Artificial dermis combined with skin grafting for the treatment of hand skin and soft tissue defects and exposure of bone and tendon

BACKGROUND The recovery time of hand wounds is long,which can easily result in chronic and refractory wounds,making the wounds unable to be properly repaired.The treatment cycle is long,the cost is high,and it is prone to recurrence and disability.Double layer artificial dermis combined with autologous skin transplantation has been used to repair hypertrophic scars,deep burn wounds,exposed bone and tendon wounds,and post tumor wounds.AIM To investigate the therapeutic efficacy of autologous skin graft transplantation in conjunction with double-layer artificial dermis in treating finger skin wounds that are chronically refractory and soft tissue defects that expose bone and tendon.METHODS Sixty-eight chronic refractory patients with finger skin and soft tissue defects accompanied by bone and tendon exposure who were admitted from July 2021 to June 2022 were included in this study.The observation group was treated with double layer artificial dermis combined with autologous skin graft transplantation(n=49),while the control group was treated with pedicle skin flap transplantation(n=17).The treatment status of the two groups of patients was compared,including the time between surgeries and hospital stay.The survival rate of skin grafts/flaps and postoperative wound infections were evaluated using the Vancouver Scar Scale(VSS)for scar scoring at 6 mo after surgery,as well as the sensory injury grading method and two-point resolution test to assess the recovery of skin sensation at 6 mo.The satisfaction of the two groups of patients was also compared.RESULTS Wound healing time in the observation group was significantly longer than that in the control group(P<0.05,27.92±3.25 d vs 19.68±6.91 d);there was no significant difference in the survival rate of skin grafts/flaps between the two patient groups(P>0.05,95.1±5.0 vs 96.3±5.6).The interval between two surgeries(20.0±4.3 d)and hospital stay(21.0±10.1 d)in the observation group were both significantly shorter than those in the control group(27.5±9.3 d)and(28.4±17.7 d),respectively(P<0.05).In comparison to postoperative infection(23.5%)and subcutaneous hematoma(11.8%)in the control group,these were considerably lower at(10.2%)and(6.1%)in the observation group.When comparing the two patient groups at six months post-surgery,the excellent and good rate of sensory recovery(91.8%)was significantly higher in the observation group than in the control group(76.5%)(P<0.05).There was also no statistically significant difference in two point resolution(P>0.05).The VSS score in the observation group(2.91±1.36)was significantly lower than that in the control group(5.96±1.51),and group satisfaction was significantly higher(P<0.05,90.1±6.3 vs 76.3±5.2).CONCLUSION The combination of artificial dermis and autologous skin grafting for the treatment of hand tendon exposure wounds has a satisfactory therapeutic effect.It is a safe,effective,and easy to operate treatment method,which is worthy of clinical promotion.

Artificial tiger bone powder for improving the quality of life in elderly patients with fracture

Objective: To investigate the application of artificial tiger bone powder on fracture healing time, wrist functional recovery and quality of life (QOL) in elderly patients with distal radius fracture. Methods: The study was a randomised controlled trials performed from January 2015 to December 2016 in a hospital. Elderly patients with distal radius fracture were divided into the treatment and the control groups by the random sealed envelope method. All patients were given splint or plaster fixation after manipulative reduction, and functional exercise, the treatment group was also given artificial tiger bone powder orally (trade name: Jintiange capsule), the control group was given an oral placebo in their appearance and usage identical with the treatment group. Prior to treatment and 6, 12 months after treatment, the wrist function was assessed by range of motion, including flexion-extension, radial-ulnar and pronation-supination, and the QOL was assessed by the Mos 36-item Short Form Health Survey. Each patient's fracture healing time was recorded. Results: Before treatment, there were no significant differences in wrist function and QOL between the two groups. At 6 and 12 months after treatment, the wrist function and QOL in the treatment group were better than those in the control group, the differences were statistically significant (P < 0.05). The fracture healing time in the treatment group was shorter than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion: The early usage of artificial tiger bone powder for elderly patients with distal radius fracture can promote the healing of fracture, recovery of wrist joint function, and ultimately improve the QOL for elderly patients.

