Compound of porous hydroxyapatite, platelet-rich plasma and fibrin glue in the treatment of bone defects

doi:10.3969/j.issn.2095-4344.2013.25.001

Abstract

Abstract:

BACKGROUND: Autogenous bone graft is the best way to treat bone defects, but its limited sources and donor site complications restrain its clinical application. Therefore, to develop a substitute material has been a hotspot in the orthopedics.
OBJECTIVE: To investigate the feasibility and effectiveness of the compound of coralline hydroxyapatite porous, platelet-rich plasma and fibrin glue acting as a bone substitute material for repair of bone defects.
METHODS: 1.5 cm radial segments from the bilateral forearms of New Zealand white rabbits were removed to prepare bone defect models. Then, bone defect models were randomly divided into a compound group (coralline hydroxyapatite porous, platelet-rich plasma and fibrin glue), control group treated with autogenous bone graft, and blank group without implantation.
RESULTS AND CONCLUSION: (1) X-ray observation: Bone defects were repaired completely in the compound group till the end of postoperative week 12, appearing with complete plasticity. The healing process in the compound group was synchronized with that in the control group. However, there were no changes in bone defects of the blank group. (2) Histopathological examination: Bone repair basically completed in the compound and control groups at week 12 after operation, presenting with mature lamellar bone and Haversian canals. In the blank group, only a great amount of fibroblasts proliferated, but no bone formed. (3) Biomechanical analysis: The maximum torque and torsional stiffness of the compound group were better than those of the control group at 2 weeks postoperation (P < 0.05). However, there was no significant difference between the maximum torque and torsional stiffness of the compound and control groups. These results demonstrate that the compound of coralline hydroxyapatite porous, platelet-rich plasma and fibrin glue acting as a bone substitute is superior to autologous bone in the early repair of bone defects, which is beneficial to bone healing.

Key words: biomaterials, tissue-engineered bone materials, coralline hydroxyapatite porous, platelet-rich plasma, fibrin glue, bone defects, biomechanics, maximum torque, torsional stiffness

CLC Number:

R318

Liu Dong-guang, Wei Zheng-chao, Cai Dao-zhang, Zheng Jun, Chen Huan-qiu, Lai Huan-le. Compound of porous hydroxyapatite, platelet-rich plasma and fibrin glue in the treatment of bone defects [J]. Chinese Journal of Tissue Engineering Research, 2013, 17(25): 4561-4569.

Figures/Tables 5

2.1 各组动物骨缺损模型观察结果 X射线检查：12周后骨缺损区无骨性连接，髓腔闭塞，断端硬化，两侧断端出现少量骨痂。大体标本观察：12周后骨缺损区无骨性连接，可见大量纤维瘢痕组织填充，骨断端硬化，髓腔闭塞，可见未吸收的骨蜡及少量骨痂，骨缺损范围为1.10- 1.40 cm。组织病理检查：12周后光镜下骨断端髓腔闭塞，可见大量纤维瘢痕组织，有少量软骨细胞及骨细胞，排列无序。 2.2 术后动物情况所有兔术后体温、胃纳无明显差异，伤口无红肿、化脓，愈合良好。实验组及空白对照组兔血常规及生化检查无明显差异。 2.3 各组大体标本观察结果术后2周时：实验组纤维蛋白部分吸收，植入物与骨断端形成粗大紧密的纤维性连接；对照组自体骨部分吸收，有少量骨痂形成。术后4周时：实验组纤维蛋白完全吸收，有大量骨痂形成，植入物与断端界限不清；对照组自体骨进一步吸收，大量骨痂形成，植入骨与断端界限不清。术后8周时：实验组骨膜部分延续，植入物完全骨化，被大量骨痂包埋；对照组骨膜部分延续，缺损区充满新生骨，覆盖板层骨。术后12周时：实验组骨膜基本完全，植入物完全骨化，羟基磷灰石部分降解，散在分布；对照组骨膜基本完全，缺损区消失，塑性完全，新骨成熟。而空白对照组在术后12周时骨膜少量延续缺损区为纤维瘢痕组织，断端少量骨痂形成，无骨性连接。 2.4 各组X射线检查结果术后2周时：实验组少量骨痂影，植入物与断端界限不清；对照组有骨痂影，植入物变小，见图4A；空白对照组骨缺损无明显变化。术后4周时：实验组骨痂影明显增多，断端界限不清，对照组植入物基本消失，大量骨痂影；空白对照组骨缺损无明显变化。术后8周时：实验组骨缺损消失，羟基磷灰石点片状分散骨痂中；对照组断端界限消失，骨皮质形成，髓腔复通；空白对照组骨缺损无明显变化。术后12周时：实验组与对照组均骨皮质连续，髓腔复通，塑性完全，见图4B；空白对照组仅少量骨痂形成，断端硬化，见图5。"

References

[1] Tancred DC,Carr AJ,Mccormack BA. Development of a new synthetic bone graft. J Mater Sci Mater Med.1998;9(12): 819-823.

