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Park SS, Lim H, Lee BT. In vivo evaluation of hyaluronic acid-polyethylene glycol amended PMMA bone cement for orthopaedic application. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024; 35:1947-1962. [PMID: 38815001 DOI: 10.1080/09205063.2024.2359789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
The utilization of polymethyl methacrylate (PMMA) bone cement is employed for the purpose of stabilizing fractured vertebral bodies. The existence of a mechanical imbalance in hard polymethylmethacrylate (PMMA) bone cement has the potential to increase the likelihood of a fracture occurring in the neighbouring vertebral body. In order to reduce potential difficulties, the primary goal of this study is to investigate the potential benefits of increasing PMMA bone cement's bioactivity and lowering its elastic modulus. The incorporation of a 10% volume fraction of hyaluronic acid (HyA) and polyethylene glycol (PEG) into the bone cement led to an improvement in the bioactivity and decreasing of elastic modulus of polymethylmethacrylate (PMMA). The integration of HyPE gel phase presents several advantages over pure PMMA bone cement, including enhanced setting parameters, improved degradability, and increased biocompatibility. The gel phase is additionally accountable for a reduction in the elastic modulus of polymethylmethacrylate (PMMA) bone cement. In addition, the existence of a porous structure that arises from the degradation of the HyPE gel phase delivers a significant amount of room, thereby enhancing the process of bone regeneration when implanted in the femur of rabbits. The utilization of HyPE in PMMA has been shown through comprehensive µ-CT analysis to enhance bone formation, thereby promoting osteointegration at the implantation site. Furthermore, the histological analysis demonstrated the existence of osteogenic activity in the PMMA polyethylene glycol supplemented with 10% HyA and 10% PEG after a 2-month period subsequent to implantation.
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Affiliation(s)
- Seong-Su Park
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Hansung Lim
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Byong-Taek Lee
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
- Institute of Tissue Regeneration, College of Medicine, Soonchunhyang University, Cheonan, South Korea
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Szewczyk T, Sinha MS, Gerling J, Zhang JK, Mercier P, Mattei TA. Health Care Fraud and Abuse: Lessons From One of the Largest Scandals of the 21st Century in the Field of Spine Surgery. ANNALS OF SURGERY OPEN 2024; 5:e452. [PMID: 38911625 PMCID: PMC11191893 DOI: 10.1097/as9.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/17/2024] [Indexed: 06/25/2024] Open
Abstract
Up to hundreds of billions of dollars are annually lost to fraud and abuse in the US health care, making it a significant burden on the system. This study investigates a specific instance of health care fraud in spine surgery, in which a medical device company ended up paying $75 million to settle violations of the False Claims Act. We review the surgical background regarding the kyphoplasty procedure, as well as its billing and reimbursement details. We also explore the official legal complaint brought by the US Department of Justice to tell the story of how one of the most significant medical innovations in spine surgery in the 21st century turned into a widespread fraudulent marketing scheme. In the sequence, we provide a detailed root cause analysis of this scandal and propose some proactive measures that can be taken to avoid such type of unfortunate events. Ultimately, this historical health care scandal constitutes a valuable lesson to surgeons, health care administrators, medical device companies, and policymakers on how misaligned incentives and subsequent unscrupulous practices can transform a medical innovation into an unfortunate tale of fraud and deceit.
