RECONSTRUCTION OF BONE DEFECTS AFTER TUMOR RESECTION BY AUTOAND ALLOGRAFTS (review of literature)

Use of biodegradable polycaprolactone matrix for filling bone defects (experimental study)

Background. There are unresolved issues in bone defect management associated with complications, invasiveness and long duration of treatment. The use of elastic implants made of bioactive biodegradable materials that take any form of defect could close many of them.

The aim. To investigate features of reparative regeneration in filling bone defects with an elastic degradable implant made of polycaprolactone (PCL) with and without hydroxyapatite (HA).

Materials and methods. The study was carried out on 10 adult mongrel dogs. A non-through cylindrical hole, 4 mm in diameter and 10 mm deep, was modeled in the upper third of the diaphysis of the tibia. The defects thus formed were filled with an elastic degradable implant made of polycaprolactone. In Group 1, HA was not added to polycaprolactone, while HA was added in dogs of Group 2. Radiographic and histological methods were used to study the results.

Results. It was found that the tested materials did not cause toxic and allergic reactions, both local and general, during intravital observations and in post-mortem anatomical preparations. After 28 days in both series, the implant biodegraded and was replaced by bone tissue. The proportion of the bone component and the numerical density of microvessels in the defect zone in Group 2 were significantly higher than in Group 1.

Conclusion. Elastic implants produced of polycaprolactone by electrospinning are biologically compatible, biodegradable and can be used to heal bone defects. Hydroxyapatite that was added stimulates the activity of osteogenesis.

Bone Xenografts in Trauma and Orthopaedics (Analytical Review)

Purpose of the analytical review — to evaluate the application experience of bone xenografts in trauma and orthopaedics surgery. Methods. Data search was performed in the electronic databases of PubMed and eLIBRARY with depth of 20 years. Results. The authors identified 13 papers which described the application experience of bone xenografts in trauma surgery and orthopaedics. The highest efficiency (from 92 to 100%) was reported for cases of xenografts use to replace defects in intraarticular fractures and revision arthroplasty. Unsatisfactory outcomes were related to cases with no integration and graft rejection. The least efficiency (from 41,9 to 46,1%) was reported in reconstructive foot surgery. No effect of bone xenografts was observed for replacement of defects in cases of pseudoarthrosis. The most frequent complication was graft material infection. The summarized literature data provided the calculated share of complications following xenograft use of 7,53% (18 out of 239 cases, CI 5-95%, 4,53-11,21). Two areas were identified for improvement of technical and biological properties of bone xenografts: 1. Modification of original xeno-matrix (enhancement of purification technique, alteration of structure of chemical composition of the bone matrix); 2. Augmentation of matrix volume by additional elements (biologically active agents, stem cells). It’s noted that demand for xenografts in traumatology and orthopaedics can increase after refining and expanding the indications for clinical use. Conclusion. Bone xenografts used in the modern trauma surgery and orthopaedics to replace bone defects in revision arthroplasty as well as in certain fracture types. Such material is relatively safe and its ability to be modified allows to improve its biological properties.