Additive manufacturing(AM)has revolutionized the design and manufacturing of patient-specific,three-dimensional(3D),complex porous structures known as scaffolds for tissue engineering applications.The use of advanced ...Additive manufacturing(AM)has revolutionized the design and manufacturing of patient-specific,three-dimensional(3D),complex porous structures known as scaffolds for tissue engineering applications.The use of advanced image acquisition techniques,image processing,and computer-aided design methods has enabled the precise design and additive manufacturing of anatomically correct and patient-specific implants and scaffolds.However,these sophisticated techniques can be timeconsuming,labor-intensive,and expensive.Moreover,the necessary imaging and manufacturing equipment may not be readily available when urgent treatment is needed for trauma patients.In this study,a novel design and AM methods are proposed for the development of modular and customizable scaffold blocks that can be adapted to fit the bone defect area of a patient.These modular scaffold blocks can be combined to quickly form any patient-specific scaffold directly from two-dimensional(2D)medical images when the surgeon lacks access to a 3D printer or cannot wait for lengthy 3D imaging,modeling,and 3D printing during surgery.The proposed method begins with developing a bone surface-modeling algorithm that reconstructs a model of the patient’s bone from 2D medical image measurements without the need for expensive 3D medical imaging or segmentation.This algorithm can generate both patient-specific and average bone models.Additionally,a biomimetic continuous path planning method is developed for the additive manufacturing of scaffolds,allowing porous scaffold blocks with the desired biomechanical properties to be manufactured directly from 2D data or images.The algorithms are implemented,and the designed scaffold blocks are 3D printed using an extrusion-based AM process.Guidelines and instructions are also provided to assist surgeons in assembling scaffold blocks for the self-repair of patient-specific large bone defects.展开更多
Bone regeneration is a critical area in regenerative medicine,particularly in orthopedics,demanding effective biomedical materials for treating bone defects.45S5 bioactive glass(45S5 BG)is a promising material because...Bone regeneration is a critical area in regenerative medicine,particularly in orthopedics,demanding effective biomedical materials for treating bone defects.45S5 bioactive glass(45S5 BG)is a promising material because of its osteoconductive and bioactive properties.As research in this field continues to advance,keeping up-to-date on the latest and most successful applications of this material is imperative.To achieve this,we conducted a comprehensive search on Pub-Med/MEDLINE,focusing on English articles published in the last decade.Our search used the keywords“bioglass 45S5 AND bone defect”in combination.We found 27 articles,and after applying the inclusion criteria,we selected 15 studies for detailed examination.Most of these studies compared 45S5 BG with other cement or scaffold materials.These comparisons demonstrate that the addition of various composites enhances cellular biocompatibility,as evidenced by the cells and their osteogenic potential.Moreover,the use of 45S5 BG is enhanced by its antimicrobial properties,opening avenues for additional investigations and applications of this biomaterial.展开更多
Because of its simplicity,reliability,and replicability,the Masquelet induced membrane technique(IMT)has become one of the preferred methods for critical bone defect reconstruction in extremities.Although it is now us...Because of its simplicity,reliability,and replicability,the Masquelet induced membrane technique(IMT)has become one of the preferred methods for critical bone defect reconstruction in extremities.Although it is now used worldwide,few studies have been published about IMT in military practice.Bone reconstruction is particularly challenging in this context of care due to extensive soft-tissue injury,early wound infection,and even delayed management in austere conditions.Based on our clinical expertise,recent research,and a literature analysis,this narrative review provides an overview of the IMT application to combat-related bone defects.It presents technical specificities and future developments aiming to optimize IMT outcomes,including for the management of massive multi-tissue defects or bone reconstruction performed in the field with limited resources.展开更多
The biomechanical effects of acetabular revision with jumbo cups are unclear.This study aimed to compare the biomechanical effects of bionic trabecular metal vs.titanium jumbo cups for the revision of acetabular bone ...The biomechanical effects of acetabular revision with jumbo cups are unclear.This study aimed to compare the biomechanical effects of bionic trabecular metal vs.titanium jumbo cups for the revision of acetabular bone defects.We designed and reconstructed American Academy of Orthopaedic Surgeons(AAOS)type I–III acetabular bone defect models using computed tomography scans of a man without acetabular bone defects.The implantation of titanium and trabecular metal jumbo cups was simulated.Stress distribution and relative micromotion between the cup and host bone were assessed using finite element analysis.Contact stress on the screws fixing the cups was also analyzed.The contact stress analysis showed that the peak contact stress between the titanium jumbo cup and the host bone was 21.7,20.1,and 23.8 MPa in the AAOS I–III models,respectively;the corresponding values for bionic tantalum jumbo cups decreased to 4.7,6.7,and 11.1 MPa.Analysis of the relative micromotion showed that the peak relative micromotion between the host bone and the titanium metal cup was 10.2,9.1,and 11.5μm in the AAOS I–III models,respectively;the corresponding values for bionic trabecular metal cups were 17.2,18.2,and 31.3μm.The peak contact stress on the screws was similar for the 2 cup types,and was concentrated on the screw rods.Hence,acetabular reconstruction with jumbo cups is biomechanically feasible.We recommend trabecular metal cups due to their superior stress distribution and higher relative micromotion,which is within the threshold for adequate bone ingrowth.展开更多
