Objective To explore the situation of tendon-bone heal ing when allogenic tendon graft is wrapped with autologous periosteum around the tendon in rabbits. Methods Twenty healthy New Zealand white rabbits with the age of 4-5 months were used in the experiment, weighing 2.5-3.0 kg. One-side posterior l imb was selected randomly as the test, and thecontralateral l imb was served as the control at the same time. The allogenic tendon graft was designed as a tendon-bone model in the proximal tibial metaphysis of rabbits. The portion of tendon in the bone tunnel was wrapped with autologous periosteal graft in which the cambium layer was facing the bone tunnel in the experimental group, while the portion of tendon in the bone tunnel was not wrapped with autologous periosteal graft in the control group. The histologic examination of the tendon-bone interface (n=2) and the biomechanical test for maximal pullout load (n=8) were conducted 4 and 8 weeks after operation, respec tively. Results All specimens were observed with naked eyes 4 and 8 weeks after the operation. Many new bones around bone tunnel outlet were seen in the experimental group, while a few or few new bones were seen in the control group. Four weeks after operation, histological observation showed there were a lot of prol iferative mesenchymal cells in the periosteal germinal layer in the experimental group and conspicuous membrane bone formation was obvious. The arrangement of massive osteoblasts around newborn bone trabecula was similar to pal isade. The newborn bone trabecula was l inked with the periosteum. Some loose connective tissues and few newborn bones between the tendon graft and the bone tunnel were seen in the control group, and the connection of them was loose. Eight weeks after operation, the connection between the tendon graft and the bone tunnel was tight and no gap existed in the experimental group. The number of newborn bones was large and their arrangement was relatively regular. The tidemark l ine was seen between the tendon graft and the bone tunnel, which was similar to normal tendon-bone interface. The prol iferation of fibroblast was active in the periosteum, and there were many fibrous joints betweenthe periosteum and the tendon graft. Partial bone formation was seen between the tendon graft and the bone tunnel in thecontrol group, with disorderly arrangement, and there were many collagen fibrous joints between the tendon graft and the bone tunnel. Four and 8 weeks after operation, the pullout or pull and break loads of the experimental group were (35.03 ± 1.21) N/ cm and (42.36 ± 1.31) N/cm, respectively, and those of the control group were (26.14 ± 6.13) N/cm and (31.63 ± 6.87) N/ cm, respectively. There was significant difference between the two groups (P lt; 0.05). Conclusion The transplantation of autologous periosteum graft wrapping around allogenic tendon graft may shorten the time of osteochondral ossification between the tendon graft and the bone tunnel, improve heal ing strength and promote tendon-bone heal ing in the bone tunnel in rabbits.
Osteoblasts were cultured and isolated from a piece of tibial pettiosteum of four New-Zealandrabbits. After subeultured,these cells Were incubatd in vitro with tritiated thvmidine for 36 hoursand then these labeled cells were implanted in the subeutaneous layer of the defects of the auriclarcartilage and the radial bone, After 2 weeks and 4 weeks respectively, these rabbits were killed andthe spoimens were obtained from the site where the cells had been transplanted. The transformation of these cells was observed by autoradiographic method. The results indicated that nearly all of the cultured cells were labeled. After 2 weeks, it was observed that many labeled osteoblasts were in different stages of differentiation, some were beried by extracellular matrix and resembled osteocyte, thers were differentiated into chondrocyte-like cell. In addition, some labeled osteoblasts were congregated in the form of multinucleated osteoclast. After 4 weeks , in the subcutaneous layer the labeled osteoblasts were changed to osteoid tissue and in the defect of the auricular crtilage these cells transformed into chondritic tissue; moreover, those labeled osteoblsts which had been implanted into the radial defect had differentiated into typical bone tissue. The results of this research indicated that the osteoblasts isolated from the periosteum if reimplanted to the same donor might be possible to repair the bone and cartilage defects.
Objective To introduce an effective method of treating old scaphoid fracture. Methods From April 1995 to April2002,11 patients with old scaphoid fracture were treated with transposition of vascularized periosteal flap and internal fixation; if necessary, the radial styloid was removed. Out of 11 patients( 8 males and 3 females, aged from 17 to 46 years), the fracture siteswere medialscaphoid in 7, the proximal one in 2 and the distal one in 2. The X-ray filmsshowed separated fracture lines. The fracture lines were less than 1 mm in 4patients and more than 1 mm in 3 patients. Sclerosis of skeleton ends and cystoid degeneration occurred in 2 patients, respectively. Results After a follow-up of 3 to 24 months, the fracture healing was obtained within 4 months in 9 casesand within 6 to 7 months in 2 cases. Internal fixation was taken out 3 months after bone healing. The carpal joint pain and weakness vanished in all cases.Conclusion Transposition of vascularized periosteal flap and internal fixation have many advantages, such as easy dissection, rich blood supply, quick new bone formation, short time of fracture healing and satisfactory function recovery of carpal joint.
