| Objective To develop a composite that has a good hemostatic effect in cancellous bone wound bleeding and does not affect bone interface healing.Methods (1) Preparation of the compsite:The appropriate amount of prepared absorbable bone wax and Yunnan Baiyao powder was sufficiently mixed. Then the mixture was injected into a mold. After it was cooled, the composite was produced and then disinfected into standby application.(2) Animal experiment:The40healthy SD rats produced skull bone defect model, and randomly divided into experimental groups and control groups. Each group had20rats. Absorbable bone wax combination Yunnan Baiyao composite were implanted into skull defect in the experimental group, and in the control group, the defect was only filled with bone wax. Rats were killed though excessive anesthesia in four batches at2,4,8,12weeks, each batch has10rats. The bone interface between the implant material and bone skull defect were observed though the following ways:general observation, X-ray examination, histological analysis,immune staining.(3) Clinical application:Selected patients with cervical myelopathy in22cases, including13males and9females。All patients were randomly divided into experimental group (absorbable bone wax composite with Yunnan Baiyao group) control group (Ethicon bone wax group).Each group included11cases. The effect was evaluated.Result (1)2weeks after operation, visible absorption. The material was partly absorbed in experimental group, no significant callus formed in the defect. At4weeks, the material was nearly completely absorbed in experimental group, the defect was covered by soft tissue. At8weeks, the material was completely absorbed and the size in the defect area obviously reduced. While in control group, no materials were absorbed and the defect size remained the same to pre-experiment at any time.12weeks postoperatively, the defect almost healed in the experimental group and the boundary between the defect and normal area was unable to be distinguished. Imaging tests showed that much callus formed in the defect area in experimental group and no obvious callus could found in the control group.(2)At2,4,8,12weeks, ashes of value testing indicated that ashes of value of the experimental group was significantly lower than the control group with statistical significance (P<0.05).(3)Histology shows:At2weeks in the experimental group, the experimental group partially degraded material, can be seen around macrophages, and osteoblasts of bone formation. Seen the residual materials and the control group of connective tissue, and seen the lymphocytes and macrophages.After4weeks,the experimental group of bone defects could be seen class osteocytes and osteoblasts.Control group still remaining material defect, dense fibrous connective tissue,And saw a small amount of trabecular bone and osteoblasts.After8weeks, the defects of the experimental group see a large number of callus filled, unclear boundaries with the surrounding normal bone tissue, cell derangement. The control group defects visible part of the fibrous callus.After12weeks, the experimental group defect filled callus cells arranged in order.(4) After2,4,8,12weeks the experimental group and the control group underwent BMP-2immunohistochemistry, BMP-2positive staining measuring optical density (OD), with t-test, The differences of the two groups had statistical significance (P<0.05).(5) Compared the Absorbable hemostatic bone wax composite Baiyao group (11cases) with Ethicon bone wax group (11cases) in hemostatic effect, hemostasis faster than Ethicon bone wax group, there is a significant difference (P<0.05). The former is significantly less in blood loss and intraoperative blood transfusion than the latter.Conclusion Absorbable bone wax combined with Yunnan Baiyao could stop bleeding quickly in the bone wound, and always has good adhesivity. It does not affect bone interface healing, and could even become a viable alternative to general bone wax in further study... |
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