Magnesium-based biomaterials have been in extensive research for orthopedic applications for decades due to their optimal mechanical features and osteopromotive nature;nevertheless,rapid degradation restricts their cl...Magnesium-based biomaterials have been in extensive research for orthopedic applications for decades due to their optimal mechanical features and osteopromotive nature;nevertheless,rapid degradation restricts their clinical applicability.In this study,pristine magnesium was purified(P-Mg)using a melt self-purification approach and reinforced using indigenously synthesized nanohydroxyapatite(HAP,0.6 wt.%)and strontium substituted nanohydroxyapatite(SrHAP,0.6 wt.%)using a low-cost stir assisted squeeze casting method to control their degradation rate.Using electron back-scattered diffraction(EBSD)and X-ray diffraction(XRD)examinations,all casted materials were carefully evaluated for microstructure and phase analysis.Mechanical characteristics,in vitro degradation,and in vitro biocompatibility with murine pre-osteoblasts were also tested on the fabricated alloys.For in vivo examination of bone formation,osteointegration,and degradation rate,the magnesium-based alloys were fabricated as small cylindrical pins with a diameter of 2.7 mm and a height of 2 mm.The pins were implanted in a critical-sized defect in a rat femur shaft(2.7 mm diameter and 2 mm depth)for 8 weeks and evaluated by microCT and histological evaluation for bone growth and osteointegration.When compared to P-Mg and P-MgHAP,micro-CT and histological analyses revealed that the P-MgSrHAP group had the highest bone formation towards the periphery of the implant and hence maximum osteointegration.When the removed pins from the bone defect were analyzed using GIXRD,they displayed hydroxyapatite peaks that were consistent with bio-integration.For P-Mg,P-MgHAP,and P-MgSrHAP 8 weeks after implantation,in vivo degradation rates derived from micro-CT were around 0.6 mm/year,0.5 mm/year,and 0.1 mm/year,respectively.Finally,P-MgSrHAP possesses the requisite degradation rate as well as sufficient mechanical and biological properties,indicating that it has the potential to be used in the development/fabrication of biodegradable bioactive orthopaedic implants.展开更多
The bone defects of the cranial vault encompassed rare malformations including acalvaria, hypocalvaria, acrania, hypocrania, anencephaly and exencephaly. They are also described in some pathological entities such as a...The bone defects of the cranial vault encompassed rare malformations including acalvaria, hypocalvaria, acrania, hypocrania, anencephaly and exencephaly. They are also described in some pathological entities such as aplasia cutis congenita of the scalp. We report an unusual case of cephalic malformation which combine defects of the skin, the dura mater, and the bones of the vault, with a malformation of the central nervous system. This unique case emphasizes a problem of nosological definition between the terms mentioned above. acalvaria, the acrania, the hypocalvaria and the aplasia cutis congenita. Thus, herein, we proceed to a literature review of bone defects of the skull and their differential diagnosis.展开更多
BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in...BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use.AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes.METHODS Three databases(Pub Med, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period(2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results,complications and described large patient samples(not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded.RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen.Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously(bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion.CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.展开更多
Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing techn...Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing technology in the reconstruction of such acetabular bone defects.We retrospectively analyzed the prognosis of four severe bone defects around the acetabulum in three patients who were treated using 3D printing technology.Reconstruction of bone defect by conventional methods was difficult in these patients.In this endeavor,we used radiographic methods,related computer software such as Materialise's interactive medical image control system and Siemens NX software,and actual surgical experience to estimate defect volume,prosthesis stability,and installation accuracy,respectively.Moreover,a Harris hip score was obtained to evaluate limb function.It was found that bone defects could be adequately reconstructed using a 3D printing prosthesis,and its stability was reliable.The Harris hip score indicated a very good functional recovery in all three patients.In conclusion,3D printing technology had a good therapeutic effect on both complex and large bone defects in the revision of THA.It was able to achieve good curative effects in patients with large bone defects.展开更多
Compared with non-degradable materials,biodegradable biomaterials play an increasingly important role in the repairing of severe bone defects,and have attracted extensive attention from researchers.In the treatment of...Compared with non-degradable materials,biodegradable biomaterials play an increasingly important role in the repairing of severe bone defects,and have attracted extensive attention from researchers.In the treatment of bone defects,scaffolds made of biodegradable materials can provide a crawling bridge for new bone tissue in the gap and a platform for cells and growth factors to play a physiological role,which will eventually be degraded and absorbed in the body and be replaced by the new bone tissue.Traditional biodegradable materials include polymers,ceramics and metals,which have been used in bone defect repairing for many years.Although these materials have more or fewer shortcomings,they are still the cornerstone of our development of a new generation of degradable materials.With the rapid development of modern science and technology,in the 21 st century,more and more kinds of new biodegradable materials emerge in endlessly,such as new intelligent micro-nano materials and cell-based products.At the same time,there are many new fabrication technologies of improving biodegradable materials,such as modular fabrication,3 D and 4 D printing,interface reinforcement and nanotechnology.This review will introduce various kinds of biodegradable materials commonly used in bone defect repairing,especially the newly emerging materials and their fabrication technology in recent years,and look forward to the future research direction,hoping to provide researchers in the field with some inspiration and reference.展开更多
