| Background and Objective:Osteonecrosis of femoral head is a multifactorial induced and progressive disease, involving disruption to the vascular supply to the femoral head, resulting in surface collapse of articular and osteoarthritis, eventual total hip arthroplasties. Clinically the pain may be minimal at onset, but if no active intervention is done it may worsen gradually, affecting the activities of daily living. Therefore, early diagnosis and prevention of progressive development is particularly critical. According to the progress of the avascular necrosis of the femoral head, the corresponding treatment measures are taken, including weight restrictions, core decompression, osteotomy, bone and implant materials transplantation. Along with progress of bone tissue engineering and the research of bone substitute material, β-Tricalcium Phosphate has been deeply studied with good biocompatibility, biodegradability and a good degradation, So, it has been widely used in tissue engineering. The material properties of the surface for adhesion and proliferation of bone cells, namely, good bone conductibility; also can effectively stimulate the formation of new bone, namely excellent bone induced, also can give recruited bone marrow stromal stem cells to a specific location to induce bone formation. Isolation and culture of bone marrow stem cells and osteoblasts are the basis of cell transplantation in bone tissue engineering. Isolating and culturing Bone marrow stem cells and osteoblasts are the foundation of transplantation in bone tissue engineer. To maintain a high alkaline phosphatase activity and in vitro calcification ability are two characteristics of bone cell proliferation and differentiation. Porous tricalcium phosphate (TCP) artificial bioceramic materials can be used as a good three-dimensional environment in vitro for osteoblasts growth and proliferation, while at the same time in vivo implantation it can also fill the bone defect. The efficacy of bone repairmen can be monitor by the key factors, VEGF and BMP-1, which are related with the bone differentiation and repair. Currently, there are some kind of animal models of Osteonecrosis of femoral head, such as steroid-induced or avascular necrosis ONFH. In our experiment, based on the co-culture of osteoblast in vitro, we explore the in vivo efficacy of porous bioceramic Beta-tricalium phosphate for therapy of osteonescrosis in rabbit ONFH model.Methods:1) Set up the method to isolate and culture the osteoblasts from femoral head of 2-day rabbit; detect the cell viability of fourth and tenth passage of osteoblasts by MTT; evaluate the ALP level and Alizarin red S staining with fourth passage osteoblasts.2) Co-culture of porous bioceramic Beta-tricalium phosphate and osteoblasts, detect the cell viability by MTT, the ALP activity, and the expression of VEGF and BMP2.3) Set up the necrosis of femoral head model in rabbit; transplant osteoblasts and porous tricalcium phosphate artificial bioceramic material composite, porous tricalcium phosphate artificial bioceramic materials only and traditional bone cement into the necrosis area of rabbit femoral head, and observe the curative effect and detect the expression of VEGF and BMP2.Results:1) The osteoblasts (4th and 10th) were successfully isolated and cultured. The Logarithmic growth period was at 4th day. There was no significant different between the two generation.2) Porous tricalcium phosphate artificial bioceramic materials were pre-coated on the plate whereosteoblast was cultured. There were no any differences on cell viability during the 7-day culturing. The expression of VEGF and BMP2 was increased when osteoblasts were cultured with porous tricalcium phosphate artificial bioceramic materials.3) The osteonecrosis of femoral head model has been set up successfully. Porous tricalcium phosphate artificial bioceramic materials showed the better effect to promote the reparation of femoral head structure.Conclusion:1) The methodology to isolate and culture the osteoblasts has been set up;2) The osteonecrosis of femoral head model in rabbit was set up successfully;3) Porous tricalcium phosphate artificial bioceramic materials can improve the repair of the necrosis area in animal study;Background and Objective:when necrosis of the femoral head, it is supposed to cause high pressure in femoral head cavity, to increase resistance of blood circulation in bone, to aggravate avascular, and become a leading cause of cell death in femoral head. Core decompression can have many different schemes and methods in the implementation process. In the traditional decompression,8-10mm wide ring or hollow drill is used to bring small loss for patients, but the disadvantage is difficult to clear the necrosis. The Enlarge Undercutting Core Decompression can effectively remove the necrosis of femoral bones, but will loss of femoral head surface structure. In our experiment, based on the co-culture of osteoblast in vitro and therapy of osteonescrosis in rabbit ONFH model, we explore the clinical efficacy of combining porous bioceramic Beta-tricalium phosphate with enlarge undercutting core decompression for patients with early stage Osteonescrosis of Femoral Head.Methods:Clinical study:100 volunteers diagnosed with Ⅰ/Ⅱ osteonecrosis were enrolled and divided into three group. One group was operated with traditional core decompression(8mm drill) combined with autogenous iliac bone graft (n=32), second group was operated with enlarge undercutting core decompression combined with autogenous iliac bone graft (n=34) and third group was operated with enlarge undercutting core decompression combined with porous tricalcium phosphate artificial bioceramic material (n=34). Then observe the efficacy of different operation at the indicated time point.Results:The data from clinical study showed the enlarge undercutting core decompression combined with porous tricalcium phosphate artificial bioceramic materials delivered the excellent performance to repair the necrosis. The score from hip function was increased to 80% in traditional core decompression operation,86% in enlarge undercutting core decompression combined with TCP, and 88% in enlarge undercutting core decompression combined with autogenous iliac bone graft. The score from x-ray were 79%,85% and 90%, respectively.Conclusion:1) Enlarge undercutting core decompression combined with porous tricalcium phosphate artificial bioceramic materials has more powerful effect to cure ONFH and show the promising therapy in clinical study.2) The equipment for enlarge undercutting core decompression has the characteristics of easy-operating, flexible and time saving. What’s important, the equipment can clean the necrosis more thoroughly than the traditional equipment. It can be popularized and used widely. |
