MD1391Z - Method for restoring long tubular bone defects - Google Patents
Method for restoring long tubular bone defects Download PDFInfo
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- MD1391Z MD1391Z MDS20190032A MDS20190032A MD1391Z MD 1391 Z MD1391 Z MD 1391Z MD S20190032 A MDS20190032 A MD S20190032A MD S20190032 A MDS20190032 A MD S20190032A MD 1391 Z MD1391 Z MD 1391Z
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- 210000000988 bone and bone Anatomy 0.000 title claims abstract description 32
- 230000007547 defect Effects 0.000 title claims abstract description 16
- 238000000034 method Methods 0.000 title claims description 10
- 239000004568 cement Substances 0.000 claims abstract description 8
- 239000002184 metal Substances 0.000 claims abstract description 8
- 125000006850 spacer group Chemical group 0.000 claims abstract description 8
- 230000001054 cortical effect Effects 0.000 claims abstract description 5
- 210000002901 mesenchymal stem cell Anatomy 0.000 claims abstract description 5
- 239000003242 anti bacterial agent Substances 0.000 claims abstract description 4
- 230000002421 anti-septic effect Effects 0.000 claims abstract description 4
- 230000003115 biocidal effect Effects 0.000 claims abstract description 4
- 239000012634 fragment Substances 0.000 claims abstract description 4
- 210000004872 soft tissue Anatomy 0.000 claims abstract description 4
- 210000002303 tibia Anatomy 0.000 claims abstract description 4
- 244000309466 calf Species 0.000 claims description 9
- 238000004113 cell culture Methods 0.000 claims description 5
- 239000003814 drug Substances 0.000 abstract description 2
- 230000000399 orthopedic effect Effects 0.000 abstract description 2
- 238000002278 reconstructive surgery Methods 0.000 abstract description 2
- 210000001699 lower leg Anatomy 0.000 abstract 3
- 208000006735 Periostitis Diseases 0.000 abstract 1
- 210000003460 periosteum Anatomy 0.000 abstract 1
- 210000001519 tissue Anatomy 0.000 description 5
- 210000004027 cell Anatomy 0.000 description 4
- 230000010354 integration Effects 0.000 description 4
- 239000012528 membrane Substances 0.000 description 4
- 210000004204 blood vessel Anatomy 0.000 description 3
- 206010052779 Transplant rejections Diseases 0.000 description 2
- 210000001185 bone marrow Anatomy 0.000 description 2
- 230000008520 organization Effects 0.000 description 2
- 210000004663 osteoprogenitor cell Anatomy 0.000 description 2
- 230000035515 penetration Effects 0.000 description 2
- 206010016654 Fibrosis Diseases 0.000 description 1
- 238000010171 animal model Methods 0.000 description 1
- 230000010478 bone regeneration Effects 0.000 description 1
- 210000000845 cartilage Anatomy 0.000 description 1
- 238000002591 computed tomography Methods 0.000 description 1
- 230000003111 delayed effect Effects 0.000 description 1
- 230000004761 fibrosis Effects 0.000 description 1
- 238000010562 histological examination Methods 0.000 description 1
- 210000001621 ilium bone Anatomy 0.000 description 1
- 238000004377 microelectronic Methods 0.000 description 1
- 230000000877 morphologic effect Effects 0.000 description 1
- 102000004169 proteins and genes Human genes 0.000 description 1
- 108090000623 proteins and genes Proteins 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
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- Materials For Medical Uses (AREA)
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Abstract
Description
Invenţia se referă la medicină, în special la traumatologie şi ortopedie, chirurgie reconstructivă şi poate fi utilizată pentru restabilirea defectelor oaselor tubulare lungi. The invention relates to medicine, in particular to traumatology and orthopedics, reconstructive surgery and can be used to restore defects in long tubular bones.
Este cunoscută metoda de tratament chirurgical al defectelor osoase tubulare lungi prin metoda membranei induse şi plastia cavităţii restante osoase cu os spongios mursecat [1]. The surgical treatment method of long tubular bone defects is known by the induced membrane method and the plasty of the remaining bone cavity with decayed cancellous bone [1].
Dezavantajele constau în aceea că osul în această grefă nu este demineralizat, nu are o structură morfologică asemenea unui os tubular precum şi nu asigură pătrunderea bună a celulelor gazdei şi vaselor sangvine în grefă. Aceasta în final se soldează cu integrarea şi organizarea morfo-funcţională mult mai întârziată a grefei în zona de plastie. The disadvantages are that the bone in this graft is not demineralized, does not have a morphological structure similar to a tubular bone, and does not ensure good penetration of host cells and blood vessels into the graft. This ultimately results in much delayed integration and morpho-functional organization of the graft in the area of plasty.