BACKGROUND Continuous severe horizontal bone defect is common in the aesthetic maxillary anterior area,and presents a major challenge in implant dentistry and requires predictable bone augmentation to increase the wid...BACKGROUND Continuous severe horizontal bone defect is common in the aesthetic maxillary anterior area,and presents a major challenge in implant dentistry and requires predictable bone augmentation to increase the width of the alveolar bone.CASE SUMMARY A 24-year-old man,with a history of well-controlled IgA nephropathy,presented to the Dentistry Department of our hospital complaining of missing his right maxillary anterior teeth 1 mo ago.Severe horizontal alveolar bone defects at sites of teeth 12,13 and 14 were diagnosed.A modified guided bone regeneration surgical approach stabilizing the absorbable collagen membrane and particulate graft materials by periosteal diagonal mattress suture(PDMS)combined with four corner pins was used for this severe continuous horizontal bone defect.The outcome revealed that the newly formed alveolar ridge dimension increased from 0.72 mm to 11.55 mm horizontally 10 mo postoperatively,with no adverse events.The implant surgery was successfully performed.CONCLUSION This case highlights that PDMS combined with four corner pins is feasible to maintain the space and stabilize the graft and membranes in severe continuous horizontal bone defect.展开更多
BACKGROUND Hip revision surgery is the final treatment option for the failure of artificial hip joints, but it is more difficult than the initial operation. For patients with hip joint loosening around the prosthesis ...BACKGROUND Hip revision surgery is the final treatment option for the failure of artificial hip joints, but it is more difficult than the initial operation. For patients with hip joint loosening around the prosthesis combined with large inflammatory pseudotumours and large segment bone defects, hip revision is even more difficult, and clinical reports are rare.CASE SUMMARY Male, 59 years old. The patient underwent left hip replacement 35 years ago and was now admitted to hospital due to massive masses in the left thigh, shortening of the left lower extremity, and pain and lameness of the left hip joint. X-ray, computed tomography and magnetic resonance imaging revealed prosthesis loosening, left acetabular bone defect(Parprosky IIIB type), and a bone defect of the left proximal femur(Parprosky IIIA type). Inflammatory pseudotumours were seen in the left hip and left thigh. Hip revision surgery was performed using a 3Dprinted custom acetabular prosthesis was used for hip revision surgery, which was produced by Arcam Electron Beam Melting system with Electron Beam Melting technology. The operation was successful, and the patient was followed up regularly after the operation. The custom-made acetabular prosthesis was well matched, the inflammatory pseudotumour was completely removed, the postoperative hip prosthesis was stable, and the old greater trochanter fracture was well reduced and fixed. The patient was partially weight-bearing with crutches 3 mo after the operation and walked with full weight-bearing after 6 mo. The hip prosthesis was stable, and there was no recurrence of inflammatory pseudotumours at the last follow-up. The Visual Analogue Scale was 3, and the Harris hip score was 90.CONCLUSION The use of 3D-printed personalized custom prostheses for complex hip revision surgery has satisfactory surgical results and has great clinical application value.展开更多
Objective: To systematically evaluate the clinical efficacy and safety of Masquelet technology and Llizarov group technology in the treatment of infectious bone defects by meta-analysis. Methods: The computer searched...Objective: To systematically evaluate the clinical efficacy and safety of Masquelet technology and Llizarov group technology in the treatment of infectious bone defects by meta-analysis. Methods: The computer searched China Knowledge Network (CNKI), Wanfang, VIP, Chinese Biomedical Literature Database (CBM), Pubmed, Medline, Cochrane Llibrary databases. The retrieval time was from the time of the establishment of the database to January 2020. According to the inclusion and exclusion criteria, randomized controlled trials on the treatment of infectious bone defects using Masquelet technology and Llizarov technology were collected, and the retrieved literature was independently screened, evaluated, and data extracted by two researchers, and then RevMan5.3 software was used so for meta-analysis. Results: A total of 10 RCT documents were included, with a total of 496 patients, including 242 in the Masquelet group and 254 in the Llizarov group. The results of the meta-analysis showed that: in terms of bone defect healing time, total weight bearing time, treatment cost, and complication rate, the Masquelet group was significantly different from the Llizarov group, and the Masquelet group was better than the Llizarov group (P <0.05);In terms of knee joint Lowa score and SF-36 score, Masquelet group has significant differences compared with Llizarov group, Llizarov group is better than Masquelet group (P <0.05);in excellent rate, number of operations, ankle Lowa score, infection control rate In terms of excellent rate of affected limb function, there was no significant difference between Masquelet group and Llizarov group (P> 0.05). Conclusion:Compared with Llizarov technology, Masquelet technology has obvious advantages in the treatment of infectious bone defects in terms of bone defect healing time, total weight-bearing time, treatment cost, and complication rate. In terms of scoring, it has advantages over Masquelet technology, but in terms of excellent treatment rate, number of operations, and ankle lowa score. In terms of infection control rate and excellent function of affected limbs, there was no significant difference between Masquelet technology and Llizarov technology,However, due to the low quality of the included studies and the small sample size, the exact efficacy still needs to be confirmed by higher quality RCT studies.展开更多
In total knee arthroplasty (TKA), a treatment of bone defect varies depending on the location and extent of defect and requires proper surgical procedure. Metal augmentation is readily available for both femoral and t...In total knee arthroplasty (TKA), a treatment of bone defect varies depending on the location and extent of defect and requires proper surgical procedure. Metal augmentation is readily available for both femoral and tibial bone defects. We report the operative technique of modular metal augmentation using a downsized block for ambiguous proximal tibial and distal femoral bone defects in primary and revision TKA. Regarding bone defects, bone loss can be minimized by using a different size of metal augmentation, and suitable reinforcement for bone defects can be achieved. Once our technique is properly used, it will be very helpful in treating bone defects.展开更多