In order to observe the effects of different facing directions of the germinal layer of periosteum on the cartilage regeneration, the human fibrin adhesive agent was used to adhere autogenous periosteum to repair the articular cartilage defect of rabbits. Twentyfour rabbits with 48 knee joints were divided randomly into two groups. A 0.6cm×1.2cm articular cartilage defect was created on the femoral trochlea until there was bleeding from the subchondral bone. A piece of periosteum, sized 0.75cm×1.5cm, was removed from the medial aspect of upper tibia. The periosteum was adhered to the defect by human fibrin adhesive agent. In Group 1 the germinal layer faced the subchondral bone and in Group 2 the germinal layer faced the joint cavity. The cartilage regeneration in both groups was observed by naked eyes and light microscope in 2nd and 6th weeks and by electron microscope after Safronin Ostained in 12th and 20th weeks. The results showed that before the 6th week, the cartilage regeneration was faster in Group 2 than that in Group 1. After that there was no significant difference in regeneration between the two groups. This suggested that the facing direction of the germinal layer was not a critical factor on cartilage regeneration. It was also found that the strength of the adhesive agent was not enough. The regenerated cartilage was proved to be hyaline cartilage.
To evaluate the initial cl inical effect of the autologous bone marrow integrating artificial bone and il ium periosteum transplantation in treatment of problematic nonunion. Methods From January 2004 to July 2006, 12 patients (13 l imbs)with problematic nonunion were treated with autologous bone marrow integrating artificial bone and il iumperiosteum. There were 8 males and 4 females, aged 17-58 years old. The position of nonunion were the tibia in 7 l imbs, the femur in 3 l imbs, the humerus in 2 l imbs. The operated number was 1-4, mean 2.5. The time from injury to therapy was 13 months to 9 years, mean 47.6 months. The bone defect distance was 6-30 mm (mean 15 mm) through 1 ∶ 1 X-rays before operation. Eleven l imbs were treated by internal fixation (10 l imbs by the bone nail and 1 l imb by the l imited contact-dynamic compression plate), 2 l imbs were treated by the external fixation. The X-ray films were taken at 1 day, 1, 3, 6, 9, 12 months after operation to observe fracture union. Results All patients were followed up for 12-26 months (mean 17.5 months) and achieved union within 4-7 months (mean 6 months). No deformity of rotation, angulation and crispation occurred in 13 l imbs, but functional impairment occurred in 6 l imbs after union of fracture. Conclusion Autologous bone marrow integrating artificial bone and il ium periosteum transplantation for treatment of problematic nonunion has the satisfactory result.
Abstract To investigate the ectopic new bone formation following implantation of bovine hydroxyapatite Bio-oss together with free periosteum, 12 chabb: ch rabbits were selected. In 10 rabbits, Bio-oss block together with free periosteum was implanted in the gastrocnemius muscle of one leg randomly, and Bio-oss block alone was implanted in the same muscle of the other leg. In the other 2 rabbits, the periosteum was implanted into the gastrocnemius musle of both legs. Histologic examination and quantitative analysis of newbone formation were performed at 3 and 6 weeks postoperatively. The results showed that in the legs implanted bovine hydroxyapatite Bio-oss together with freeperiosteum, new bone formation began at 5th day after implantation. The area ofnew bone composed of 19.0% of the specimens at 3 weeks postoperatively. No boneformation through out the experimental period in Bio-oss block alone implantedlegs and also periosteum implanted legs. We concluded that bovine hydroxyapatite Bio-oss has a good capacity of osteoconduction. New bone can be formed after the implantation of hydroxyapatite combined with free periosteum.
OBJECTIVE To introduce a new method of bone defect repairing after bone cyst curettage. METHODS Eight cases with bone cyst were treated with this new method. The pieces of autogenous periosteum were implanted into the hematoma within the enveloped bone defect created after the bone cyst curettage. Among these patients, there were 5 males and 3 females, aged from 14 to 36 years old. All the lesions located in the upper of femur except one being located in humerus. The results were evaluated through the postoperative radiological findings with the preoperative ones and analysis of clinical functions. RESULTS All the patients were followed up for 2 to 11 years. X-ray films showed that osteogenesis developed well and that the enveloped bone defects had been repaired. No recurrence was found and the function of the affected limbs were maintained. CONCLUSION Autogenous periosteum grafting is effective in the treatment of solitary bone cyst.