Un alt tip de grefă utilizat cu acelaşi scop este ţesutul osteocondral demineralizat [2]. Dezavantajele constau în aceea, că cartilajul în această grefă nu este decelularizat, în el se păstrează celule care pot fi vizualizate la o eventuală scanare microelectronică sau examen histologic. Astfel, în aceast transplant mai este prezent material genetic alo- sau xenogen care poate duce la rejetul transplantului şi fibrozarea acestuia. Another type of graft used for the same purpose is demineralized osteochondral tissue [2]. The disadvantages are that the cartilage in this graft is not decellularized, it retains cells that can be visualized in a possible microelectronic scan or histological examination. Thus, in this transplant there is also allo- or xenogeneic genetic material present which can lead to transplant rejection and fibrosis.
Problema pe care o rezolvă invenţia constă în extinderea arsenalului de metode utilizate pentru tratamentul defectelor oaselor tubulare lungi, în obţinerea unui transplant osos alo- sau xenogen, demineralizat, decelularizat pe toată lungimea, care permite o integrare mai bună a ţesutului în organismul gazdă, fără risc de rejet al transplantului. De asemenea, datorită formei tubulare creşte posibilitatea de îmbogăţire mai uniformă a transplantului cu celule osteoprogenitoare, totodată prezintă o suprafaţa de contact mai mare pentru celulele gazdă şi vasele sangvine, aceasta în final asigură o integrare mai rapidă a transplantului şi organizare morfofuncţională (ca lungime şi diametru, cortical şi măduvă osoasă). The problem solved by the invention consists in expanding the arsenal of methods used for the treatment of defects in long tubular bones, in obtaining an allo- or xenogeneic bone transplant, demineralized, decellularized along the entire length, which allows for better integration of the tissue in the host organism, without the risk of transplant rejection. Also, due to the tubular shape, the possibility of more uniform enrichment of the transplant with osteoprogenitor cells increases, at the same time it presents a larger contact surface for host cells and blood vessels, this ultimately ensures faster integration of the transplant and morphofunctional organization (in length and diameter, cortical and bone marrow).
Esenţa invenţiei constă în aceea că se efectuează în două etape şi anume la prima etapă se efectuează o incizie la nivelul gambei, pe partea antero-medială, de la tuberozitatea mare a tibiei şi până la 1/3 distală a gambei, apoi se deperiostează osul tibial, se formează un defect osos circular de o lungime de 3,0 cm în 1/3 medie a gambei, fragmentele osoase se amplasează în poziţie corectă şi se fixează cu ajutorul unei plăci metalice cu şuruburi, iar cavitatea defectului se suplineşte cu un spacer de ciment cu un antibiotic, după care se efectuează lavajul plăgii cu soluţii antiseptice şi plaga se suturează pe straturi. Peste 2 săptămâni se efectuează a doua etapă, care include incizia ţesuturilor moi la acelaşi nivel, se înlătură spacerul de ciment, iar cavitatea restantă se suplineşte cu un transplant osos cortical tubular demineralizat şi apoi plaga se suturează pe straturi, iar local se inoculează un alotransplant ce conţine o cultură de celule stem mezenchimale cu concentraţia de 4,5 x 106/ml, apoi la a 6-a săptămână se efectuează incizia la acelaşi nivel şi se înlătură placa metalică şi şuruburile, iar plaga se suturează pe straturi. The essence of the invention is that it is performed in two stages, namely in the first stage an incision is made at the level of the calf, on the antero-medial side, from the greater tuberosity of the tibia to the distal 1/3 of the calf, then the tibial bone is deperiosteated, a circular bone defect of 3.0 cm in length is formed in the middle 1/3 of the calf, the bone fragments are placed in the correct position and fixed using a metal plate with screws, and the defect cavity is filled with a cement spacer with an antibiotic, after which the wound is washed with antiseptic solutions and the wound is sutured in layers. After 2 weeks, the second stage is performed, which includes the incision of the soft tissues at the same level, the cement spacer is removed, and the remaining cavity is replaced with a demineralized tubular cortical bone transplant and then the wound is sutured in layers, and an allotransplant containing a mesenchymal stem cell culture with a concentration of 4.5 x 106/ml is locally inoculated, then at the 6th week, the incision is performed at the same level and the metal plate and screws are removed, and the wound is sutured in layers.
Avantajele metodei revendicate constau în aceea că cavitatea restantă a membranei induse poate fi manşonat cu un transplant alo- sau xenogen, ce are capacitate rapidă de integrare în ţesutul gazdă şi risc minim de rejet, datorită ţesutului osos decelularizat, iar în asociere cu celulele osteoprogenitoare - asigură o suprafaţă de contact mai mare cu celulele gazdei şi o pătrundere mai bună a vaselor sangvine. The advantages of the claimed method are that the remaining cavity of the induced membrane can be sleeve with an allo- or xenogeneic transplant, which has a rapid capacity for integration into the host tissue and minimal risk of rejection, due to the decellularized bone tissue, and in association with osteoprogenitor cells - ensures a larger contact surface with the host cells and better penetration of the blood vessels.