This study evaluated the clinical effect of impaction bone graft and distal press-fit fixation for the reconstruction of severe femoral bone defect in revision total hip arthroplasty.A total of 234 patients (involving...This study evaluated the clinical effect of impaction bone graft and distal press-fit fixation for the reconstruction of severe femoral bone defect in revision total hip arthroplasty.A total of 234 patients (involving 236 hips) with Paprosky Ⅲ and Ⅳ femoral bone defects were treated with the revision total hip arthroplasty from June 1998 to Aug.2006.Impaction bone graft technique was used for 112 hips,with allogeneic freeze-dried bone as bone graft and SPⅡ as prosthesis.With 124 hips,modular distal press-fit fixation and tapered femoral stem (MP stem) were employed.After the operation,the subjects were followed up on regular basis and results were assessed by using the Harris Hip Score (HHS) and 12-item Short Form Health Survey (SF-12).Radiolucence,subsidence and loosening were observed and complications,including infection,fracture,dislocation etc.were recorded.A 6-14-year follow-up showed that prostheses failed,due to infection,in 4 patients of impaction bone graft group and that 6 patients in the press-fit fixation group experienced prosthesis failure,with the survival rates for the two techniques being 96.43% and 95.16%,respectively.One-way ANOVA showed that prosthesis survival was significantly associated with surgery-related complications (P<0.05) and was not related to the type of the bone defects (P>0.05).The rate of complications bore significant association with the type of bone defects in the two groups (P<0.05).Our study showed that the two revision methods could achieve satisfactory mid-term and long-term results for the reconstruction of severe bone defects.It is of great significance for attaining high prosthesis survival rate to select suitable operation on the basis of the type of bone defect.Careful operative manipulation and post-operative rehabilitation aimed at reducing complications are also important.展开更多
Objective:To study the possibility of natural hydroxyapatite/chitosan composite on repairing bone defects. Methods:We developed a natural hydroxyapatite/chitosan composite that could be molded into any desired shape. ...Objective:To study the possibility of natural hydroxyapatite/chitosan composite on repairing bone defects. Methods:We developed a natural hydroxyapatite/chitosan composite that could be molded into any desired shape. The powder component consists of natural hydroxyapatite, which is epurated from bone of pigs. The liquid component consists of malic acid and chitosan. Operations were performed on the left tibias of 15 white rabbits to create two square bone defects. One of the defects was reconstructed with the composite, while the other was not repaired and used as a blank control. Three of the animals were killed at the end of 2 weeks, 4 weeks, 8 weeks, 12 weeks and 16 weeks respectively and implants were evaluated anatomically and histologically. Results:No apparent rejection reaction was found, except for a mild inflammatory infiltration observed 2 weeks after surgery. Fibrous tissue became thinner 2～8 weeks after surgery and bony connections were detected 12 weeks after surgery. The new bone was the same as the recipient bone by the 16th postoperative week. Conclusion:The hydroxyapatite/chitosan composite has good biocompatibility and osteoconduction. It is a potential repairing material for clinical application.展开更多
AIM: To determine the effects of transplanting osteogenic matrix cell sheets and beta-tricalcium phosphate(TCP) constructs on bone formation in bone defects.METHODS: Osteogenic matrix cell sheets were prepared from bo...AIM: To determine the effects of transplanting osteogenic matrix cell sheets and beta-tricalcium phosphate(TCP) constructs on bone formation in bone defects.METHODS: Osteogenic matrix cell sheets were prepared from bone marrow stromal cells(BMSCs), and a porous TCP ceramic was used as a scaffold. Three experimental groups were prepared, comprised of TCP scaffolds(1) seeded with BMSCs;(2) wrapped with osteogenic matrix cell sheets; or(3) both. Constructs were implanted into a femoral defect model in rats and bone growth was evaluated by radiography, histology, biochemistry, and mechanical testing after 8 wk. RESULTS: In bone defects, constructs implanted with cell sheets showed callus formation with segmentalor continuous bone formation at 8 wk, in contrast to TCP seeded with BMSCs, which resulted in bone nonunion. Wrapping TCP constructs with osteogenic matrix cell sheets increased their osteogenic potential and resulting bone formation, compared with conventional bone tissue engineering TCP scaffolds seeded with BMSCs. The compressive stiffness(mean ± SD) values were 225.0 ± 95.7, 30.0 ± 11.5, and 26.3 ± 10.6 MPa for BMSC/TCP/Sheet constructs with continuous bone formation, BMSC/TCP/Sheet constructs with segmental bone formation, and BMSC/TCP constructs, respectively. The compressive stiffness of BMSC/TCP/Sheet constructs with continuous bone formation was significantly higher than those with segmental bone formation and BMSC/TCP constructs.CONCLUSION: This technique is an improvement over current methods, such as TCP substitution, and is useful for hard tissue reconstruction and inducing earlier bone union in defects.展开更多
Objective:To report the clinical outcome of repairing massive bone defects biologically in limbs by homeochronous using structural bone allografts with intramedullary vascularized fibular autografts. Methods: From Jan...Objective:To report the clinical outcome of repairing massive bone defects biologically in limbs by homeochronous using structural bone allografts with intramedullary vascularized fibular autografts. Methods: From January 2001 to December 2005, large bone defects in 19 patients (11 men and 8 women, aged 6 to 35 years) were repaired by structural bone allografts with intramedullary vascularized fibular autografts in the homeochronous period. The range of the length of bone defects was 11 to 25 cm (mean 17.6 cm), length of vascularized free fibular was 15 to 29 cm (mean 19.2 cm), length of massive bone allografts was 11 to 24 cm (mean 17.1 cm). Location of massive bone defects was in humerus(n=1), in femur(n=9) and in tibia(n=9), respectively. Results: After 9 to 69 months (mean 38.2 months) follow-up, wounds