Objective To review the latest researches of synthetic biodegradable polymers for bone repair and reconstruction, to predict the progress of bone substitute materials and bone tissue engineering scaffolds in future. Methods The l iterature concerning synthetic biodegradable polymers as bone substitute materials or bone tissue engineering scaffolds was collected and discussed. Results Al i phatic polyester, polyanhydride, polyurethane and poly (amino acids) were the most extensively studied synthetic biodegradable polymers as bone substitutes and the scaffolds. Each polymer was of good biological safety and biocompatibil ity, and the degradation products were nontoxic to human body. The mechanical properties and degradation rate of the polymers could be adjusted by the type or number of the monomers anddifferent synthetic methods. Therefore, the polymers with suitable mechanical strength and degradation rate could be produced according to the different requirements for bone grafting. Prel iminary studies in vivo showed their favorable capacity for bone repair. Conclusion The synthetic biodegradable polymers, especially the copolymers, composite materials and those carrying bone growth factors are expected to be the most promising and ideal biomaterials for bone repair and reconstruction.
Objective To sum up the recent progress of common biodegradable internal fixation materials and to forecast the possible directions for further research. Methods The latest original articles about biomechanical properties, degradation characteristics, advantages and disadvantages of biodegradable internal fixation materials were extensively reviewed.Several common biodegradable materials were selected and expounded in different categories. Results The disadvantages of stress shielding and the second time removal, could be avoided by using biodegradable internal fixation materials instead of metal materials. Biodegradable internal fixation materials could fix fracture stably and they were ideal orthopedic internal fixation materials. Natural biodegradable polymers had excellent biocompatibil ity but poor mechanical strength. Synthetic biodegradable materials could be artificially regulated their degradation rate and had better mechanical strength, however, they had shortcomings in biocompatibil ity. Composite materials could learn from others’ b points to offset their weakness, therefore, they had pronounced advantages over the former two materials. Conclusion There still exist many problems in present biodegradable internal fixation materials although they are of great potential in its appl ication. Combining various biomaterials and using the specific processing technology to develop a biodegradable material which has better biomechanical properties, chemical properties and physical structure is the direction for future research.
Objective To investigate the research advance in repair of the peripheral nerve defect with an acellular nerve allograft. Methods The recent related literature was extensively and comprehensively reviewed. The methods and the effects of the allografts with acellular nerves were analyzed. Results The immunogenicity of the allograft was more significantly relieved by the chemical treatment than by the physicaltreatment. The effect of the chemical treatment on the axon regeneration was better than that of the physical treatment. Conclusion Because of the limitation of the host Schwann cell translation in the longsegment acellular nerve allografts, the effect of Schwann cells is not satisfactory and regeneration of the nerve is limited. So, the recellularized treatment with some related measures can enhance the host Schwann cell translation so that this problem can be solved.
Objective To study an effect of the peripheral nerve allograft with subcutaneous preservation at different times on the sciatic nerve regenerationin rats. Methods Fifty-five Wistar rats were used in this experiment, which were randomly divided into the following 5 groups: the experimental groups (Groups A, B, C, 10 rats), the control group (Group D, 10 rats), and the donorgroup (Group E, 15 rats). In the experimental groups, a 15-mm segment of the sciatic nerve harvested from the donors was separately inserted into the subcutaneous compartment on the left thigh after the 1week (Group A), 2-week (Group B), and 3week (Group C) preservation; the segment of the sciatic nerve in the subcutaneous compartment was removed and transplanted into a 10-mm defect of theright sciatic nerve, which was made immediately. In Group D, a 10-mm sciatic nerve defect was made and immediately repaired in situ on the right thigh. The function of the sciatic nerve was evaluated by the sciatic functional index (SFI) at 2, 4, 6, 8, 10 and 12 weeks after operation. The histological and electrophysiological examinations were performed at 12 weeks after operation. Results After operation, SFI decreased gradually at 12 weeks afteroperation, SFI inGroups A and D was at the minimal level and had a significant difference compared with that in Groups B and C (Plt;0.05).There was no significant difference between Group A and Group D. A large number of the myelinated nerve fibers and a small number of the unmyelinated nerve fibers were regenerated in Groups A and D. The number and the structure of the regenerated nerve were similar to the normal ones. The number and the size of the regenerated axon had a significant difference compared with those in Groups B and C (Plt;0.05). There was no significant difference between Group A and Group D. The conduction velocity and the latent period of the motor nerve had significant differences between Groups A and D and Groups B and C (Plt;0.05), and there was no significant difference betweenGroupA and Group D. Conclusion The nerve allograft with a 1-weeksubcutaneous preservation can promote nerve regeneration better.
