Epästabiilien ja osoteoporoottisten trokanteerimurtumien korjausleikkauksissa on PMMA osoitautunut hyödylliseksi iäkkäillä potilailla, muta haittana on ollut aineen inerttisyys ja biologinen hajoamattomuus ja todennäköinen pinttynyt pysyminen reisiluun päässä jatkuvasti. Tämä pinttyneisyys saattoi vaikuttaa luun uudelleenmuodostumiskykyyn vaikuttamalla luun aineenvaihduntaan ja luutrabekkelit saattoivat heikentyä mekaanisen miljöön muutoksesta. Tämän takia DHS:n vahvistamista PMMA-luusementillä tulisi käyttää vain iäkkäille osteoporoosia poteville Guptan artikkelin mukaan. Guptan työryhmä oli kehittnyt välineen, "sementtipyssyn",jolla vahvistettiin DHS- menetelmä osteoporoottisen trokantteerimurtumankorjauksessa injisoimalla PMMA-sementtiä reisiluun päähän. He tutkivat 64 potilaan ryhmän. Murtumien luokittelu oli tehty AO luokituksella, keskimääräinen ikä oli 72 v ( 60-94).https://link.springer.com/article/10.4103/0019-5413.104193
AO tyyppi (https://radiopaedia.org/articles/aoota-classification-of-proximal-femoral-fractures)
31 A2.1 tämä on stabiili 3 fraktuurapalan pertrokantterinen murtuma ( kuten ryhmä 31 A1, jossa on yksittäien murtumalinja ja 2 murtumapalaa, mutta ryhmä 3- A2 omaa kolmannen murumapalan)
Muut 31- A2 ryhmästä ovat epästabiileja:
31-A2.2 (29 potilasta), stabiili
31 -A2.3 (17 potilasta)
Todelliset intertrokantteriset murtumat, murtumalinja torkantterien välissä . Instabiuliteettiongelmaa reduktion jälkeen.
31-A3.1 ( viisi potilasta)
31-A3.2 (3 potilasta),
31 -A3.3 ( kaksi potilasta)
uusia artikkeleita: 2021 : PMMA luusementille käyttöä luumaligniteeteissa .
PMMA Bone Cement in Interventional Oncology.
Crit Rev Biomed Eng. 2021;49(1):35-50. doi: 10.1615/CritRevBiomedEng.2021037591.
PMID: 34347986
Polymethylmethacrylate (PMMA) bone cement is increasingly being used for percutaneous minimally invasive treatments of patients suffering from bone malignancies. ...PMMA interacts with the surrounding cancellous bone through mechanical in …
A novel antibacterial zirconia-containing PMMA bone cement.
J Mech Behav Biomed Mater. 2022 May;129:105135. doi: 10.1016/j.jmbbm.2022.105135. Epub 2022 Feb 26.
PMID: 35279449
A non-leaching antibacterial bone cement has been developed and
evaluated. Chlorine- and bromine-containing furanone derivatives were
synthesized and covalently coated onto the surface of zirconia filler
particles, followed by mixing into a conventional poly(methyl
methacrylate) bone cement. Flexural strength and bacterial viability
were used to evaluate the modified cements. Effects of coated
antibacterial moiety content, coated zirconia loading and halogen on
furanone were investigated. Results showed that the experimental cement
showed significant enhanced antibacterial function against
bone-associated Gram-positive Staphylococcus aureus as well as
Gram-negative Pseudomonas aeruginosa, as compared to commercial PMMA
cement. …
PMMA bone cement containing long releasing silica-based chlorhexidine nanocarriers.
PLoS One. 2021 Sep 29;16(9):e0257947. doi: 10.1371/journal.pone.0257947. eCollection 2021.
PMID: 34587194
Free PMC article.
Prosthetic joint infections (PJI) are still an extremely concerning
eventuality after joint replacement surgery; growing antibiotic
resistance is also limiting the prophylactic and treatment options.
Chlorhexidine (a widely used topical non-antibiotic antimicrobial
compound) coatings on silica nanoparticles capable of prolonged drug
release have been successfully developed and characterised. Such
nanocarriers were incorporated into commercial formulation PMMA bone
cement (Cemex), without adversely affecting the mechanical performance.
Moreover, the bone cement containing the developed nanocarriers showed
superior antimicrobial activity against different bacterial species
encountered in PJI, including clinical isolates already resistant to
gentamicin. Cytocompatibility tests also showed non inferior performance
of the bone cements containing chlorhexidine releasing silica
nanocarriers to the equivalent commercial formulation.
