变的效果及其可能的机制。方法 以聚乙烯醇溶液（PVA）、淀粉和氯化钠为主要原料制备可注射、组织黏附性水凝胶（PWN）。通过流变学测试、注射器推出实验、体外降解实验、CCK-8实验、活/死细胞染色、细菌黏附实验、组织黏附实验分别对其流变学性能、可注射性、降解性能、细胞相容性、抗细菌黏附性能和组织黏附性能进行表征。构建大鼠膝关节力学失稳模型,并分为正常组、PWN组、透明质酸组（HA组）与未治疗组,其中PWN组、HA组术后1周时注射PWN与HA进行治疗。治疗4周后取大鼠膝关节标本进行Micro-CT分析和组织学染色分析,对比评估PWN对关节软骨退变的抑制作用。结果 PWN具有良好的细胞相容性和可注射性。此外,相比于HA,PWN的流变学特征更接近正常关节滑液,并且PWN具有缓慢降解的特性、更高的组织黏附性能和抗细菌黏附的能力。动物实验Micro-CT分析结果显示,PWN组软骨下骨的骨密度和骨体积/组织体积均显著高于未治疗组和HA组（P＜0.05）。同时,番红快绿染色结果显示,相比于HA组,PWN组软骨表面连续性较好,未见明显破损、侵蚀,蛋白聚糖分布丰度接近正常组。结论 相比于临床使用的HA产品,PWN水凝胶具有仿生正常关节滑液的流变学特征、缓慢降解的特性和较强的组织黏附性能,可延缓大鼠膝关节力学失稳下关节骨软骨的退变,有望单独或与HA联合应用于骨关节炎等关节软骨病变的临床治疗。     

跗骨窦切口复位空心钉内固定与“L”形切口复位钢板内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的疗效分析

目的 探讨跗骨窦切口复位植骨空心钉内固定与“L”形切口复位植骨钢板内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折的临床疗效。方法 回顾性分析自2017年1月至2021年1月在丹阳市中医院骨伤科收治的53例Sanders Ⅱ、Ⅲ型跟骨骨折患者资料。其中,26例采用跗骨窦切口复位植骨空心钉内固定（空心钉组）,27例采用“L”形切口复位植骨钢板内固定（钢板组）。比较观察两组患者的手术时间、术中出血量、切口长度、切口愈合时间及骨折愈合时间、住院天数,术前、术后跟骨Bӧhler角、Gissane角、跟骨高度、跟骨宽度、美国足踝外科协会（AOFAS）评分、视觉模拟评分法（VAS）评分及术后并发症发生率等。结果 空心钉组在手术时间、术中出血量、切口长度、切口愈合时间优于钢板组,差异具有统计学意义（P＜0.05）;在骨折愈合时间、住院天数比较,差异无统计学意义（P＞0.05）。比较两组患者术前、术后X线片显示的跟骨宽度、跟骨高度、Bӧhler角、Gissane角,术后较术前明显改善（P＜0.05）,但两组间比较差异无统计学意义（P＞0.05）;两组术后末次随访AOFAS评分、VAS评分较术前明显改善（P＜0.05）,且空心钉组优于钢板组（P＜0.05）;空心钉组术后并发症发生率明显低于钢板组（P＜0.05）。结论 跗骨窦切口复位植骨空心钉内固定与“L”形切口复位植骨钢板内固定治疗跟骨Sanders Ⅱ、Ⅲ型骨折均能获得有效的力学稳定,促进足踝关节功能的恢复,并且跗骨窦切口复位植骨空心钉内固定对组织损伤小,极大降低术后并发症发生率。     