Objective To investigate the research advances of the peripheral nerve allograft.Methods The recent articles on peripheral nerve allograft were reviewed extensively. The treatments of allograft and host were analyzed. Results The immunogenicity of allograft was relieved by the physical,chemical or biological treatments; the immunosuppressive therapy makes the rejection relieved and the regeneration of axon accelerated. Conclusion The effect of peripheral nerve allograft is inferior to autograft. If the immunologic tolerance are inducedsuccessfully, the problem shall be solved.
Objective To summarize the physicochemical properties, manufacturing technique, and biological characteristics of porous tantalum and its application progress and related problems in spinal surgery. Methods The domestic and foreign related literature about porous tantalum was summarized and analyzed. Results Porous tantalum is characterized by high porosity, high coefficient of friction, low elastic modulus, good biocompatibility, and superior osseointegration capability. Its manufacture methods include chemical vapor deposition and infiltration technique, foam impregnation and powder metallurgy technique, and heat treatment method. Good clinical efficacy has achieved in the application of porous tantalum interbody fusion Cage in cervical and lumbar fusion surgery, but there is controversy in spinal fusion rate, especially in cervical fusion rate. Surface modification can increase the osseointegration capability of porous tantalum and intervertebral bony fusion. Conclusion Good clinical efficacy has achieved in the application of porous tantalum interbody fusion Cage in lumbar fusion surgery, while there is a dispute in cervical fusion surgery. In order to further observation, studies with more patients and longer follow-up would be needed.
Objective The biomechanical characteristics of three internal fixation modes for femoral subtrochanteric spiral fracture in osteoporotic patients were compared and analyzed by finite element technology, so as to provide the basis for the optimization of fixation methods for femoral subtrochanteric spiral fracture. MethodsTen female patients with osteoporosis and femoral subtrochanteric spiral fractures caused by trauma, aged 65-75 years old, with a height of 160-170 cm and a body weight mass of 60-70 kg, were selected as the study subjects. The femur was scanned by spiral CT and a three-dimensional model of the femur was established by digital technology. The computer aided design models of proximal intramedullary nail (PFN), proximal femoral locking plate (PFLP), and the combination of the two (PFLP+PFN) were constructed under the condition of subtrochanteric fracture. Then the same load of 500 N was applied to the femoral head, and the stress distribution of the internal fixators, the stress distribution of the femur, and the displacement of femur after fracture fixation were compared and analyzed under the three finite element internal fixation modes, so as to evaluate the fixation effect. ResultsIn the PFLP fixation mode, the stress of the plate was mainly concentrated in the main screw channel, the stresses of the different part of the plate were not equal, and gradually decreased from the head to the tail. In the PFN fixation mode, the stress was concentrated in the upper part of the lateral middle segment. In the PFLP+PFN fixation mode, the maximum stress appeared between the first and the second screws in the lower segment, and the maximum stress appeared in the lateral part of the middle segment of the PFN. The maximum stress of PFLP+PFN fixation mode was significantly higher than that of PFLP fixation mode, but significantly lower than that of PFN fixation mode (P<0.05). In PFLP and PFN fixation modes, the maximum stress of femur appeared in the medial and lateral cortical bone of the middle femur and the lower side of the lowest screw. In PFLP+PFN fixation mode, the stress of femur concentrated in the medial and lateral of the middle femur. There was no significant difference in the maximum stress of femur among the three finite element fixation modes (P>0.05). The maximum displacement occurred at the femoral head after three finite element fixation modes were used to fix subtrochanteric femoral fractures. The maximum displacement of femur in PFLP fixation mode was the largest, followed by PFN, and PFLP+PFN was the minimum, with significant differences (P<0.05). ConclusionUnder static loading conditions, the PFLP+PFN fixation mode produces the smallest maximum displacement when compared with the single PFN and PFLP fixation modes, but its maximum plate stress is greater than the single PFN and PFLP fixation mode, suggesting that the combination mode has higher stability, but the plate load is greater, and the possibility of fixation failure is higher.
