Comparison between the induced membrane technique and distraction osteogenesis in treating segmental bone defects: An experimental study in a rat model

Abstract BackgroundThe current research explores the early therapeutic efficacy and healing outcomes of segmental bone defects in the ankle joint treated with induced membrane technique. MethodsA segmental bone defect model of ankle joint was first constructed by removing 2mm bone from the ankle joint of the rat, and then the induced membrane treatment was performed in two steps: the first step was to implant polymethyl methacrylate bone cement after thorough debridement, followed by the second step to remove bone cement after membrane formation and to replace with the rat’s autologous cancellous bone. The physiological indicators (body temperature and body weight) of the rats and the TNF-α and CRP in the blood were monitored post-surgery, and the efficacy was analyzed based on the above combining Micro-CT and X-ray analysis. Postoperative histological analysis of the tissue morphology of partial induced membrane was performed in rats at 2, 4, 6, and 8 weeks to evaluate the tissue status at the sites of bone defect. ResultsResults showed that the rats survived well after operation: the body temperature slowly decreased, and the CRP was also gradually reduced to normal; the 12-week Micro-CT and palpation indicated a satisfying bone healing trend; histological studies found calcified tissue in the second week post-operation, and vascular network was established in the induced sites at 8 weeks.ConclusionThe study proves that the induced membrane technique can effectively treat segmental bone defects of ankle joint, and is less prone to infection.

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Comparison between Tonifying Kidney Yang and Yin in Treating Segmental Bone Defects Based on the Induced Membrane Technique: An Experimental Study in a Rat Model

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/6575127 ◽

2020 ◽

Vol 2020 ◽

pp. 1-15

Author(s):

Zhen Shen ◽

Zehua Chen ◽

Xiaodong Shi ◽

Tao Wang ◽

Minling Huang ◽

...

Keyword(s):

Bone Repair ◽

Bone Defects ◽

Treated Group ◽

Control Group ◽

Induced Membrane ◽

Membrane Technique ◽

The Difference ◽

Segmental Bone ◽

Stage 1 ◽

Segmental Bone Defects

Tonifying kidney therapy consisting of tonifying kidney yang and yin is the basic principle of Chinese medicine in treating segmental bone defects (SBDs). Previous studies have demonstrated the presence of the differences between tonifying kidney yang and yin in bone metabolism of osteoporosis and distraction osteogenesis models. However, whether the difference between the two tonifying kidney methods in bone repair for the induced membrane (IM) technique occurs or what is the difference remain unclear. Angiogeneic-osteogenic coupling plays an important role in bone repair and the induced membrane couples angiogenesis with the later osteogenesis during the IM process. This study aimed at investigating the effects of tonifying kidney yang (total flavonoids of Rhizoma Drynariae, TFRD) and yin (plastrum testudinis extract, PTE) on angiogenesis and osteogenesis in the IM-treated SBDs. Rats of 6 mm tibia bone defect model treated with IM were divided into five groups: the control group, the model group, the tonifying kidney yang group (TFRD-treated group), the tonifying kidney yin group (PTE-treated group), and the western medicine group. At 4 weeks after insertion of the polymethylmethacrylate (PMMA), three caudal vertebrae from the tail in each rat were implanted into the 6 mm defect gap. Radiographical, histological, immunohistochemical, and immunofluorescent analyses were performed to assess bone and vessel formation at 4 or 12 weeks after insertion of the PMMA, respectively. Our results revealed that TFRD and PTE were beneficial to both angiogenesis and osteogenesis. TFRD exerted a better effect on angiogenesis than PTE and achieved a better result in stage 1 rather than in stage 2 of IM, whereas PTE was superior to TFRD in osteogenesis and achieved a better result in stage 2 instead of stage 1. Collectively, these findings elucidated the beneficial effects of tonifying kidney yang and yin on angiogenesis and osteogenesis of SBD repair during the IM process, as well as the difference that tonifying kidney yang surpasses tonifying kidney yin in angiogenesis while tonifying kidney yin outperforms tonifying kidney yang in osteogenesis, which suggests that the combination between the application of tonifying kidney yang method in stage 1 of IM and tonifying kidney yin method in stage 2 may achieve better repair efficiency.