Osteogenic Potential of Porous Titanium. An Experimental Study in Sheep

The search for osteoinductive as well as osteoconductive materials has led to the novel idea of using titanium in bone augmentations of the alveolar crest. Due to its excellent biocompatibility and favorable osteogenic properties, highly porous TiO₂ granules has been proposed as a promising material for non-resorbable synthetic bone grafts in the restoration of large bone defects, and for bone augmentation in dental applications.ObjectivesThe aim of this study was to investigate the osteoconductive properties and biological performance of porous titanium granules used in osseous defects adjacent to the maxillary sinus in sheep. The experimental animal study involved 15 yearling sheep with a focus on the osteogenic potential of porous titanium used for subantral augmentation.Material and methodsCalibrated defects were prepared in the subantral region of sheep. The defects were randomized into tests and control group. The test defects were grafted with porous titanium granules (PTG), whereas control defects were left empty (sham). Defects were left for healing for 30, 60, and 90 days. After healing, the grafted areas were removed and finally osteoconductivity was analyzed by an orthopantograph (OPG} and histology.ResultsSignificantly more new bone formed in PTG grafted defects compared with sham. The control group showed significantly less expression of key inflammation cells, but with no significant difference in key inflammation cells compared with the experimental groups.ConclusionPorous titanium can offer as an effective alternative to calcium phosphate and bone collagen-based materials used for subantral augmentation of the maxillary bone in cases of dental implantation.     

Histological evaluation and surface componential analysis of modified micro-arc oxidation-treated titanium implants

The objective of this study is to investigate soft tissue and bone tissue reaction to titanium implants treated by a modified micro arc oxidation (MAO) technique, and analyze the surface components and implant-bone contact ratio by animal experiments to evaluate the osseointegration condition of implants with this modified MAO surface. MAO titanium plates were installed subcutaneously in rabbits. Tissue reaction was evaluated by HE sections. MAO titanium implants designed for endosseous examination were installed in Beagles' femurs. Bone tissue surrounding implants was analyzed histologically. Surfaces of retrieved implants were observed and examined by SEM and EDX. All procedures were performed under the control of untreated pure titanium implants. Thin homogeneous fibrous envelope could be found without apparent inflammation cells infiltration around the subcutaneously imbedded MAO titanium plates, which was almost same as control group. Fast osteoid deposition comprising high content of calcium, phosphor, carbon, and nitrogen elements was found on the retrieved MAO implant surfaces, while comparatively less amount of carbon and nitrogen elements were found on the retrieved implants of control group. Matured bone tissue comprising bone trabeculae and Haversian canals appeared in 8 weeks, while it took 12 weeks needed to form matured bone tissue in control group. In conclusion, MAO titanium materials shows good biocompatibility and calcium phosphate inducement capability in vivo and could accelerate bone tissue growth and shorten the osseointegration time.     

3D打印钛合金孔隙支架骨长入影响因素的分析

BACKGROUND: With the development of three-dimensional (3D) printing technology, 3D printed porous titanium scaffolds as bone substitutes have become a research hotspot. OBJECTIVE: To introduce and discuss the effects of each parameter of 3D printed porous titanium scaffolds on bone ingrowth, and to sum out the optimal parameters for bone ingrowth. METHODS: The first author retrieved PubMed, Springerlink and Medline databases with “three-dimensional (3D) printing, scaffold, titanium, bone ingrowth” as keywords for relevant articles published from 2006 to 2016. 125 articles were retrieved initially, and finally 42 eligible articles were included for analysis. RESULTS AND CONCLUSION: Pore size, porosity, pore structures and surface modifications of 3D printed porous titanium scaffolds all make effects on bone ingrowth or osteoblasts in scaffolds. Scaffolds with appropriate pore size and porosity can promote the vascularization and provide adequate nutrition and oxygen supplement, to ensure high cell viability. Regulations of cell performances, such as cell attachment, proliferation and differentiation, are also affected by pore structures and nano-scale surface modification. Herein, a detailed combination of the parameters, as mentioned above, can create a better porous scaffold for better bone ingrowth. Hence, the high-stability interface between bone and scaffolds may be obtained through the parameter adjustment.     

Porous titanium and silicon-substituted hydroxyapatite biomodification prepared by a biomimetic process: Characterization and in vivo evaluation

Porous titanium with a pore size of 150–600 μm and a porosity of 67% was prepared by fiber sintering. The porous titanium had a complete three-dimensional (3D) interconnected structure and a high yield strength of 100 MPa. Si-substituted hydroxyapatite (Si-HA) was coated on the surface by a biomimetic process to improve the surface bioactivity. X-ray diffraction results showed that Si-HA coating was not well crystallized. New bone tissue was found in the uncoated porous titanium after 2 weeks of implantation and a significant increase (p < 0.05) in the bone ingrowth rate (BIR) was found after 4 weeks of implantation, indicating the good osteoconductivity of the porous structure. The HA-coated and Si-HA-coated porous titanium exhibited a significantly higher BIR than the uncoated titanium at all intervals, highlighting the better surface bioactivity and osteoconductivity of the HA- and Si-HA coatings. Also, the Si-HA-coated porous titanium demonstrated a significantly higher BIR than the HA-coated porous titanium, showing that silicon plays an active role in the surface bioactivity. For Si-HA-coated porous titanium, up to 90% pore area was covered by new bone tissue after 4 weeks of implantation in cortical bone. In the bone marrow cavity, the pore spaces were filled with bone marrow, displaying that the interconnected pore structure could provide a channel for body fluid. It was concluded that both the 3D interconnected pore structure and the Si-HA coating contributed to the high BIR.     