of donor and recipient sites were healed inⅠstage, monitoring-flaps were alive, eject reaction of massive bone allografts were slight, no complications in donor limbs. Fifteen patients had the evidence of radiographic union 3 to 6 months after surgery, 3 cases united 8 months later, and the remained one case of malignant synovioma in distal femur recurred and amputated the leg 2.5 months, postoperatively. Five patients had been removed internal fixation, complete bone unions were found one year postoperatively. None of massive bone allografts were absorbed or collapsed at last follow-up. Conclusion: The homeochronous usage of structural bone allograft with an intramedullary vascularized fibular autograft can biologically obtain a structure with the immediate mechanical strength of the allograft, a potential result of revascularization through the vascularized fibula, and accelerate bone union not only between fibular autograft and the host but also between massive bone allograft and the host.展开更多
文摘Additive manufacturing(AM)has revolutionized the design and manufacturing of patient-specific,three-dimensional(3D),complex porous structures known as scaffolds for tissue engineering applications.The use of advanced image acquisition techniques,image processing,and computer-aided design methods has enabled the precise design and additive manufacturing of anatomically correct and patient-specific implants and scaffolds.However,these sophisticated techniques can be timeconsuming,labor-intensive,and expensive.Moreover,the necessary imaging and manufacturing equipment may not be readily available when urgent treatment is needed for trauma patients.In this study,a novel design and AM methods are proposed for the development of modular and customizable scaffold blocks that can be adapted to fit the bone defect area of a patient.These modular scaffold blocks can be combined to quickly form any patient-specific scaffold directly from two-dimensional(2D)medical images when the surgeon lacks access to a 3D printer or cannot wait for lengthy 3D imaging,modeling,and 3D printing during surgery.The proposed method begins with developing a bone surface-modeling algorithm that reconstructs a model of the patient’s bone from 2D medical image measurements without the need for expensive 3D medical imaging or segmentation.This algorithm can generate both patient-specific and average bone models.Additionally,a biomimetic continuous path planning method is developed for the additive manufacturing of scaffolds,allowing porous scaffold blocks with the desired biomechanical properties to be manufactured directly from 2D data or images.The algorithms are implemented,and the designed scaffold blocks are 3D printed using an extrusion-based AM process.Guidelines and instructions are also provided to assist surgeons in assembling scaffold blocks for the self-repair of patient-specific large bone defects.
文摘Bone regeneration is a critical area in regenerative medicine,particularly in orthopedics,demanding effective biomedical materials for treating bone defects.45S5 bioactive glass(45S5 BG)is a promising material because of its osteoconductive and bioactive properties.As research in this field continues to advance,keeping up-to-date on the latest and most successful applications of this material is imperative.To achieve this,we conducted a comprehensive search on Pub-Med/MEDLINE,focusing on English articles published in the last decade.Our search used the keywords“bioglass 45S5 AND bone defect”in combination.We found 27 articles,and after applying the inclusion criteria,we selected 15 studies for detailed examination.Most of these studies compared 45S5 BG with other cement or scaffold materials.These comparisons demonstrate that the addition of various composites enhances cellular biocompatibility,as evidenced by the cells and their osteogenic potential.Moreover,the use of 45S5 BG is enhanced by its antimicrobial properties,opening avenues for additional investigations and applications of this biomaterial.
文摘Because of its simplicity,reliability,and replicability,the Masquelet induced membrane technique(IMT)has become one of the preferred methods for critical bone defect reconstruction in extremities.Although it is now used worldwide,few studies have been published about IMT in military practice.Bone reconstruction is particularly challenging in this context of care due to extensive soft-tissue injury,early wound infection,and even delayed management in austere conditions.Based on our clinical expertise,recent research,and a literature analysis,this narrative review provides an overview of the IMT application to combat-related bone defects.It presents technical specificities and future developments aiming to optimize IMT outcomes,including for the management of massive multi-tissue defects or bone reconstruction performed in the field with limited resources.
基金This work was supported by funding from China Postdoctoral Science Foundation(No:2020M670863)Jilin Scientific and Technological Development Program(No:20230203089SF).
文摘The biomechanical effects of acetabular revision with jumbo cups are unclear.This study aimed to compare the biomechanical effects of bionic trabecular metal vs.titanium jumbo cups for the revision of acetabular bone defects.We designed and reconstructed American Academy of Orthopaedic Surgeons(AAOS)type I–III acetabular bone defect models using computed tomography scans of a man without acetabular bone defects.The implantation of titanium and trabecular metal jumbo cups was simulated.Stress distribution and relative micromotion between the cup and host bone were assessed using finite element analysis.Contact stress on the screws fixing the cups was also analyzed.The contact stress analysis showed that the peak contact stress between the titanium jumbo cup and the host bone was 21.7,20.1,and 23.8 MPa in the AAOS I–III models,respectively;the corresponding values for bionic tantalum jumbo cups decreased to 4.7,6.7,and 11.1 MPa.Analysis of the relative micromotion showed that the peak relative micromotion between the host bone and the titanium metal cup was 10.2,9.1,and 11.5μm in the AAOS I–III models,respectively;the corresponding values for bionic trabecular metal cups were 17.2,18.2,and 31.3μm.The peak contact stress on the screws was similar for the 2 cup types,and was concentrated on the screw rods.Hence,acetabular reconstruction with jumbo cups is biomechanically feasible.We recommend trabecular metal cups due to their superior stress distribution and higher relative micromotion,which is within the threshold for adequate bone ingrowth.