Rezultatul constă în aceea că metoda revendicată este eficientă, sigură, calitativă şi economă, permite obţinerea unei regenerări osoase depline morfo-funcţionale, în repararea defectului de ţesut osos masiv - atât în lungime, cât şi în diametru. The result is that the claimed method is efficient, safe, qualitative and economical, allowing for full morpho-functional bone regeneration in repairing the massive bone tissue defect - both in length and in diameter.
Metoda se realizează în modul următor. The method is carried out in the following way.
Metoda se efectuează în două etape şi anume la prima etapă se efectuează o incizie la nivelul gambei, pe partea antero-medială, de la tuberozitatea mare a tibiei şi până la 1/3 distală a gambei, apoi se deperiostează osul tibial, se formează un defect osos circular de o lungime de 3,0 cm în 1/3 medie a gambei, fragmentele osoase se amplasează în poziţie corectă şi se fixează cu ajutorul unei plăci metalice cu şuruburi, iar cavitatea defectului se suplneşte cu un spacer de ciment cu un antibiotic (Aminofix), după care se efectuează lavajul plăgii cu soluţii antiseptice şi plaga se suturează pe straturi. Peste 2 săptămâni se efectuează a doua etapă, care include incizia ţesuturilor moi la acelaşi nivel, se înlătură spacerul de ciment, iar cavitatea restantă se suplineşte cu un transplant osos cortical tubular demineralizat şi apoi plaga se suturează pe straturi, iar local se inoculează un alotransplant ce conţine o cultură de celule stem mezenchimale cu concentraţia de 4,5 x 106/ml. Cultura de celule stem mezenchimale este izolată şi cultivată în cadrul Laboratorului de Ingenerie Tisulară, perioada 20 zile, din măduva osoasă extrasă din osul iliac. Apoi la a 6-a săptămână se efectuează incizia la acelaşi nivel şi se înlătură placa metalică şi şuruburile, iar plaga se suturează pe straturi. După fiecare etapă se efectuează radiografia de control, iar tomografia computerizată după 8 saptămâni. The method is performed in two stages, namely in the first stage an incision is made on the calf, on the anteromedial side, from the greater tuberosity of the tibia to the distal 1/3 of the calf, then the tibial bone is deperiosteated, a circular bone defect of 3.0 cm in length is formed in the middle 1/3 of the calf, the bone fragments are placed in the correct position and fixed using a metal plate with screws, and the defect cavity is replaced with a cement spacer with an antibiotic (Aminofix), after which the wound is washed with antiseptic solutions and the wound is sutured in layers. After 2 weeks, the second stage is performed, which includes the incision of the soft tissues at the same level, the cement spacer is removed, and the remaining cavity is replaced with a demineralized tubular cortical bone transplant and then the wound is sutured in layers, and an allotransplant containing a mesenchymal stem cell culture with a concentration of 4.5 x 106/ml is locally inoculated. The mesenchymal stem cell culture is isolated and cultivated in the Tissue Engineering Laboratory, for a period of 20 days, from bone marrow extracted from the iliac bone. Then, at the 6th week, the incision is performed at the same level and the metal plate and screws are removed, and the wound is sutured in layers. After each stage, a control radiograph is performed, and a computed tomography scan after 8 weeks.
Această metodă a fost utilizată în Laboratorul de Inginerie Tisulară şi Culturi Celulare pentru tratarea defectelor oaselor tubulare lungi pe modele animale cu rezultate mai bune comparativ cu lotul martor, unde a fost utilizat metoda membranei induse şi plastia cavităţii restante osoase cu os spongios mursecat. This method was used in the Tissue Engineering and Cell Culture Laboratory to treat long tubular bone defects in animal models with better results compared to the control group, where the induced membrane method and plasty of the remaining bone cavity with decayed cancellous bone were used.
1. Masquelet A.C., Fitoussi F., Begue T., Muller G.P. Reconstruction des os longs par membrane induite et autogreffe spongieuse. 2000, Jun., no. 45(3), p.346-353 1. Masquelet A.C., Fitoussi F., Begue T., Muller G.P. Reconstruction des long bones par membranes induced et autograffe spongieuse. 2000, June, no. 45(3), p.346-353
2. US 2007/0276506 A1 2007.11.29 2. US 2007/0276506 A1 2007.11.29
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20190032A MD1391Z (en) | 2019-03-05 | 2019-03-05 | Method for restoring long tubular bone defects |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20190032A MD1391Z (en) | 2019-03-05 | 2019-03-05 | Method for restoring long tubular bone defects |
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| MD1391Y MD1391Y (en) | 2019-11-30 |
| MD1391Z true MD1391Z (en) | 2020-06-30 |
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| MDS20190032A MD1391Z (en) | 2019-03-05 | 2019-03-05 | Method for restoring long tubular bone defects |
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