A PMMA bone cement with improved antibacterial function and flexural strength.
J Biomater Sci Polym Ed. 2022 Aug;33(11):1398-1414. doi: 10.1080/09205063.2022.2056943. Epub 2022 Mar 26.
PMID: 35321628
A novel non-leaching antibacterial bone cement has been developed and
evaluated. An antibacterial furanone derivative was synthesized and
covalently coated onto the surface of alumina filler particles, followed
by mixing into a conventional poly(methyl methacrylate) bone cement.
Flexural strength and bacterial viability were used to evaluate the
modified cements. Effects of coated antibacterial moiety content, coated
alumina filler particle size and loading were investigated.
Bioactive, Ion-Releasing PMMA Bone Cement Filled with Functional Graphenic Materials.
Adv Healthc Mater. 2021 Jan;10(2):e2001189. doi: 10.1002/adhm.202001189. Epub 2020 Dec 16. Graphene oxide and functionalized graphenic materials (FGMs) have
promise as platforms for imparting programmable bioactivity to
poly(methyl methacrylate) (PMMA)-based bone cement. To date, however,
graphenic fillers have only been feasible in PMMA cements at extremely
low loadings, limiting the bioactive effects. At higher loadings,
graphenic fillers decrease cement strength by aggregating and
interfering with curing process. Here, these challenges are addressed by
combining bioactive FGM fillers with a custom cement formulation. These
cements contain an order of magnitude more graphenic filler than
previous reports. Even at 1 wt% FGM, these cements have compressive
strengths of 78- 88 MPa, flexural strengths of 74-81 MPa, and flexural
stiffnesses of 1.8-1.9 GPa, surpassing the ASTM requirements for bone
cement and competing with traditional PMMA cement. Further, by utilizing
designer FGMs with programmed bioactivity, these cements demonstrate
controlled release of osteogenic calcium ions (releasing a total of 5 ± 2
µmol of Ca2+ per gram of cement over 28 d) and stimulate a 290%
increase in expression of alkaline phosphatase in human mesenchymal stem
cells in vitro. Also, design criteria are described to guide creation
of future generations of bone cements that utilize FGMs as platforms to
achieve dynamic biological activity.
Fabrication of the antibiotic-releasing gelatin/PMMA bone cement.
Colloids Surf B Biointerfaces. 2019 Nov 1;183:110448. doi: 10.1016/j.colsurfb.2019.110448. Epub 2019 Aug 21.
PMID: 31472387
High mechanical property especially the exorbitant elastic modulus is
the common complication of the clinical polymethylmethacrylate (PMMA)
bone cement which will generate the fracture of the adjacent bone and
even aseptic loosening, other side effects including excess thermal
temperature and low efficiency of the drug release bother the
development of the PMMA bone cement. The present study aims to
investigate the optimum dosage of gelatin as the porogen, which reduced
the elastic modulus of the bone cement to the relatively close level of
the cancellous bone. Meanwhile, better antibiotic release profile was
introduced by enhancing the specific surface area and interconnectivity
than the neat PMMA bone cement. Compared to the PMMA bone cement, the
mechanical and thermal property was successfully reduced by the porous
structure, the component with 200-400 μm gelatin has the better porosity
which resulted in the increasing drug release amount and rate than that
of the PMMA bone cement. Furthermore, data analysis and fitting curve
could guide experiments, in turn, to obtain the PMMA bone cement with
specific requirements of the mechanical properties by the addition of
gelatin as the pore-forming agent, and in some cases for predictive
purposes, to estimate how a change of gelatin may affect the porosity,
mechanical properties, and drug release profiles.
PMMA Bone Cement Composite Functions as an Adjuvant Chemotherapeutic Platform for Localized and Multi-Window Release during Bone Reconstruction.
Macromol Biosci. 2022 May;22(5):e2100415. doi: 10.1002/mabi.202100415. Epub 2022 Feb 19.