基金the funding received from Ministry of Human Resource Development(MHRD),India and Indian Council of Medical Research(ICMR),India projects(IMPRINT-6714UAY/MHRD_IITK_006),MHRD,India project(SPARC/2018–2019/P612/S)+3 种基金Science and Engineering Research Board(SERB),India project(IPA/2020/000026)Department of Science and Technology(DST),Govt.of India project(DST/NM/NT-2018/48)Department of Biotechnology(DBT),Govt.of India project(DBT/IN/SWEDEN/08/AK/2017–18)Ortho Regenics Private Limited(ORPL)。
文摘Magnesium-based biomaterials have been in extensive research for orthopedic applications for decades due to their optimal mechanical features and osteopromotive nature;nevertheless,rapid degradation restricts their clinical applicability.In this study,pristine magnesium was purified(P-Mg)using a melt self-purification approach and reinforced using indigenously synthesized nanohydroxyapatite(HAP,0.6 wt.%)and strontium substituted nanohydroxyapatite(SrHAP,0.6 wt.%)using a low-cost stir assisted squeeze casting method to control their degradation rate.Using electron back-scattered diffraction(EBSD)and X-ray diffraction(XRD)examinations,all casted materials were carefully evaluated for microstructure and phase analysis.Mechanical characteristics,in vitro degradation,and in vitro biocompatibility with murine pre-osteoblasts were also tested on the fabricated alloys.For in vivo examination of bone formation,osteointegration,and degradation rate,the magnesium-based alloys were fabricated as small cylindrical pins with a diameter of 2.7 mm and a height of 2 mm.The pins were implanted in a critical-sized defect in a rat femur shaft(2.7 mm diameter and 2 mm depth)for 8 weeks and evaluated by microCT and histological evaluation for bone growth and osteointegration.When compared to P-Mg and P-MgHAP,micro-CT and histological analyses revealed that the P-MgSrHAP group had the highest bone formation towards the periphery of the implant and hence maximum osteointegration.When the removed pins from the bone defect were analyzed using GIXRD,they displayed hydroxyapatite peaks that were consistent with bio-integration.For P-Mg,P-MgHAP,and P-MgSrHAP 8 weeks after implantation,in vivo degradation rates derived from micro-CT were around 0.6 mm/year,0.5 mm/year,and 0.1 mm/year,respectively.Finally,P-MgSrHAP possesses the requisite degradation rate as well as sufficient mechanical and biological properties,indicating that it has the potential to be used in the development/fabrication of biodegradable bioactive orthopaedic implants.
文摘The bone defects of the cranial vault encompassed rare malformations including acalvaria, hypocalvaria, acrania, hypocrania, anencephaly and exencephaly. They are also described in some pathological entities such as aplasia cutis congenita of the scalp. We report an unusual case of cephalic malformation which combine defects of the skin, the dura mater, and the bones of the vault, with a malformation of the central nervous system. This unique case emphasizes a problem of nosological definition between the terms mentioned above. acalvaria, the acrania, the hypocalvaria and the aplasia cutis congenita. Thus, herein, we proceed to a literature review of bone defects of the skull and their differential diagnosis.
文摘BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use.AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes.METHODS Three databases(Pub Med, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period(2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results,complications and described large patient samples(not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded.RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen.Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously(bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion.CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.
基金This work is supported by National Key Research and Development Program of China(2016YFC1100600)the National Natural Science Foundation of China(81972058 and 81902194)the Multicenter Clinical Research Project of Shanghai Jiao Tong University School of Medicine(DLY201506).
文摘Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing technology in the reconstruction of such acetabular bone defects.We retrospectively analyzed the prognosis of four severe bone defects around the acetabulum in three patients who were treated using 3D printing technology.Reconstruction of bone defect by conventional methods was difficult in these patients.In this endeavor,we used radiographic methods,related computer software such as Materialise's interactive medical image control system and Siemens NX software,and actual surgical experience to estimate defect volume,prosthesis stability,and installation accuracy,respectively.Moreover,a Harris hip score was obtained to evaluate limb function.It was found that bone defects could be adequately reconstructed using a 3D printing prosthesis,and its stability was reliable.The Harris hip score indicated a very good functional recovery in all three patients.In conclusion,3D printing technology had a good therapeutic effect on both complex and large bone defects in the revision of THA.It was able to achieve good curative effects in patients with large bone defects.
基金supported by grants from the National Natural Science Foundation of China(11772226,81871777 and 81572154)the Tianjin Science and Technology Plan Project(18PTLCSY00070,16ZXZNGX00130)grants awarded to Xiao-Song Gu by the National Natural Science Foundation of China(31730031 and L1924064)。
文摘Compared with non-degradable materials,biodegradable biomaterials play an increasingly important role in the repairing of severe bone defects,and have attracted extensive attention from researchers.In the treatment of bone defects,scaffolds made of biodegradable materials can provide a crawling bridge for new bone tissue in the gap and a platform for cells and growth factors to play a physiological role,which will eventually be degraded and absorbed in the body and be replaced by the new bone tissue.Traditional biodegradable materials include polymers,ceramics and metals,which have been used in bone defect repairing for many years.Although these materials have more or fewer shortcomings,they are still the cornerstone of our development of a new generation of degradable materials.With the rapid development of modern science and technology,in the 21 st century,more and more kinds of new biodegradable materials emerge in endlessly,such as new intelligent micro-nano materials and cell-based products.At the same time,there are many new fabrication technologies of improving biodegradable materials,such as modular fabrication,3 D and 4 D printing,interface reinforcement and nanotechnology.This review will introduce various kinds of biodegradable materials commonly used in bone defect repairing,especially the newly emerging materials and their fabrication technology in recent years,and look forward to the future research direction,hoping to provide researchers in the field with some inspiration and reference.