[2] Mnaymneh W, Mailinin T. Massive allografts in surgery of bone tumors. Orthop Clin North Am.1989;20(3):455.

[3] Johnson EE,Urist MR,Schmalzried TP,et al.Autogenic cancellous bone grafts in extensive segmental ulnar defects in dogs. Effects of xenogenic bovine bone morphogentic protein without and with interposition of soft tissues and interruption of blood supply. Clin Orthop Relat Res.1989; (243):254-265.

[4] Kimura T,Takemoto T,Fujiwara Y,et al.Esophageal perforation caused by a fish bone Treated with surgically Indwelling drainage and fibrin glueI injection for fistula formation. Ann Thorac Cardiovasc Surg. 2012. [Epub ahead of print]

[5] Pupka A,Chudoba P,Barc P,et al.Intraoperatinve hemostasis during kidney transplantation and the use collagen mesh dressing cover by fibrin glue ( TachoComb). Polim Med. 2003;33(3):27-32.

[6] Fan W,Chen CZ,Li F,et al. Zhonghua Shiyan Yanke Zazhi. 2011;12(12): 1125-1129.范雯, 陈长征, 李菲,等. 翼状胬肉切除联合自体球结膜移植术中使用纤维蛋白胶和缝线有效性的随机对照试验的Meta分析[J].中华实验眼科杂志,2011,12(12): 1125-1129.

[7] Liu JP,Yin CG,Song DY.Zhongguo Wuzhenxue Zazhi.2011; 11(1):57.刘继攀,尹长恒,宋德余. 纤维蛋白胶预防腹腔术后肠粘连的临床观察[J].中国误诊学杂志,2011,11(1):57.

[8] Ren L,Sun YQ,Fan L.Shiyong Yixue Zazhi.2011;27(3): 434-435.任磊,孙永青,范磊.纤维蛋白胶在髋关节置换手术中的应用[J].实用医学杂志,2011, 27(3): 434-435.

[9] Cui W,Liu CL.Zhongguo Guzhi Shusong Zazhi. 1998;4(1): 90-92.崔伟,刘成林. 基础骨生物力学(二):动物骨生物力学指标的选择及计算方法[J].中国骨质疏松杂志,1998,4(1):90-92.

[10] Feng YZ.Beijing:Kexue Jishu Chubanshe. 1983:248.冯元祯. 生物力学[M]. 北京:科学技术出版社,1983:248.

[11] Langer R,Vacanti JP. Tissue engineering. Science. 1993; 260(5110):920-926.

[12] Pelker RR,Friedlaender GD,Markham TC. Biomechanical properties of bone allografts. Clin Orthop Relat Res.1983; (174):54-57.

[13] Yang KQ,Wang Z,Sang HX,et al.Yiyong Shengwu Lixue. 2000;15(3):183-186.杨克强,王臻,桑宏勋,等.深低温冷冻异体骨生物力学特性与储存时间的关系[J].医用生物力学,2000,15(3):183-186.

[14] Chen GZ, Chen X, Cui HL, et al. Shengwu Lixue Zazhi. 1988; 3(3):43.陈国振,陈玺,崔洪洛,等.振动冲量促进骨重建的实验研究[J].生物力学杂志,1988,3(3):43.

[15] Gu HQ,Xu GF.Tianjin:Tianjin Kexue Chubanshe.1993: 361-362.顾汉卿,徐国风.生物医学材料学[M].天津:科学技术出版社,1993: 361-362.

[16] Su Y,Hou YW,Gao MZ.Yufang Yixue Qingbao Zazhi. 2001; 17(6): 433-435.苏怡,候延文,高珉之.医用生物蛋白胶生物性能的研究[J].预防医学情报杂志,2001,17(6):433-435.

[17] Schantz JZ,Hutmacher DW,Lam CX,et al.Repair of calvarial defects with customised tissue-engineered bone grafts Ⅱ. Evaluation of cellular efficiency and efficacy in vivo. Tissue Eng.2003;9 suppl 1:S127-139.

[18] Peng SL,Fang H,Chen AM.Shengwu Guke Cailiao yu Linchuang Yanjiu. 2004;1(2):35-37.彭松林,方煌,陈安民.骨髓间质干细胞与纤维蛋白胶生物相容性的实验研究[J].生物骨科材料与临床研究,2004,1(2):35-37.