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Artificial Membrane Induced by Novel Biodegradable Nanofibers in the Masquelet Procedure for Treatment of Segmental Bone Defects

Journal of Nanomaterials ◽

10.1155/2018/8246571 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

Yi-Hsun Yu ◽

Ren-Chin Wu ◽

Demei Lee ◽

Che-Kang Chen ◽

Shih-Jung Liu

Keyword(s):

Bone Graft ◽

Bone Defects ◽

Artificial Membrane ◽

Union Rate ◽

Segmental Bone Defect ◽

Additional Surgery ◽

Membrane Technique ◽

Induced Membrane Technique ◽

Segmental Bone ◽

Segmental Bone Defects

The Masquelet induced-membrane technique for the treatment of segmental bone defects includes a two-stage surgical procedure, and polymethylmethacrylate (PMMA) plays a major role in the treatment. However, the PMMA spacer must be surgically removed. Here, we investigated the potential of poly(lactic-co-glycolic acid) (PLGA) nanofibers, a biodegradable material to replace the PMMA spacer, allowing the bioactive membrane to be induced and the spacer to degrade without the additional surgery on a rabbit femoral segmental bone defect model. PLGA nanofibers were shown to degrade completely six weeks after implantation in the investigated animals, and a thick membrane was found to circumferentially fold around the segmental bone defects. Results from image studies demonstrated that, in the group without the bone graft, all studied femurs exhibited either nonunion or considerable malunion. In contrast, the femurs in the bone graft group had a high union rate without considerable deformities. Histological examinations suggested that the membranous tissue in this group was rich in small blood vessels and the expression of BMP2 and VEGF increased. Our results demonstrate that the biodegradable PLGA nanofibers may be useful for replacing the PMMA spacer as the bioactive-membrane inducer, facilitating the process of healing and removing the need for repeated surgeries.

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Artificial Membrane Induced by Novel Biodegradable Nanofibrous Scaffold in the Masquelet Procedure for the Treatment of Segmental Bone Defects

10.20944/preprints201806.0047.v1 ◽

2018 ◽

Cited By ~ 1

Author(s):

Yi-Hsun Yu ◽

Ren-Chin Wu ◽

Demei Lee ◽

Che-Kang Chen ◽

Shih-Jung Liu

Keyword(s):

Bone Graft ◽

Bone Defects ◽

Artificial Membrane ◽

Segmental Bone Defect ◽

Additional Surgery ◽

Membrane Technique ◽

Induced Membrane Technique ◽

Segmental Bone ◽

Without Bone Graft ◽

Segmental Bone Defects

Masquelet induced-membrane technique for the treatment of segmental bone defects includes a two-stage surgical procedure, and polymethylmethacrylate (PMMA) plays a major role in the treatment. However, the PMMA spacer must be surgically removed. Here, we investigated the potential of poly (lactic-co-glycolic acid) (PLGA) nanofibers, a biodegradable material to replace PMMA spacer, allowing the bioactive membrane to be induced, and the spacer to degrade without the additional surgery on a rabbit femoral segmental bone defect model. PLGA nanofibers were shown to degrade completely six weeks after implantation in the investigated animals, and a thick membrane was found to circumferentially fold around the segmental bone defects. Results from image studies demonstrated that, in the group without bone graft, all studied femurs exhibited either nonunion or considerable malunion. In contrast, the femurs in the bone graft group had a high union rate without considerable deformities. Histological examinations suggested that the membranous tissue in this group was rich in small blood vessels and the expression of BMP2 and VEGF increased. Our results demonstrate that the biodegradable PLGA nanofibers may be useful for replacing the PMMA spacer as the bioactive-membrane inducer, facilitating the process of healing and removing the need for repeated surgeries.

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