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Affiliation(s)
- Thomas Szewczyk
- From the Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, MO
| | - Michael S. Sinha
- Center for Health Law Studies, Saint Louis University School of Law, Saint Louis, MO
| | - Jack Gerling
- From the Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, MO
| | - Justin K. Zhang
- From the Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, MO
- Department of Neurosurgery, University of Utah, Salt Lake City, UT
| | - Philippe Mercier
- From the Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, MO
| | - Tobias A. Mattei
- From the Division of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, MO
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3
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Zhang C, Cai X, Li M, Peng J, Mei J, Wang F, Zhang R, Zhou Y, Fang S, Xia D, Zhao J. Preclinical Evaluation of Bioactive Small Intestinal Submucosa-PMMA Bone Cement for Vertebral Augmentation. ACS Biomater Sci Eng 2024; 10:2398-2413. [PMID: 38477550 PMCID: PMC11005825 DOI: 10.1021/acsbiomaterials.3c01629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
In vertebroplasty and kyphoplasty, bioinert poly(methyl methacrylate) (PMMA) bone cement is a conventional filler employed for quick stabilization of osteoporotic vertebral compression fractures (OVCFs). However, because of the poor osteointegration, excessive stiffness, and high curing temperature of PMMA, the implant loosens, the adjacent vertebrae refracture, and thermal necrosis of the surrounding tissue occurs frequently. This investigation addressed these issues by incorporating the small intestinal submucosa (SIS) into PMMA (SIS-PMMA). In vitro analyses revealed that this new SIS-PMMA bone cement had improved porous structure, as well as reduced compressive modulus and polymerization temperature compared with the original PMMA. Furthermore, the handling properties of SIS-PMMA bone cement were not significantly different from PMMA. The in vitro effect of PMMA and SIS-PMMA was investigated on MC3T3-E1 cells via the Transwell insert model to mimic the clinical condition or directly by culturing cells on the bone cement samples. The results indicated that SIS addition substantially enhanced the proliferation and osteogenic differentiation of MC3T3-E1 cells. Additionally, the bone cement's biomechanical properties were also assessed in a decalcified goat vertebrae model with a compression fracture, which indicated the SIS-PMMA had markedly increased compressive strength than PMMA. Furthermore, it was proved that the novel bone cement had good biosafety and efficacy based on the International Standards and guidelines. After 12 weeks of implantation, SIS-PMMA indicated significantly more osteointegration and new bone formation ability than PMMA. In addition, vertebral bodies with cement were also extracted for the uniaxial compression test, and it was revealed that compared with the PMMA-implanted vertebrae, the SIS-PMMA-implanted vertebrae had greatly enhanced maximum strength. Overall, these findings indicate the potential of SIS to induce efficient fixation between the modified cement surface and the host bone, thereby providing evidence that the SIS-PMMA bone cement is a promising filler for clinical vertebral augmentation.
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Affiliation(s)
- Chi Zhang
- Department
of Orthopaedic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo University, Ningbo 315010, China
- Zhejiang
Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo 315211, China
| | - Xiongxiong Cai
- Department
of Orthopaedic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo University, Ningbo 315010, China
| | - Mei Li
- Key
Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang
Province, The First Affiliated Hospital
of Ningbo University, Ningbo 315010, China
| | - Jing Peng
- Zhejiang
Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo 315211, China
| | - Jin Mei
- Institute
of Biomaterials, The First Affiliated Hospital
of Ningbo University, Ningbo 315010, China
| | - Fangfang Wang
- Institute
of Biomaterials, The First Affiliated Hospital
of Ningbo University, Ningbo 315010, China
| | - Rui Zhang
- Institute
of Biomaterials, The First Affiliated Hospital
of Ningbo University, Ningbo 315010, China
| | - Yingjie Zhou
- Institute
of Biomaterials, The First Affiliated Hospital
of Ningbo University, Ningbo 315010, China
| | - Shuyu Fang
- Department
of Clinical Laboratory, The First Affiliated
Hospital of Ningbo University, Ningbo 315010, China
| | - Dongdong Xia
- Department
of Orthopaedic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo University, Ningbo 315010, China
| | - Jiyuan Zhao
- Zhejiang
Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo 315211, China
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4