Objective To study the effects of the human keratinocyte growth factor 2 (hKGF-2) on the survival and differentiation of human neural stem cells (hNSCs). Methods The hNSCs at 17 passages preserved in liquid nitrogen were resuscitated and cultured for 7 days with normal methods to form neural spheres. The specific Nestin antigen and differentiated cells antigen were identified using immunohistochemistry technology. Some concentrated hNSCs were incubated in 12-well culture plate with 1 mL basic medium [(DMEM/F12 + N2 (1 ∶ 100) + epidermal growth factor (EGF) (20 ng/mL)] and divided into 7 groups, 6 wells each group. hKGF-2 (0, 10, 30, 60, 90, and 120 ng/mL) and bFGF (10 ng/mL) were added in groups A (control), B, C, D, E, F, and G, respectively. The neurospheres and the cell number were recorded for analyzing growth and multiplication of neural spheres. Some concentrated hNSCs were incubated in 6-well culture plate (cover glass coated with polylysine) with 3 mL DMEM/F12 medium and divided into 4 groups, 6 wells each group. N2 (1 ∶ 100), N2 (1 ∶ 100) + hKGF-2 (90 ng/mL), FBS (1 ∶ 20), and FBS (1 ∶ 20) + hKGF-2 (90 ng/mL) were added in groups A1, B1, C1, and D1, respectively. Then, the growth and multiplication of neural spheres were observed during culture; the separated neural spheres was identified and analyzed with indirect immunofluorescence and flow cytometry. Results Reanimated hNSCs could form neural spheres containing a lot of Nestin antigen; differentiated cells by induction expressed the specific antigens of neurofilament 200 (NF- 200) and glial fibrillary acidic protein (GFAP). At 7 days after culture, enlarged neural spheres were observed in each group. The neurospheres and the cell number of hNSCs increased with increased concentration of hKGF-2, showing a gradually increasing tendency; they were significantly higher in groups E, F, and G than that in groups A, B, C, and D (P lt; 0.05); significant differences were found among groups B, C, and D (P lt; 0.05), but no significant difference between groups A and B, and among groups E, F, and G (P gt; 0.05). After induction in vitro, the cell growth showed a progressive increase, significant difference was found among groups (P lt; 0.05); the percentage of NF-200 positive cells in group B1 was significantly higher than that in the other 3 groups (P lt; 0.05); the percentage of GFAP positive cells in group B1 was significantly lower than that in the other 3 groups (P lt; 0.05), but no significant difference among groups A1, C1, and D1 (P gt; 0.05). At 14 days after culture, cell growth reached the peak, which were mainly astero-cells. Conclusion The hNSCs are pure after incubated to 17 passages in vitro. hKGF-2 can promote the clone and the growth of differentiated cells, and increase the proportion of neuron.
Objective To explore the effect of tri pterygium glycoside (TG) on the skeletal muscle atrophy and apoptosis after nerve allograft. Methods Twenty Wistar male rats were adopted as donors, weighing 200-250 g, and the sciatic nerves were harvested. Fifty SD male rats were adopted as recipients, weighing 200-250 g. Fifty SD rats were made the models of10 mm right sciatic nerve defect randomly divided into five groups (n=10): group A, group B, group C, group D and group E.groups A and B received fresh nerve allograft, groups C and D received sciatic nerve allograft pretreated with TG, and group E received autograft. The SD rats were given medicine for 5 weeks from the second day after the transplantation: groups A and E were given physiological sal ine, groups B and D TG 5 mg/ (kg·d), and group C TG 2.5 mg/ (kg·d). At 3 and 6 weeks, respectively, after nerve transplantation, general observation was performed; the structure of skeletal muscles was observed by HE staining; the diameter of skeletal muscles was analyzed with Image-Pro Plus v5.2; the ultrastructure of skeletal muscles was observed by TEM; the expressions of Bax and Bcl-2 were detected by immunohistochemical staining; and the apoptosis of skeletal muscles was detected by TUNEL. Results All rats survived to the end of the experiment. In general observation, the skeletal muscles of SD rates atrophied to different degrees 3 weeks after operation. The muscular atrophy in group A was more serious at 6 weeks, and that in the other groups improved. The wet weight, fiber diameter and expression of Bcl-2 in group A were significantly lower than those in groups B, C, D and E (P lt; 0.01)；those in groups B, C and D were lower than those in group E (P lt; 0.05); and there were no significant differences among groups B, C and D (P gt; 0.05). The apoptosis index and expression of Bax in group A were significantly higher than those in groups B, C, D and E (P lt; 0.01)；those in groups B, C and D were higher than in groupE (Plt; 0.05); and there were no significant differences among groups B, C and D (P gt; 0.05). Three weeks after nerve allograft, under the l ight microscope, the muscle fibers became thin; under the TEM, the sarcoplasmic reticulum was expanded. Six weeks after nerve allograft, under the l ight microscope, the gap of the muscle fibers in group A was found to broaden and connective tissue hyperplasia occurred obviously; under the TEM, sarcomere damage, serious silk dissolution and fragmentary Z l ines were seen in group A, but the myofibrils were arranged tidily in the other groups, and the l ight band, dark band and sarcomere were clear. Conclusion TG can decrease the skeletal muscle atrophy and apoptosis after nerve allograft. The donor’s nerve that is pretreated with TG can reduce the dosage of immunosuppressant for the recipient after allograft.