MD1551Z - Method for restoring tibial metaphyseal defects - Google Patents
Method for restoring tibial metaphyseal defects Download PDFInfo
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- MD1551Z MD1551Z MDS20200135A MDS20200135A MD1551Z MD 1551 Z MD1551 Z MD 1551Z MD S20200135 A MDS20200135 A MD S20200135A MD S20200135 A MDS20200135 A MD S20200135A MD 1551 Z MD1551 Z MD 1551Z
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- 230000007547 defect Effects 0.000 title claims abstract description 18
- 238000000034 method Methods 0.000 title claims description 11
- 210000000988 bone and bone Anatomy 0.000 claims abstract description 33
- 210000002303 tibia Anatomy 0.000 claims abstract description 13
- 239000004568 cement Substances 0.000 claims abstract description 8
- 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
- 210000001185 bone marrow Anatomy 0.000 claims abstract description 4
- 239000012634 fragment Substances 0.000 claims abstract description 4
- 210000002901 mesenchymal stem cell Anatomy 0.000 claims abstract description 4
- 239000002184 metal Substances 0.000 claims abstract description 4
- 244000309466 calf Species 0.000 claims description 6
- 125000006850 spacer group Chemical group 0.000 claims description 6
- 210000001621 ilium bone Anatomy 0.000 claims description 3
- 210000001519 tissue Anatomy 0.000 abstract description 6
- 239000003814 drug Substances 0.000 abstract description 4
- 238000002316 cosmetic surgery Methods 0.000 abstract description 3
- 230000001172 regenerating effect Effects 0.000 abstract description 2
- 208000006735 Periostitis Diseases 0.000 abstract 1
- 210000003692 ilium Anatomy 0.000 abstract 1
- 210000003460 periosteum Anatomy 0.000 abstract 1
- 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
- 210000004663 osteoprogenitor cell Anatomy 0.000 description 2
- 230000035515 penetration Effects 0.000 description 2
- 206010016654 Fibrosis Diseases 0.000 description 1
- 206010052779 Transplant rejections 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
- 238000004113 cell culture Methods 0.000 description 1
- 238000002591 computed tomography Methods 0.000 description 1
- 230000003111 delayed effect Effects 0.000 description 1
- 210000003414 extremity Anatomy 0.000 description 1
- 230000004761 fibrosis Effects 0.000 description 1
- 238000010562 histological examination Methods 0.000 description 1
- 210000003141 lower extremity Anatomy 0.000 description 1
- 238000004377 microelectronic Methods 0.000 description 1
- 230000000877 morphologic effect Effects 0.000 description 1
- 230000008520 organization 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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Abstract
Изобретение относится к медицине, в частности к травматологии и пластической хирургии, регенеративной медицине и тканевой инженерии, и может быть использовано для пластики метафизарных дефектов большеберцовой кости и других губчатых костей.Сущность изобретения состоит в том, что на первом этапе выполняют разрез на переднемедиальной стороне голени, а именно от большого бугорка большеберцовой кости и до средней 1/3 голени, удаляют надкостницу большеберцовой кости, формируют кольцевой костный дефект длиной 3,0 см в проксимальной 1/3 большеберцовой кости, костные фрагменты фиксируют металлической пластиной и шурупами согласно продольной оси, а полость дефекта заполняют цементной прокладкой с антибиотиком, выполняют лаваж антисептическими растворами и рану послойно ушивают; на втором этапе, а именно через две недели, выполняют повторно разрез на том же уровне, удаляют цементную прокладку, а оставшуюся полость заполняют деминерализованным костным ксенотрансплантатом и рану послойно ушивают, после чего в костный трансплантат инокулируют аллокультуру, предварительно приготовленную из мезенхимальных стволовых клеток, извлеченных из костного мозга подвздошной кости и культивированных в течение 20 дней, в концентрации 4,5х106/мл, затем на 6-й неделе повторяют разрез на одном уровне и снимают пластину и шурупы, после чего рану послойно ушивают.The invention relates to medicine, in particular to traumatology and plastic surgery, regenerative medicine and tissue engineering, and can be used for plastic surgery of metaphyseal defects of the tibia and other spongy bones. , namely from the greater tubercle of the tibia to the middle 1/3 of the tibia, the periosteum of the tibia is removed, an annular bone defect 3.0 cm long is formed in the proximal 1/3 of the tibia, the bone fragments are fixed with a metal plate and screws according to the longitudinal axis, and the defect cavity is filled with a cement pad with an antibiotic, lavage is performed with antiseptic solutions, and the wound is sutured in layers; at the second stage, namely after two weeks, the incision is repeated at the same level, the cement pad is removed, and the remaining cavity is filled with a demineralized bone xenograft and the wound is sutured in layers, after which an alloculture previously prepared from mesenchymal stem cells extracted from the bone marrow of the ilium and cultured for 20 days, at a concentration of 4.5x106 / ml, then on the 6th week the incision is repeated at the same level and the plate and screws are removed, after which the wound is sutured in layers.