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Li SF, Li XY, Bai XH, Wang YL, Han PF, Li HZ. A meta-analysis comparing the efficacy of mineralized collagen-polymethylmethacrylate and polymethylmethacrylate bone cements in the treatment of vertebral compression fractures. PLoS One 2024; 19:e0299325. [PMID: 38457423 PMCID: PMC10923492 DOI: 10.1371/journal.pone.0299325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
PURPOSE Vertebral compression fractures are often treated with vertebroplasty, and filling the injured vertebrae with bone cement is a key part of vertebroplasty. This meta-analysis was performed to compare the clinical efficacy and safety of mineralized collagen-polymethylmethacrylate (MC-PMMA) and polymethylmethacrylate (PMMA) bone cement in the treatment of vertebral compression fractures by vertebroplasty. METHODS A computerized search of the published literature on mineralized collagen-polymethylmethacrylate and polymethylmethacrylate bone cement in the treatment of vertebral compression fractures was conducted in the China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, Embase, and Cochrane Library. The search was carried out from the time the database was created to March 2023 and 2 researchers independently conducted literature searches to retrieve a total of 884 studies, of which 12 were included in this meta-analysis. Cochrane systematic review methods were used to assess the quality of the literature and a meta-analysis was performed using ReviewManager 5.4 software. RESULTS The results of the present meta-analysis showed that in postoperative adjacent vertebral fractures [OR = 0.25; 95% CI (0.15, 0.41)], postoperative cement leakage [OR = 0.45; 95% CI (0.30, 0.68)], Oswestry Disability Index (ODI) scores in the first 3 days after surgery [OR = -0.22; 95% CI (-0.42, -0.03)], ODI score at 6-12 months postoperatively [OR = -0.65; 95% CI (-0.97, -0.32)], visual analog scale (VAS) score at 6-12 months postoperatively [OR = -0.21; 95% CI (-0.46, 0.04)], and 1-year postoperative CT values [OR = 5.56; 95% CI (3.06, 8.06)], the MC-PMMA bone cement group was superior to the PMMA bone cement group. However, the differences between the two groups were not statistically different in terms of cement filling time, cement filling volume, operation time, intraoperative bleeding, hospitalization time, postoperative (<1 week, 3-6 months) vertebral body posterior convexity Cobb's angle, postoperative (<1 week, 6-12 months) vertebral body anterior margin relative height, postoperative (≤3 days, 1-3 months) pain VAS score and postoperative (1-3 months) ODI score. CONCLUSIONS Compared with PMMA bone cement, the application of MC-PMMA bone cement is advantageous in reducing postoperative complications (adjacent vertebral fracture rate, cement leakage rate), pain relief, and functional recovery in the long-term postoperative period (>6 months), but there is still a need for more high-quality randomized controlled studies to provide more adequate evidence.
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Affiliation(s)
- Song-feng Li
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
- Graduate School, Changzhi Medical College, Changzhi, P.R. China
| | - Xi-yong Li
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
- Graduate School, Changzhi Medical College, Changzhi, P.R. China
| | - Xiao-hui Bai
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
- Graduate School, Changzhi Medical College, Changzhi, P.R. China
| | - Yun-lu Wang
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
- Graduate School, Changzhi Medical College, Changzhi, P.R. China
| | - Peng-fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
| | - Hong-zhuo Li
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, P.R. China
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Dong J, Ding H, Wang Q, Wang L. A 3D-Printed Scaffold for Repairing Bone Defects. Polymers (Basel) 2024; 16:706. [PMID: 38475389 DOI: 10.3390/polym16050706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/04/2023] [Accepted: 01/30/2024] [Indexed: 03/14/2024] Open
Abstract
The treatment of bone defects has always posed challenges in the field of orthopedics. Scaffolds, as a vital component of bone tissue engineering, offer significant advantages in the research and treatment of clinical bone defects. This study aims to provide an overview of how 3D printing technology is applied in the production of bone repair scaffolds. Depending on the materials used, the 3D-printed scaffolds can be classified into two types: single-component scaffolds and composite scaffolds. We have conducted a comprehensive analysis of material composition, the characteristics of 3D printing, performance, advantages, disadvantages, and applications for each scaffold type. Furthermore, based on the current research status and progress, we offer suggestions for future research in this area. In conclusion, this review acts as a valuable reference for advancing the research in the field of bone repair scaffolds.