文摘BACKGROUND Continuous severe horizontal bone defect is common in the aesthetic maxillary anterior area,and presents a major challenge in implant dentistry and requires predictable bone augmentation to increase the width of the alveolar bone.CASE SUMMARY A 24-year-old man,with a history of well-controlled IgA nephropathy,presented to the Dentistry Department of our hospital complaining of missing his right maxillary anterior teeth 1 mo ago.Severe horizontal alveolar bone defects at sites of teeth 12,13 and 14 were diagnosed.A modified guided bone regeneration surgical approach stabilizing the absorbable collagen membrane and particulate graft materials by periosteal diagonal mattress suture(PDMS)combined with four corner pins was used for this severe continuous horizontal bone defect.The outcome revealed that the newly formed alveolar ridge dimension increased from 0.72 mm to 11.55 mm horizontally 10 mo postoperatively,with no adverse events.The implant surgery was successfully performed.CONCLUSION This case highlights that PDMS combined with four corner pins is feasible to maintain the space and stabilize the graft and membranes in severe continuous horizontal bone defect.
文摘BACKGROUND Hip revision surgery is the final treatment option for the failure of artificial hip joints, but it is more difficult than the initial operation. For patients with hip joint loosening around the prosthesis combined with large inflammatory pseudotumours and large segment bone defects, hip revision is even more difficult, and clinical reports are rare.CASE SUMMARY Male, 59 years old. The patient underwent left hip replacement 35 years ago and was now admitted to hospital due to massive masses in the left thigh, shortening of the left lower extremity, and pain and lameness of the left hip joint. X-ray, computed tomography and magnetic resonance imaging revealed prosthesis loosening, left acetabular bone defect(Parprosky IIIB type), and a bone defect of the left proximal femur(Parprosky IIIA type). Inflammatory pseudotumours were seen in the left hip and left thigh. Hip revision surgery was performed using a 3Dprinted custom acetabular prosthesis was used for hip revision surgery, which was produced by Arcam Electron Beam Melting system with Electron Beam Melting technology. The operation was successful, and the patient was followed up regularly after the operation. The custom-made acetabular prosthesis was well matched, the inflammatory pseudotumour was completely removed, the postoperative hip prosthesis was stable, and the old greater trochanter fracture was well reduced and fixed. The patient was partially weight-bearing with crutches 3 mo after the operation and walked with full weight-bearing after 6 mo. The hip prosthesis was stable, and there was no recurrence of inflammatory pseudotumours at the last follow-up. The Visual Analogue Scale was 3, and the Harris hip score was 90.CONCLUSION The use of 3D-printed personalized custom prostheses for complex hip revision surgery has satisfactory surgical results and has great clinical application value.
基金The Science and Technology Project of Henan Province (182102310487)
文摘Objective: To systematically evaluate the clinical efficacy and safety of Masquelet technology and Llizarov group technology in the treatment of infectious bone defects by meta-analysis. Methods: The computer searched China Knowledge Network (CNKI), Wanfang, VIP, Chinese Biomedical Literature Database (CBM), Pubmed, Medline, Cochrane Llibrary databases. The retrieval time was from the time of the establishment of the database to January 2020. According to the inclusion and exclusion criteria, randomized controlled trials on the treatment of infectious bone defects using Masquelet technology and Llizarov technology were collected, and the retrieved literature was independently screened, evaluated, and data extracted by two researchers, and then RevMan5.3 software was used so for meta-analysis. Results: A total of 10 RCT documents were included, with a total of 496 patients, including 242 in the Masquelet group and 254 in the Llizarov group. The results of the meta-analysis showed that: in terms of bone defect healing time, total weight bearing time, treatment cost, and complication rate, the Masquelet group was significantly different from the Llizarov group, and the Masquelet group was better than the Llizarov group (P <0.05);In terms of knee joint Lowa score and SF-36 score, Masquelet group has significant differences compared with Llizarov group, Llizarov group is better than Masquelet group (P <0.05);in excellent rate, number of operations, ankle Lowa score, infection control rate In terms of excellent rate of affected limb function, there was no significant difference between Masquelet group and Llizarov group (P> 0.05). Conclusion:Compared with Llizarov technology, Masquelet technology has obvious advantages in the treatment of infectious bone defects in terms of bone defect healing time, total weight-bearing time, treatment cost, and complication rate. In terms of scoring, it has advantages over Masquelet technology, but in terms of excellent treatment rate, number of operations, and ankle lowa score. In terms of infection control rate and excellent function of affected limbs, there was no significant difference between Masquelet technology and Llizarov technology,However, due to the low quality of the included studies and the small sample size, the exact efficacy still needs to be confirmed by higher quality RCT studies.
文摘In total knee arthroplasty (TKA), a treatment of bone defect varies depending on the location and extent of defect and requires proper surgical procedure. Metal augmentation is readily available for both femoral and tibial bone defects. We report the operative technique of modular metal augmentation using a downsized block for ambiguous proximal tibial and distal femoral bone defects in primary and revision TKA. Regarding bone defects, bone loss can be minimized by using a different size of metal augmentation, and suitable reinforcement for bone defects can be achieved. Once our technique is properly used, it will be very helpful in treating bone defects.