Autogenous bone particle/titanium fiber composites for bone regeneration in a rabbit radius critical-size defect model

Purpose: To explore the effects of autogenous bone particle/titanium fiber composites on repairing segmental bone defects in rabbits. Materials and methods: A model of bilateral radial bone defect was established in 36 New Zealand white rabbits which were randomly divided into 3 groups according to filling materials used for bilaterally defect treatment: in group C, 9 animal bone defect areas were prepared into simple bilateral radius bone defect (empty sham) as the control group; 27 rabbits were used in groups ABP and ABP-Ti. In group ABP, left defects were simply implanted with autogenous bone particles; meanwhile, group ABP-Ti animals had right defects implanted with autogenous bone particle/titanium fiber composites. Animals were sacrificed at 4, 8, and 12 weeks, respectively, after operation. Results: Micro-CT showed that group C could not complete bone regeneration. Bone volume to tissue volume values in group ABP-Ti were better than group ABP. From histology and histomorphometry Groups ABP and ABP-Ti achieved bone repair, the bone formation of group ABP-Ti was better. The mechanical strength of group ABP-Ti was superior to that of other groups. Conclusions: These results confirmed the effectiveness of autologous bone particle/titanium fiber composites for promoting bone regeneration and mechanical strength.     

MAO纯钛骨诱导能力及生物相容性的骨内植入试验研究

目的对用一定参数微弧氧化(microarc arc oxidation,MAO)处理的纯钛材料进行动物骨内植入实验,以评价MAO处理的纯钛材料骨诱导性及组织相容性。方法纯钛片经过一定参数的微弧氧化处理,在无菌手术条件下植入新西兰大白兔的胫骨里,以相同规格的钛片作对照,在两个月后取出钛片,对取出的MAO纯钛行扫描电镜观察及能谱分析以观察其表面形貌及钙磷元素的变化,再结合组织学方法评价MAO纯钛的生物相容性及骨诱导性。结果所有实验动物在实验过程中未发现明显植入区感染等异常现象,扫描电镜观察及能谱分析发现材料表面的钙、磷所占比例均下降,但是钙含量下降更明显,组织学观察,两组材料周围的骨组织未发现异常的炎症细胞集聚和浸润,对照组周围无骨组织生成,试验组未见到MAO纯钛试件涂层脱落现象,且材料表面生成约200微米厚的的成熟新生骨组织。结论MAO处理的纯钛具有良好骨组织相容性及诱导骨形成的能力。     

Biologic effects of surface roughness and fluorhydroxyapatite coating on osteointegration in external fixation systems: an in vivo experimental study

The concomitant influence of surface roughness and fluorhydroxyapatite (FHA) coating of titanium (Ti) implants on bone response was investigated. For this purpose, titanium screw-shaped implants with a lower degree (Y371) and a higher degree (TiPore300) of surface roughness, coated with FHA and uncoated, were transversally inserted into the diaphyses of sheep tibiae for 12 weeks. Four sheep received Y371 (group A) and Y371 + FHA (group B) screws and four sheep received TiPore300 (group C) and TiPore300 + FHA (group D) screws. For each type of material, the morphology and microstructure of implant-facing bone were evaluated. The host bone of each tibia was used as a control. In all groups the bone tissue did not reach a complete maturation. The higher degree of roughness, perhaps due to an excessive irregularity of the surface, induced the worst osteointegration: a fibrous tissue layer between screw and new bone tissue was often present. Nevertheless, as viewed by XRD, no crystallographic change of the apatite lattice was observed in any of the implants. In contrast, the microhardness value, an index of bone mineralization, was higher in the uncoated screws and decreased progressively in the following order: group C > group A > group B > group D. The association of plasma spraying with roughness treatment constitutes a complex system that seems to interfere with bone mineralization. A chemical change of the surface, perhaps with more Ti release or more coating degradation, could be responsible for such impairment. The authors emphasize the necessity for simultaneous evaluation of surface topography and chemistry as well as an improvement in plasma-spraying and post-processing techniques and in standard procedures for materials characterization.     