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Affiliation(s)
- Jianghui Dong
- Guangxi Engineering Research Center of Digital Medicine and Clinical Translation, School of Intelligent Medicine and Biotechnology, Guilin Medical University, Guilin 541199, China
| | - Hangxing Ding
- Guangxi Engineering Research Center of Digital Medicine and Clinical Translation, School of Intelligent Medicine and Biotechnology, Guilin Medical University, Guilin 541199, China
| | - Qin Wang
- Guangxi Engineering Research Center of Digital Medicine and Clinical Translation, School of Intelligent Medicine and Biotechnology, Guilin Medical University, Guilin 541199, China
| | - Liping Wang
- Guangxi Engineering Research Center of Digital Medicine and Clinical Translation, School of Intelligent Medicine and Biotechnology, Guilin Medical University, Guilin 541199, China
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6
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Hossain M, Jeong JH, Sultana T, Kim JH, Moon JE, Im S. A composite of polymethylmethacrylate, hydroxyapatite, and β-tricalcium phosphate for bone regeneration in an osteoporotic rat model. J Biomed Mater Res B Appl Biomater 2023; 111:1813-1823. [PMID: 37289178 DOI: 10.1002/jbm.b.35287] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 03/13/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to test several modifications of the polymethylmethacrylate (PMMA) bone cement by incorporating osteoconductive and biodegradable materials for enhancing bone regeneration capacity in an osteoporotic rat model. Three bio-composites (PHT-1 [80% PMMA, 16% HA, 4% β-TCP], PHT-2 [70% PMMA, 24% HA, 6% β-TCP], and PHT-3 [30% PMMA, 56% HA, 14% β-TCP]) were prepared using different concentrations of PMMA, hydroxyapatite (HA), and β-tricalcium phosphate (β-TCP). Their morphological structure was then examined using a scanning electron microscope (SEM) and mechanical properties were determined using a MTS 858 Bionics test machine (MTS, Minneapolis, MN, USA). For in vivo studies, 35 female Wister rats (250 g, 12 weeks of age) were prepared and divided into five groups including a sham group (control), an ovariectomy-induced osteoporosis group (OVX), an OVX with pure PMMA group (PMMA), an OVX with PHT-2 group (PHT-2), and an OVX with PHT-3 group (PHT-3). In vivo bone regeneration efficacy was assessed using micro-CT and histological analysis after injecting the prepared bone cement into the tibial defects of osteoporotic rats. SEM investigation showed that the PHT-3 sample had the highest porosity and roughness among all samples. In comparison to other samples, the PHT-3 exhibited favorable mechanical properties for use in vertebroplasty procedures. Micro-CT and histological analysis of OVX-induced osteoporotic rats revealed that PHT-3 was more effective in regenerating bone and restoring bone density than other samples. This study suggests that the PHT-3 bio-composite can be a promising candidate for treating osteoporosis-related vertebral fractures.
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Affiliation(s)
- Mosharraf Hossain
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Tamima Sultana
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Ju Hyung Kim
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Ji Eun Moon
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Soobin Im
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
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7
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Lei C, Song JH, Li S, Zhu YN, Liu MY, Wan MC, Mu Z, Tay FR, Niu LN. Advances in materials-based therapeutic strategies against osteoporosis. Biomaterials 2023; 296:122066. [PMID: 36842238 DOI: 10.1016/j.biomaterials.2023.122066] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023]
Abstract
Osteoporosis is caused by the disruption in homeostasis between bone formation and bone resorption. Conventional management of osteoporosis involves systematic drug administration and hormonal therapy. These treatment strategies have limited curative efficacy and multiple adverse effects. Biomaterials-based therapeutic strategies have recently emerged as promising alternatives for the treatment of osteoporosis. The present review summarizes the current status of biomaterials designed for managing osteoporosis. The advantages of biomaterials-based strategies over conventional systematic drug treatment are presented. Different anti-osteoporotic delivery systems are concisely addressed. These materials include injectable hydrogels and nanoparticles, as well as anti-osteoporotic bone tissue engineering materials. Fabrication techniques such as 3D printing, electrostatic spinning and artificial intelligence are appraised in the context of how the use of these adjunctive techniques may improve treatment efficacy. The limitations of existing biomaterials are critically analyzed, together with deliberation of the future directions in biomaterials-based therapies. The latter include discussion on the use of combination strategies to enhance therapeutic efficacy in the osteoporosis niche.
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Affiliation(s)
- Chen Lei
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Jing-Han Song
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Song Li
- School of Stomatology, Xinjiang Medical University. Urumqi 830011, China
| | - Yi-Na Zhu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Ming-Yi Liu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Mei-Chen Wan
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Zhao Mu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
| | - Franklin R Tay
- The Dental College of Georgia, Augusta University, Augusta, GA, 30912, USA.
| | - Li-Na Niu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
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8
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Zhu W, Li C, Yao M, Wang X, Wang J, Zhang W, Chen W, Lv H. Advances in osseointegration of biomimetic mineralized collagen and inorganic metal elements of natural bone for bone repair. Regen Biomater 2023; 10:rbad030. [PMID: 37181680 PMCID: PMC10172150 DOI: 10.1093/rb/rbad030] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/24/2023] [Accepted: 03/16/2023] [Indexed: 05/16/2023] Open
Abstract
At this stage, bone defects caused by trauma, infection, tumor, or congenital diseases are generally filled with autologous bone or allogeneic bone transplantation, but this treatment method has limited sources, potential disease transmission and other problems. Ideal bone-graft materials remain continuously explored, and bone defect reconstruction remains a significant challenge. Mineralized collagen prepared by bionic mineralization combining organic polymer collagen with inorganic mineral calcium phosphate can effectively imitate the composition and hierarchical structure of natural bone and has good application value in bone repair materials. Magnesium, strontium, zinc and other inorganic components not only can activate relevant signaling pathways to induce differentiation of osteogenic precursor cells but also stimulate other core biological processes of bone tissue growth and play an important role in natural bone growth, and bone repair and reconstruction. This study reviewed the advances in hydroxyapatite/collagen composite scaffolds and osseointegration with natural bone inorganic components, such as magnesium, strontium and zinc.