Objective To review the research progress of the role of periosteum in distraction osteogenesis. Methods The related domestic and foreign literature about the role of periosteum in distraction osteogenesis in recent years was extensively reviewed, summarized, and the mechanism and influencing factors of periosteum during traction and osteogenesis were analyzed. Results The periosteum is rich in all kinds of cells (mesenchymal stem cells, osteoblasts, etc.), microvessel and various growth factors, which are necessary for the formation of new bone. It can promote the formation of new bone in the process of traction osteogenesis significantly. Conclusion The periosteum plays an important role in the progress of distraction osteogenesis.
OBJECTIVE: To study the treatment efficacy of vascularized periosteum graft and bone filling material for long bone defect. METHODS: Forty young and forty adult rabbits were divided into four groups respectively according to the bone filling materials. A 3 cm long segment was removed from the middle part of the rabbit radius to make a bone defect model. The periosteum was reserved and restored to set up a vascularized tubulate periosteum graft. On the left side, autogenous bone graft, decalcified allograft, tricalcium phosphate, and hydroxyapatite were used to fill in the bone defect respectively; on the right side, no bone filling material was used as controls. The repairing effect of bone defect was evaluated by roentogenography, biomechanical, and histological methods. RESULTS: In young rabbits, bone defects on both sides healed in the 6th week after operation. The bending strength of radius in the tricalcium phosphate group and in the hydroxyapatite group were lower in the 12th week and there was significant difference when compared with autogenous bone graft group, decalcified allograft group and control group (P lt; 0.05). The repairing mechanism included intramembranous and endochondral ossification, and intramembranous ossification was prevalent. In the adult rabbits, the repairing rates of bone defect were 50% in the autogenous bone graft group, 40% in the decalcified allograft group, 30% in the tricalcium phosphate group and in the hydroxyapatite group and 42.5% in the control group, respectively. CONCLUSION: In young rabbits, large bone defect can be repaired with vascularized tubulate periosteum graft with or without the combining use of bone filling materials. The bone filling material which will be substituted slowly is disadvantageous to the recovery of bone strength. In adult rabbits, vascularized tubulate periosteum graft combined with bone filling materials can not repair the large bone defect effectively.
ObjectiveTo investigate the immunogenicity of freezing periosteum and bone marrow during allogeneic joint transplantation, and to explore proper pretreatment of allogeneic joint. MethodsThe allogeneic periosteum and bone marrow were harvested from knee joints of 5 New Zealand white rabbits (aged, 6 months; weighing, 2.6-3.0 kg). After gradient cooling, the tissue was cryopreserved for 1 month. The freezing periosteum and bone marrow were grinded to pieces after rewarming to prepare the suspension of periosteum and bone marrow. Eighteen Chinchilla rabbits (aged, 6 months; weighing, 2.1-2.8 kg) were divided into 3 groups randomly:normal saline injection group (group A, n=6), periosteum injection group (group B, n=6), and bone marrow injection group (group C, n=6). The normal saline, periosteum suspension, and bone marrow suspension were injected into the peritoneal cavity in groups A, B, and C, respectively. The concentrations of interleukin 2 (IL-2), IL-6, and tumor necrosis factor α (TNF-α) in serum and the ratio of CD4+ T cell/CD8+ T cell in venous blood were measured before injection, at 1 week and 2 weeks after injection. ResultsThere was no significant difference in the concentration of IL-2 between before and after injection in the same group (P=0.241), and between groups (P=0.055). The concentration of IL-6 after injection was significantly lower than that before injection in the same group (P=0.040), but no significant difference was found between groups (P=0.357). The concentration of TNF-α showed no significant difference between before and after injection in the same group (P=0.925), but the concentration of TNF-α in group B was significantly higher than that in groups A and C (P<0.05). The ratio of CD4+T cell/CD8+T cell of venous blood had no significant difference between before and after operation in the same group (P=0.248), and between groups (P=0.646). ConclusionThe freezing periosteum and bone marrow are lowly immunogenic. In order to decrease the immunogenicity of the joint, preserving the periosteum and removing the marrow cavity are recommended.