Description
Invenţia se referă la medicină, în special la traumatologie şi chirurgia plastică, medicina regenerativă şi ingineria tisulară, şi poate fi utilizată pentru plastia defectelor metafizare ale tibiei şi altor oase spongioase. The invention relates to medicine, in particular to traumatology and plastic surgery, regenerative medicine and tissue engineering, and can be used for the plasty of metaphyseal defects of the tibia and other spongy bones.
Este cunoscută metoda de tratament chirurgical al defectelor osoase prin metoda membranei induse şi plastia cavităţii restante osoase cu os spongios morsocat [1]. The surgical treatment of bone defects using the induced membrane method and the plasty of the remaining bone cavity with mortised cancellous bone is known [1].
Dezavantajele metodei cunoscute constau în aceea că osul în această grefă nu este demineralizat, nu are o structură morfologică asemenea unui os spongios, 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 of the known method are that the bone in this graft is not demineralized, does not have a morphological structure similar to a spongy bone, 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.
Mai este cunoscută o metodă cu utilizarea unui tip de grefă din ţesut osteocondral demineralizat [2]. Another method is known using a type of graft made from demineralized osteochondral tissue [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 această grefă mai este prezent material genetic alo- sau xenogen care poate conduce la rejet al transplantului şi fibrozarea acestuia. 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 graft there is still allo- or xenogeneic genetic material present which can lead to rejection of the transplant and its fibrosis.
Problema pe care o rezolvă invenţia constă în extinderea arsenalului de metode utilizate pentru tratamentul defectelor oaselor spongioase, în obţinerea unei grefe osoase xenogene, demineralizate, decelularizate, după dimensiunile necesare conform defectului, care permite o integrare mai bună a ţesutului în organismul gazdă, fără risc de rejet al transplantului. The problem solved by the invention consists in expanding the arsenal of methods used for the treatment of cancellous bone defects, in obtaining a xenogeneic, demineralized, decellularized bone graft, according to the dimensions required according to the defect, which allows for better integration of the tissue into the host organism, without the risk of transplant rejection.
Esenţa invenţiei constă în aceea că la prima etapă se efectuează o incizie pe partea anteromedială a gambei, şi anume de la tuberozitatea mare a tibiei şi până la 1/3 medie a gambei, se efectuează deperiostarea osului tibial, se formează un defect osos circular de o lungime de 3,0 cm în 1/3 proximală a tibiei, fragmentele osoase se fixează cu ajutorul unei plăci metalice şi şuruburi conform axei longitudinale, iar cavitatea defectului se suplineşte cu spacer de ciment cu un antibiotic, se efectuează lavaj cu soluţii antiseptice şi plaga se suturează pe straturi; la a doua etapă, şi anume după două săptămâni, se efectuează repetat incizia la acelaşi nivel, se înlătură spacerul de ciment, iar cavitatea restantă se manşonează cu o xenogrefă osoasă demineralizată şi plaga se suturează pe straturi, după care în grefa osoasă se inoculează o alocultură pregătită anterior de celule stem mezenchimale, extrase din măduva osoasă a osului iliac şi cultivate timp de 20 de zile, în concentraţie de 4,5x106/ml, apoi la a 6-a săptămână se repetă incizia la acelaşi nivel şi se înlătură placa şi şuruburile, după care plaga se suturează pe straturi. The essence of the invention is that in the first stage, an incision is made on the anteromedial part of the calf, namely from the greater tuberosity of the tibia to the middle 1/3 of the calf, periostealization of the tibial bone is performed, a circular bone defect of 3.0 cm in length is formed in the proximal 1/3 of the tibia, the bone fragments are fixed using a metal plate and screws according to the longitudinal axis, and the defect cavity is filled with a cement spacer with an antibiotic, lavage is performed with antiseptic solutions and the wound is sutured in layers; In the second stage, namely after two weeks, the incision is repeated at the same level, the cement spacer is removed, and the remaining cavity is lined with a demineralized bone xenograft and the wound is sutured in layers, after which a previously prepared alloculture of mesenchymal stem cells, extracted from the bone marrow of the iliac bone and cultured for 20 days, at a concentration of 4.5x106/ml, is inoculated into the bone graft, then at the 6th week the incision is repeated at the same level and the plate and screws are removed, after which the wound is sutured in layers.