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Affiliation(s)
| | | | - Mengxuan Yao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang 050051, P.R. China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, P.R. China
| | - Xiumei Wang
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, P.R. China
| | - Juan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Orthopaedic Research Institution of Hebei Province, Shijiazhuang 050051, P.R. China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, P.R. China
| | - Wei Zhang
- Correspondence address. E-mail: (W.Z.); (W.C.); (H.L.)
| | - Wei Chen
- Correspondence address. E-mail: (W.Z.); (W.C.); (H.L.)
| | - Hongzhi Lv
- Correspondence address. E-mail: (W.Z.); (W.C.); (H.L.)
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9
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Cao D, Ding J. Recent advances in regenerative biomaterials. Regen Biomater 2022; 9:rbac098. [PMID: 36518879 PMCID: PMC9745784 DOI: 10.1093/rb/rbac098] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 07/22/2023] Open
Abstract
Nowadays, biomaterials have evolved from the inert supports or functional substitutes to the bioactive materials able to trigger or promote the regenerative potential of tissues. The interdisciplinary progress has broadened the definition of 'biomaterials', and a typical new insight is the concept of tissue induction biomaterials. The term 'regenerative biomaterials' and thus the contents of this article are relevant to yet beyond tissue induction biomaterials. This review summarizes the recent progress of medical materials including metals, ceramics, hydrogels, other polymers and bio-derived materials. As the application aspects are concerned, this article introduces regenerative biomaterials for bone and cartilage regeneration, cardiovascular repair, 3D bioprinting, wound healing and medical cosmetology. Cell-biomaterial interactions are highlighted. Since the global pandemic of coronavirus disease 2019, the review particularly mentions biomaterials for public health emergency. In the last section, perspectives are suggested: (i) creation of new materials is the source of innovation; (ii) modification of existing materials is an effective strategy for performance improvement; (iii) biomaterial degradation and tissue regeneration are required to be harmonious with each other; (iv) host responses can significantly influence the clinical outcomes; (v) the long-term outcomes should be paid more attention to; (vi) the noninvasive approaches for monitoring in vivo dynamic evolution are required to be developed; (vii) public health emergencies call for more research and development of biomaterials; and (viii) clinical translation needs to be pushed forward in a full-chain way. In the future, more new insights are expected to be shed into the brilliant field-regenerative biomaterials.
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Affiliation(s)
- Dinglingge Cao
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
| | - Jiandong Ding
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
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10
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Zhang H, Cui Y, Zhuo X, Kim J, Li H, Li S, Yang H, Su K, Liu C, Tian P, Li X, Li L, Wang D, Zhao L, Wang J, Cui X, Li B, Pan H. Biological Fixation of Bioactive Bone Cement in Vertebroplasty: The First Clinical Investigation of Borosilicate Glass (BSG) Reinforced PMMA Bone Cement. ACS APPLIED MATERIALS & INTERFACES 2022; 14:51711-51727. [PMID: 36354323 DOI: 10.1021/acsami.2c15250] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PMMA bone cement has been clinically used for decades in vertebroplasty due to its high mechanical strength and satisfactory injectability. However, the interface between bone and PMMA is fragile and more prone to refracture in situ because PMMA lacks a proper biological response from the host bone with minimal bone integration and dense fibrous tissue formation. Here, we modified PMMA by incoporating borosilicate glass (BSG) with a dual glass network of [BO3] and [SiO4], which spontaneously modulates immunity and osteogenesis. In particular, the BSG modified PMMA bone cement (abbreviated as BSG/PMMA cement) provided an alkaline microenvironment that spontaneously balanced the activities between osteoclasts and osteoblasts. Furthermore, the trace elements released from the BSGs enhanced the osteogenesis to strengthen the interface between the host bone and the implant. This study shows the first clinical case after implantation of BSG/PMMA for three months using the dual-energy CT, which found apatite nucleation around PMMA instead of fibrous tissues, indicating the biological interface was formed. Therefore, BSG/PMMA is promising as a biomaterial in vertebroplasty, overcoming the drawback of PMMA by improving the biological response from the host bone.