纯钛表面微弧氧化法制备含羟基磷灰石氧化膜的实验研究

应用微弧氧化技术在纯钛表面制备含羟基磷灰石的氧化物膜.在氧化过程中,将钛试件放入含Ca、P电解液中,用直流脉冲电源处理.用扫描电镜(SEM)观察试件的表面和横断面形貌,X射线能谱(EDS)及X射线衍射(XRD)分析其元素成分和晶相结构.结果表明微弧氧化处理后,纯钛表面生成微孔结构的氧化膜,膜层厚度约20μm,由O、Ti、Ca和P四种元素组成.膜层表面有分布不均匀的火山丘状的微孔分布,直径小于5μm.膜层表面的钙磷原子比为1.63,界面处的钙磷原子比为0.51.膜层由金红石型和锐钛矿型二氧化钛及少量结晶相羟基磷灰石组成.微弧氧化技术在纯钛表面生成了内层致密外层多孔的晶相二氧化钛膜,同时含有少量羟基磷灰石,表明该技术在人工种植牙和人工骨关节等领域具有良好的医学应用前景.     

新型可吸收骨蜡的临床前动物实验研究

目的 通过动物实验了解新型可吸收骨蜡的降解周期,并研究可吸收骨蜡与骨组织的生物相容性。方法 采用18只试验羊进行骨植入试验。每只羊的6节胸骨分别作为独立的植入位点,随机选择各2个位点分别使用实验品可吸收骨蜡（实验组）或对照品强生骨蜡（对照组）止血,剩余2个位点作为空白（空白组）。术后2、6、12周各随机处死6只试验羊,取胸骨进行HE切片,进行组织学评价和材料降解情况分析。采用20只小鼠分别通过尾静脉注射和腹腔注射样品浸提液和对照观察小鼠的毒性症状。采用6只兔子通过皮内注射样品浸提液和对照观察各注射部位的红斑和水肿的组织反应。结果 实验组与空白组相比,实验品植入胸骨损伤表面2、6、12周,显示为无刺激;对照组与实验组相比,植入6、12周,显示为中度刺激。与对照品相比,实验品的组织学反应更加轻微。可吸收骨蜡降解过程中未见纤维组织包囊,新骨生长明显,至12周时,可吸收骨蜡基本降解完全,新骨连接两断端,骨损伤已得到修复。在急性毒性实验中,各组小鼠体重均稳步增长;在刺激试验中,可吸收骨蜡生理盐水的积分为0,玉米油的积分均为0.11。结论 新型可吸收骨蜡至植入12周时,已基本降解完全。该新型可吸收骨蜡是一种安全、无毒性、可用于骨创面止血的材料。     

The effect of oxytocin on osseointegration of titanium implant in ovariectomized rats

Introduction: Oxytocin (OT) was reported to control differentiation of human mesenchymal stem cells and reverse osteoporosis (OP). This study investigated the effect of systematical treatment of OT on implant osseointegration in ovariectomized (OVX) rats. Material and methods: Twenty female rats received bilateral ovariectomy. Twelve weeks later, all animals were randomly assigned to control or experimental group. Each rat received two implants at the distal femoral metaphysis. From the first postoperative day, rats in experiment group received subcutaneous injection of OT (1 mg/kg · d), while animals in control group received vehicle. Twelve weeks after implantation, specimens containing implants were harvested and evaluated by histology, micro-CT, and push-out test. Tibiae were also harvested to evaluate the effect of OT on intact bone tissue of OVX rats. Results: Compared with control, OT treatment increased the relative bone volume surrounding the implant by 2.2 times, the percent implant osseointegration by 0.62 times, and the maximum push-out force by 2.25 times. Increased bone mass was also observed in histological sections of distal femur with implant and intact bone tissue of the proximal tibiae. Conclusion: Systemic administration of OT promoted peri-implant bone healing and osseointegration of titanium implant and recovered the negative effects of OP in undisturbed bone tissue partially.