基金supported by a grant from the National High Technology Research and Development Program of China(863 Program)(NO.2011AA030101)
文摘This study evaluated the clinical effect of impaction bone graft and distal press-fit fixation for the reconstruction of severe femoral bone defect in revision total hip arthroplasty.A total of 234 patients (involving 236 hips) with Paprosky Ⅲ and Ⅳ femoral bone defects were treated with the revision total hip arthroplasty from June 1998 to Aug.2006.Impaction bone graft technique was used for 112 hips,with allogeneic freeze-dried bone as bone graft and SPⅡ as prosthesis.With 124 hips,modular distal press-fit fixation and tapered femoral stem (MP stem) were employed.After the operation,the subjects were followed up on regular basis and results were assessed by using the Harris Hip Score (HHS) and 12-item Short Form Health Survey (SF-12).Radiolucence,subsidence and loosening were observed and complications,including infection,fracture,dislocation etc.were recorded.A 6-14-year follow-up showed that prostheses failed,due to infection,in 4 patients of impaction bone graft group and that 6 patients in the press-fit fixation group experienced prosthesis failure,with the survival rates for the two techniques being 96.43% and 95.16%,respectively.One-way ANOVA showed that prosthesis survival was significantly associated with surgery-related complications (P<0.05) and was not related to the type of the bone defects (P>0.05).The rate of complications bore significant association with the type of bone defects in the two groups (P<0.05).Our study showed that the two revision methods could achieve satisfactory mid-term and long-term results for the reconstruction of severe bone defects.It is of great significance for attaining high prosthesis survival rate to select suitable operation on the basis of the type of bone defect.Careful operative manipulation and post-operative rehabilitation aimed at reducing complications are also important.
基金supported by Science and Technology Projects Fund of Nanjing Medical University(NY0522)
文摘Objective:To study the possibility of natural hydroxyapatite/chitosan composite on repairing bone defects. Methods:We developed a natural hydroxyapatite/chitosan composite that could be molded into any desired shape. The powder component consists of natural hydroxyapatite, which is epurated from bone of pigs. The liquid component consists of malic acid and chitosan. Operations were performed on the left tibias of 15 white rabbits to create two square bone defects. One of the defects was reconstructed with the composite, while the other was not repaired and used as a blank control. Three of the animals were killed at the end of 2 weeks, 4 weeks, 8 weeks, 12 weeks and 16 weeks respectively and implants were evaluated anatomically and histologically. Results:No apparent rejection reaction was found, except for a mild inflammatory infiltration observed 2 weeks after surgery. Fibrous tissue became thinner 2～8 weeks after surgery and bony connections were detected 12 weeks after surgery. The new bone was the same as the recipient bone by the 16th postoperative week. Conclusion:The hydroxyapatite/chitosan composite has good biocompatibility and osteoconduction. It is a potential repairing material for clinical application.
基金Supported by Grant-in-Aid for Young Scientists(KAKENHI)
文摘AIM: To determine the effects of transplanting osteogenic matrix cell sheets and beta-tricalcium phosphate(TCP) constructs on bone formation in bone defects.METHODS: Osteogenic matrix cell sheets were prepared from bone marrow stromal cells(BMSCs), and a porous TCP ceramic was used as a scaffold. Three experimental groups were prepared, comprised of TCP scaffolds(1) seeded with BMSCs;(2) wrapped with osteogenic matrix cell sheets; or(3) both. Constructs were implanted into a femoral defect model in rats and bone growth was evaluated by radiography, histology, biochemistry, and mechanical testing after 8 wk. RESULTS: In bone defects, constructs implanted with cell sheets showed callus formation with segmentalor continuous bone formation at 8 wk, in contrast to TCP seeded with BMSCs, which resulted in bone nonunion. Wrapping TCP constructs with osteogenic matrix cell sheets increased their osteogenic potential and resulting bone formation, compared with conventional bone tissue engineering TCP scaffolds seeded with BMSCs. The compressive stiffness(mean ± SD) values were 225.0 ± 95.7, 30.0 ± 11.5, and 26.3 ± 10.6 MPa for BMSC/TCP/Sheet constructs with continuous bone formation, BMSC/TCP/Sheet constructs with segmental bone formation, and BMSC/TCP constructs, respectively. The compressive stiffness of BMSC/TCP/Sheet constructs with continuous bone formation was significantly higher than those with segmental bone formation and BMSC/TCP constructs.CONCLUSION: This technique is an improvement over current methods, such as TCP substitution, and is useful for hard tissue reconstruction and inducing earlier bone union in defects.
文摘Objective:To report the clinical outcome of repairing massive bone defects biologically in limbs by homeochronous using structural bone allografts with intramedullary vascularized fibular autografts. Methods: From January 2001 to December 2005, large bone defects in 19 patients (11 men and 8 women, aged 6 to 35 years) were repaired by structural bone allografts with intramedullary vascularized fibular autografts in the homeochronous period. The range of the length of bone defects was 11 to 25 cm (mean 17.6 cm), length of vascularized free fibular was 15 to 29 cm (mean 19.2 cm), length of massive bone allografts was 11 to 24 cm (mean 17.1 cm). Location of massive bone defects was in humerus(n=1), in femur(n=9) and in tibia(n=9), respectively. Results: After 9 to 69 months (mean 38.2 months) follow-up, wounds of donor and recipient sites were healed inⅠstage, monitoring-flaps were alive, eject reaction of massive bone allografts were slight, no complications in donor limbs. Fifteen patients had the evidence of radiographic union 3 to 6 months after surgery, 3 cases united 8 months later, and the remained one case of malignant synovioma in distal femur recurred and amputated the leg 2.5 months, postoperatively. Five patients had been removed internal fixation, complete bone unions were found one year postoperatively. None of massive bone allografts were absorbed or collapsed at last follow-up. Conclusion: The homeochronous usage of structural bone allograft with an intramedullary vascularized fibular autograft can biologically obtain a structure with the immediate mechanical strength of the allograft, a potential result of revascularization through the vascularized fibula, and accelerate bone union not only between fibular autograft and the host but also between massive bone allograft and the host.