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Affiliation(s)
- Hao Zhang
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Yinglin Cui
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xianglong Zhuo
- Department of Orthopaedics, Fourth Affiliated Hospital of Guangxi Medical University/Liuzhou Worker's Hospital, Liuzhou 545000, Guangxi, China
| | - Jua Kim
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Honglong Li
- Shenzhen Healthemes Biotechnology Co., Ltd, Shenzhen 518120, China
| | - Shuaijie Li
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Hongsheng Yang
- Shenzhen Healthemes Biotechnology Co., Ltd, Shenzhen 518120, China
| | - Kun Su
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Chunyu Liu
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Pengfei Tian
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xian Li
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Li Li
- Department of Orthopaedics, Fourth Affiliated Hospital of Guangxi Medical University/Liuzhou Worker's Hospital, Liuzhou 545000, Guangxi, China
| | - Deping Wang
- School of Materials Science and Engineering, Tongji University, Shanghai 201804, China
| | - Limin Zhao
- Shenzhen Longhua District Central Hospital/The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen 518110, China
| | - Jianyun Wang
- Shenzhen Healthemes Biotechnology Co., Ltd, Shenzhen 518120, China
| | - Xu Cui
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Bing Li
- Department of Orthopaedics, Fourth Affiliated Hospital of Guangxi Medical University/Liuzhou Worker's Hospital, Liuzhou 545000, Guangxi, China
| | - Haobo Pan
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
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11
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Tang S, Dong Z, Ke X, Luo J, Li J. Advances in biomineralization-inspired materials for hard tissue repair. Int J Oral Sci 2021; 13:42. [PMID: 34876550 PMCID: PMC8651686 DOI: 10.1038/s41368-021-00147-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022] Open
Abstract
Biomineralization is the process by which organisms form mineralized tissues with hierarchical structures and excellent properties, including the bones and teeth in vertebrates. The underlying mechanisms and pathways of biomineralization provide inspiration for designing and constructing materials to repair hard tissues. In particular, the formation processes of minerals can be partly replicated by utilizing bioinspired artificial materials to mimic the functions of biomolecules or stabilize intermediate mineral phases involved in biomineralization. Here, we review recent advances in biomineralization-inspired materials developed for hard tissue repair. Biomineralization-inspired materials are categorized into different types based on their specific applications, which include bone repair, dentin remineralization, and enamel remineralization. Finally, the advantages and limitations of these materials are summarized, and several perspectives on future directions are discussed.
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Affiliation(s)
- Shuxian Tang
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, PR China
| | - Zhiyun Dong
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, PR China
| | - Xiang Ke
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, PR China
| | - Jun Luo
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, PR China.
| | - Jianshu Li
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, PR China.
- Med-X Center for Materials, Sichuan University, Chengdu, PR China.
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12
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Sneha KR, Sailaja GS. Intrinsically radiopaque biomaterial assortments: a short review on the physical principles, X-ray imageability, and state-of-the-art developments. J Mater Chem B 2021; 9:8569-8593. [PMID: 34585717 DOI: 10.1039/d1tb01513c] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
X-ray attenuation ability, otherwise known as radiopacity of a material, could be indisputably tagged as the central and decisive parameter that produces contrast in an X-ray image. Radiopaque biomaterials are vital in the healthcare sector that helps clinicians to track them unambiguously during pre and post interventional radiological procedures. Medical imaging is one of the most powerful resources in the diagnostic sector that aids improved treatment outcomes for patients. Intrinsically radiopaque biomaterials enable themselves for visual targeting/positioning as well as to monitor their fate and further provide the radiologists with critical insights about the surgical site. Moreover, the emergence of advanced real-time imaging modalities is a boon to the contemporary healthcare systems that allow to perform minimally invasive surgical procedures and thereby reduce the healthcare costs and minimize patient trauma. X-ray based imaging is one such technologically upgraded diagnostic tool with many variants like digital X-ray, computed tomography, digital subtraction angiography, and fluoroscopy. In light of these facts, this review is aimed to briefly consolidate the physical principles of X-ray attenuation by a radiopaque material, measurement of radiopacity, classification of radiopaque biomaterials, and their recent advanced applications.