PMID: 35113499
Primary bone tumor resections often result in critical size defects,
which then necessitate challenging clinical management approaches to
reconstruct. One such intervention is the Masquelet technique, in which
poly(methyl methacrylate) (PMMA) bone cement is placed as a spacer
temporarily while adjuvant chemotherapeutics are administered
systemically. The spacer is later removed and replaced with bone
autograft. Local recurrence remains an important and devastating
problem, therefore, a system capable of locally delivering
chemotherapeutics will present unique advantages. In this work, a
refillable chemotherapeutic (doxorubicin, DOX) delivery platform
comprised of PMMA bone cement and insoluble γ-cyclodextrin (γ-CD)
polymeric microparticles is developed and explored towards application
as a temporary adjuvant chemotherapeutic spacer. The system is
characterized for porosity, mechanical strength, DOX filling and
refilling capacity, elution kinetics, and cytotoxicity. Since residual
chemotherapeutics can adversely impact bone healing, it is important
that virtually all DOX be released from material. Composites containing
15 wt% γ-CD microparticles demonstrate 100% DOX release within 100 days,
whereas only 6% DOX is liberated from PMMA with free DOX over same
period. Refillable properties of PMMA composite system may find utility
for customizing dosing regimens. Findings suggest that PMMA composites
can have potential as chemotherapeutic delivery platforms to assist in
bone reconstruction.
Novel Tuning of PMMA Orthopedic Bone Cement Using TBB Initiator: Effect of Bone Cement Extracts on Bioactivity of Osteoblasts and Osteoclasts.
Cells. 2022 Dec 10;11(24):3999. doi: 10.3390/cells11243999.
PMID: 36552761
Free PMC article.
However, toxic complications caused by bone cement are a clinically significant problem. Poly (methyl methacrylate) tri-n-butylborane (PMMA-TBB), a newly developed material containing TBB as a polymerization initiator, was found to be more biocompatibl …
Biological Fixation of Bioactive Bone Cement in Vertebroplasty: The First Clinical Investigation of Borosilicate Glass (BSG) Reinforced PMMA Bone Cement.
ACS Appl Mater Interfaces. 2022 Nov 23;14(46):51711-51727. doi: 10.1021/acsami.2c15250. Epub 2022 Nov 10.
PMID: 36354323
PMMA bone cement has been clinically used for decades in vertebroplasty
due to its high mechanical strength and satisfactory injectability.
However, the interface between bone and PMMA is fragile and more prone
to refracture in situ because PMMA lacks a proper biological
response from the host bone with minimal bone integration and dense
fibrous tissue formation. Here, we modified PMMA by incoporating
borosilicate glass (BSG) with a dual glass network of [BO3] and [SiO4],
which spontaneously modulates immunity and osteogenesis. In particular,
the BSG modified PMMA bone cement (abbreviated as BSG/PMMA cement)
provided an alkaline microenvironment that spontaneously balanced the
activities between osteoclasts and osteoblasts. Furthermore, the trace
elements released from the BSGs enhanced the osteogenesis to strengthen
the interface between the host bone and the implant. This study shows
the first clinical case after implantation of BSG/PMMA for three months
using the dual-energy CT, which found apatite nucleation around PMMA
instead of fibrous tissues, indicating the biological interface was
formed. Therefore, BSG/PMMA is promising as a biomaterial in
vertebroplasty, overcoming the drawback of PMMA by improving the
biological response from the host bone.
Biomed Mater. 2021 Aug 19;16(5). doi: 10.1088/1748-605X/ac1ab5.
PMID: 34410226
Poly(methyl methacrylate) (PMMA) has been widely used in orthopedic
applications, but bone ingrowth and toxic monomer release are drawback
of this material. Particle reinforcement with osteoconductive
substitute, such as calcium sulfate (CaSO4), is one of the
solutions used to modify PMMA bone cement. The current study
investigated the mechanical, chemical and biological properties of CaSO4-augmented
bone cement. Mechanical strength was measured by a material testing
machine. The concentration of methyl methacrylate (MMA) monomer from the
various formulations of PMMA mixed with CaSO4was measured by
ultra-performance liquid chromatography (UPLC). CCK-8 assay and ALP
assay were performed to evaluate cytotoxicity of released MMA monomer
and cell differentiation. The attachment of cells to CaSO4-augmented
bone cement discs was observed by confocal and scanning electron
microscopy, and surface topography was also evaluated by atomic force
microscopy. The results revealed that increased CaSO4weight
ratios led to compromised mechanical strength and increased MMA monomer
release. Cell density and cell differentiation on CaSO4-augmented bone cement discs were decreased at CaSO4weight
ratios above 10%. In addition, the presence of micropores on the
surface and surface roughness were both increased for PMMA composite
discs containing higher levels of CaSO4. These results demonstrated that fewer MC3T3-E1 cells on the surface of CaSO4-PMMA
composites was correlated to increased MMA monomer release, micropore
number and surface roughness. In summary, the augmentation of a higher
proportion of CaSO4(>10 wt. %) to PMMA did not promote the biological properties of traditional PMMA bone cement.
Inga kommentarer:
Skicka en kommentar