Rezultatul constă în aceea că respectiva metodă este eficientă, sigură, calitativă şi economă, permite obţinerea unei regenerări osoase depline din punct de vedere morfo-funcţional pentru repararea defectului de ţesut osos spongios de orice lungime şi diametru. The result is that the method is efficient, safe, qualitative and economical, allowing for full bone regeneration from a morpho-functional point of view to repair cancellous bone tissue defects of any length and diameter.
Avantajele metodei revendicate constau în aceea că cavitatea restantă a membranei induse poate fi manşonată cu o grefă xenogenă, ce are capacitate de integrare rapidă 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. Datorită formei ce corespunde defectului creşte posibilitatea de îmbogăţire mai uniformă a transplantului cu celule osteoprogenitoare, totodată conţine o suprafaţă de contact mai mare pentru celulele gazdă şi vasele sangvine, aceasta în final asigură o integrare mai rapidă a transplantului. The advantages of the claimed method are that the remaining cavity of the induced membrane can be sleeved with a xenogeneic graft, which has the capacity for rapid 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 blood vessels. Due to the shape corresponding to the defect, the possibility of more uniform enrichment of the transplant with osteoprogenitor cells increases, at the same time it contains a larger contact surface for the host cells and blood vessels, this ultimately ensures a faster integration of the transplant.
Metoda se realizează în modul următor. The method is carried out in the following way.
La prima etapă se efectuează prelucrarea aseptică a membrului inferior, se efectuează o incizie pe partea anteromedială a gambei, şi anume de la tuberozitatea mare a tibiei şi până la 1/3 medie a gambei, se efectuează deperiostarea osului tibial, se formează un defect osos circular de o lungime de 3,0 cm în 1/3 proximală a tibiei, fragmentele osoase se fixează cu ajutorul unei plăci metalice şi şuruburi conform axei longitudinale, iar cavitatea defectului se suplineşte cu spacer de ciment cu un antibiotic, se efectuează lavaj cu soluţii antiseptice şi plaga se suturează pe straturi; la a doua etapă, şi anume după două săptămâni, se efectuează repetat incizia la acelaşi nivel, se înlătură spacerul de ciment, iar cavitatea restantă se manşonează cu o xenogrefă osoasă demineralizată şi plaga se suturează pe straturi, după care în grefa osoasă se inoculează o alocultură pregătită anterior de celule stem mezenchimale, extrase din măduva osoasă a osului iliac şi cultivate timp de 20 de zile, în concentraţie de 4,5x106/ml, apoi la a 6-a săptămână se repetă incizia la acelaşi nivel şi se înlătură placa şi şuruburile, după care plaga se suturează pe straturi. Se efectuează Rx de control la fiecare etapă, finisând cu examenul de tomografie computerizată a membrului după 8 săptămâni. At the first stage, the lower limb is aseptically processed, an incision is made on the anteromedial side of the calf, namely from the greater tuberosity of the tibia to the middle 1/3 of the calf, periosteation of the tibial bone is performed, a circular bone defect of 3.0 cm in length is formed in the proximal 1/3 of the tibia, the bone fragments are fixed using a metal plate and screws according to the longitudinal axis, and the defect cavity is filled with a cement spacer with an antibiotic, lavage is performed with antiseptic solutions and the wound is sutured in layers; in the second stage, namely after two weeks, the incision is repeated at the same level, the cement spacer is removed, and the remaining cavity is sleeve with a demineralized bone xenograft and the wound is sutured in layers, after which a previously prepared alloculture of mesenchymal stem cells, extracted from the bone marrow of the iliac bone and cultured for 20 days, in a concentration of 4.5x106/ml, is inoculated into the bone graft, then at the 6th week the incision is repeated at the same level and the plate and screws are removed, after which the wound is sutured in layers. A control X-ray is performed at each stage, ending with a computed tomography examination of the limb after 8 weeks.
Această metodă a fost utilizată în Laboratorul de Inginerie Tisulară şi Culturi Celulare pentru tratarea defectelor de os spongios pe modele animale cu rezultate mai bune comparativ cu lotul martor, unde a fost utilizată metoda membranei induse şi plastia cavităţii restante osoase cu os spongios morsocat. This method was used in the Tissue Engineering and Cell Culture Laboratory to treat cancellous 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 mortised 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 |
|---|---|---|---|
| MDS20200135A MD1551Z (en) | 2020-10-26 | 2020-10-26 | Method for restoring tibial metaphyseal defects |
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| MDS20200135A MD1551Z (en) | 2020-10-26 | 2020-10-26 | Method for restoring tibial metaphyseal defects |
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| MD1551Y MD1551Y (en) | 2021-07-31 |
| MD1551Z true MD1551Z (en) | 2022-02-28 |
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