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Affiliation(s)
- K R Sneha
- Department of Polymer Science and Rubber Technology, Cochin University of Science and Technology, Kochi - 682022, India.
| | - G S Sailaja
- Department of Polymer Science and Rubber Technology, Cochin University of Science and Technology, Kochi - 682022, India. .,Interuniversity Centre for Nanomaterials and Devices, CUSAT, Kochi - 682022, India.,Centre for Advanced Materials, CUSAT, Kochi - 682022, India
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13
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Wang D, Zhang P, Mei X, Chen Z. Repair calvarial defect of osteoporotic rats by berberine functionalized porous calcium phosphate scaffold. Regen Biomater 2021; 8:rbab022. [PMID: 34211732 PMCID: PMC8240619 DOI: 10.1093/rb/rbab022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/15/2021] [Accepted: 05/03/2021] [Indexed: 12/21/2022] Open
Abstract
In this article, we propose a simple scheme of using berberine (BBR) to modify porous calcium phosphate ceramics (named PCPC). These BBR molecules regulate the crystallization of hydroxyapatite nanorods on PCPC. We found that these nanorods and the adsorbed BBR changed the interface micro-environment of PCPC by SEM images. The microenvironment of PCPC surface is essential for promoting BMSCs’ proliferation and differentiation. These results demonstrated that PCPC/BBR markedly improved the bone regeneration of osteoporosis rats. Moreover, PCPC/BBR had significantly increased the expression levels of ALP, osteocalcin and bone morphogenetic protein2 and RUNX2 in BMSCs originated from osteoporosis rats.
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Affiliation(s)
- Dahao Wang
- Liaoning University of Traditional Chinese Medicine, Shenyang 110847, China
| | - Peng Zhang
- Jinzhou Medical University, Jinzhou 121001, China
| | - Xifan Mei
- Jinzhou Medical University, Jinzhou 121001, China
| | - Zhenhua Chen
- Jinzhou Medical University, Jinzhou 121001, China
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14
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Exploration of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture as day surgery: a retrospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2718-2725. [PMID: 34075472 DOI: 10.1007/s00586-021-06887-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/05/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The purpose of this retrospective study was to evaluate and compare the clinical outcomes of patients underwent PVP for OVCF as day surgery with the outcomes of patients managed as traditional inpatients. METHODS According to the selection criteria, patients who underwent PVP for single-segment thoracolumbar OVCF were included retrospectively in the day surgery procedure (DSP) group and the traditional inpatient procedure (TIP) group between April 2018 and September 2019. The visual analog scale score (VAS) and Oswestry Disability Index (ODI) score were recorded preoperatively and 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. Duration of hospital stay, preoperative waiting time, hospital cost, and postoperative complications were recorded and analyzed. RESULTS A total of 335 patients (53 in DSP group; 282 in TIP group) were enrolled and completed 12-month follow-up. The mean duration of hospital stay, the mean preoperative waiting time, and the mean hospital costs were significant lower in the DSP group. The postoperative VAS and ODI scores in both groups were significantly improved after surgery. Moreover, both VAS and ODI scores at each follow-up stage were also significantly lower than the previous follow-up stage. However, the ODI score in the DSP group was significantly lower at 1-day, 1-week, 1-month, and 3-month follow-up, respectively. For cement leakage and secondary vertebral compression fractures, there was no statistical difference between the two groups. CONCLUSIONS We suggest that PVP for OVCFs in day surgery procedure is worthy of wide application.
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15
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Wang X, Xu J, Kou J, Tian W, Gao C, Cui F, Qiu Z. The clinical results of treating Kummell's disease with mineralized collagen modified polymethyl methacrylate. J Biomater Appl 2021; 35:1366-1371. [PMID: 33554721 DOI: 10.1177/0885328221990821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To investigate the clinical results of treating Kummell's Disease by using mineralized collagen modified polymethyl methacrylate bone cement, 23 cases (23 vertebras) who sustained Kummell's Disease treated with mineralized collagen modified polymethyl methacrylate bone cement from July 2017 to February 2019 were reviewed retrospectively. The visual analogue scale, vertebral body height, Cobb angle, CT values pre-operation and post-operation as well as incidence of complications were observed. All the patients were successfully followed up with an average period of 11.3 months (ranging from 6 to 12 months). The patients could ambulate on the second day after the operation. The visual analogue scale scores significantly decreased from two days after the operation to the last follow-up compared with that before the operation (p < 0.05); the average vertebral height and local Cobb angle had significant recovery (p < 0.05); the CT value of the treated vertebra significantly increased compared with that before the operation (p < 0.05). Bone cement leakage occurred in one case, anterior edge leakage occurred in one case, and no clinical symptoms caused by bone cement leakage occurred. No re-fracture of the treated vertebral body or adjacent vertebral bodies were observed in the follow-ups. With good osteogenic activity and degradable absorption characteristics, mineralized collagen was compounded with the existing polymethyl methacrylate bone cement to reduce its strength in the vertebral body and enhance biocompatibility, the incidence of adjacent vertebral fractures and re-fractures within the injured vertebrae is significantly reduced, and good clinical results are obtained, which is worthy of popularization.
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Affiliation(s)
- Xi Wang
- Department of Orthopedics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Jin Xu
- Department of Basic Medicine, Kangda College of Nanjing Medical University, Lianyungang, China
| | - Jianming Kou
- Department of Orthopedics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Wei Tian
- Department of Orthopedics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Chong Gao
- Department of Orthopedics, Lianyungang Second People's Hospital, Lianyungang, China
| | - Fuzhai Cui
- School of Materials Science and Engineering, Tsinghua University, Beijing, China.,R&D Department, Allgens Medical Technology Corporation, Beijing, China
| | - Zhiye Qiu
- School of Materials Science and Engineering, Tsinghua University, Beijing, China.,R&D Department, Allgens Medical Technology Corporation, Beijing, China
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Zhu J, Yang S, Cai K, Wang S, Qiu Z, Huang J, Jiang G, Wang X, Fang X. Bioactive poly (methyl methacrylate) bone cement for the treatment of osteoporotic vertebral compression fractures. Theranostics 2020; 10:6544-6560. [PMID: 32483469 PMCID: PMC7255031 DOI: 10.7150/thno.44428] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/05/2020] [Indexed: 12/14/2022] Open
Abstract
Rationale: Poly (methyl methacrylate) (PMMA) bone cement is one of the most commonly used biomaterials for augmenting/stabilizing osteoporosis-induced vertebral compression fractures (OVCFs), such as percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP). However, its clinical applications are limited by its poor performance in high compressive modulus and weak bonding to bone. To address these issues, a bioactive composite bone cement was developed for the treatment of osteoporotic vertebral compression fractures, in which mineralized collagen (MC) was incorporated into the PMMA bone cement (MC-PMMA). Methods: The in vitro properties of PMMA and MC-PMMA composite bone cement were determined, including setting time, compressive modulus, adherence, proliferation, and osteogenic differentiation of rat bone mesenchymal stem cells. The in vivo properties of both cements were evaluated in an animal study (36 osteoporotic New Zealand female rabbits divided equally between the two bone cement groups; PVP at L5) and a small-scale and short-term clinical study (12 patients in each of the two bone cement groups; follow-up: 2 years). Results: In terms of value for PMMA bone cement, the handling properties of MC-PMMA bone cement were not significantly different. However, both compressive strength and compressive modulus were found to be significantly lower. In the rabbit model study, at 8 and 12 weeks post-surgery, bone regeneration was more significant in MC-PMMA bone cement (cortical bone thickness, osteoblast area, new bone area, and bone ingrowth %; each significantly higher). In the clinical study, at a follow-up of 2 years, both the Visual Analogue Score and Oswestry Disability Index were significantly reduced when MC-PMMA cement was used. Conclusions: MC-PMMA bone cement demonstrated good adaptive mechanical properties and biocompatibility and may be a promising alternative to commercial PMMA bone cements for the treatment of osteoporotic vertebral fractures in clinical settings. While the present results for MC-PMMA bone cement are encouraging, further study of this cement is needed to explore its viability as an ideal alternative for use in PVP and BKP.
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Affiliation(s)
- Jinjin Zhu
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine & Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
- Department of Spinal Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, China
| | - Shuhui Yang
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Kaiwen Cai
- Department of Spinal Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, China
| | - Shuo Wang
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Zhiye Qiu
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Junfei Huang
- Shimadzu (China) Co., Ltd. Shenzhen Branch, Shenzhen 518042, China
| | - Guoqiang Jiang
- Department of Spinal Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo 315020, China
| | - Xiumei Wang
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Xiangqian Fang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine & Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou 310016, China
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