The Construction and Investigation of PLGA Artificial Bone by Biomimetic Mineralization

To modify the surface property of poly lactide-co-glycolide （PLGA） by biomimetic mineralization to construct a new kind of artificial bone. PLGA films and 3-diamensional （3-D） porous scaffolds hydrolyzed in alkaline solution were minerilized in SBF for 14 days. The morphology and composition of the mineral grown on PLGA were analyzed with SEM, FTIR and XRD. The porosity of the scaffolds was detected by using the liquid displacement method. The compressive strength of the scaffolds was detected by using a Shimadzu universal mechanic tester. An obvious mineral coating was detected on the surface of films and scaffolds. The main compqnent of the mineral was carbonated hydroxyapatite （HA） similar to the major mineral component of bone tissues. The porosity of the un-mineralized and mineralized porous scaffolds was （84.86±8.52） % and （79.70 ± 7.70） % respectively. The compressive strength was 0. 784±0. 156 N/mm^2 in un-mineralized 3-D porous PLGA and 0. 858±0. 145 N/mm^2 in mineralized 3-D porous PLGA. There were no significant differences between the mineralized and un-mineralized scaffolds （P〉0, 05） in porosity and biomechanics. Biomimetic mineralization is a suitable method to construct artificial bone.

Macrophages in Degradation of Calcium Phosphate Compound Artificial Bone： An in vitro Study

The isolated mice peritoneal macrophages in degradation of calcium phosphate compound artificial bone - collagen/hydroxylapatite (CHA). hydroxylapatite (HA), beta-tricalcium phosphate (TCP) ceramics, have been studied by use of both Ca++, P concentration assay in cultured supernatant and scanning electron microscopy (SEM). The solubility of Ca++ . composition of materials increased more significantly when macrophages were inoculated than when macrophages were not seeded (P< 0.001), and it was shown that the ground materials were wrapped and phagocytized or resorbed extracellularly by macrophages under SEM, suggesting that macrophages could mediate the degradation of calcium phosphate compound artificial bone by phagocytizing and/or degrading extracellularly.

Autotransplantation of Teeth and the Reconstruction of Alveolar Bone Defects Using Artificial Bone: A Case Series

The aim of this study was to evaluate the outcome of autotransplantation or replantation of extracted teeth combining with reconstruction of alveolar bone defects in use of artificial bone grafting clinically and radiographically. This article presents a more useful and convenient method for repairing tooth and reconstruction of bone defecting with some interesting cases. Eleven patients (seven men and four women) in whom teeth with complete root formation were extracted and autotransplanted, the bone of receiving area was Insufficient. All transplanted teeth were stabilized with orthodontic wire and resin or 4-0 silk sutures;at the same time, artificial bone powder was filled. In 11 cases, the missing teeth were restored by autogenous teeth and the alveolar bone defect was restored by artificial bone, the improvement in the radiographic and clinical parameters strongly suggest that it may be a useful therapy to solve the problem of the missing teeth and alveolar bone insufficiency simultaneously. However, the risk of replacement root resorption remains.

Experimental Study on Polymer Artificial Bone with HA Coated and Fiber Liners

Layers of ante-polymerized PMMA （ Polymethylmethacrylate ） ore manually smeared on both sides of carbon fiber and polyester fiber to a certain thickness. It was pre-solidified, stripped and cut for sterilization. Based on the results of a series of experiments, HA coated artificial bone is considered to be a non-senshizing, non- irritant, and non- toxic biomaterial for medical applications. The artificial bone has excellent mechanical and biological property. And it conforms to the national standard requirement. Safety analysis guarantees h a prosperous future of clinical application.

Development of an Artificial Finger-Like Knee Loading Device to Promote Bone Health

This study presents the development of an innovative artificial finger-like device that provides position specific mechanical loads at the end of the long bone and induces mechanotransduction in bone. Bone cells such as osteoblasts are the mechanosensitive cells that regulate bone remodelling. When they receive gentle, periodic mechanical loads, new bone formation is promoted. The proposed device is an under-actuated multi-fingered artificial hand with 4 fingers, each having two phalanges. These fingers are connected by mechanical linkages and operated by a worm gearing mechanism. With the help of 3D printing technology, a prototype device was built mostly using plastic materials. The experimental validation results show that the device is capable of generating necessary forces at the desired frequencies, which are suitable for the stimulation of bone cells and the promotion of bone formation. It is recommended that the device be tested in a clinical study for confirming its safety and efficacy with patients.

Mechanical Properties of a Vacuum-Sintered Apatite Body for Use as Artificial Bone

Regenerative artificial bone material and bone parts were fabricated using vacuum-sintered bodies of a “titanium medical apatite (TMA?)” that is formed by chemically connecting Ti oxide molecules to the reactive [Ca10 (PO4 )6 ] group of hydroxyapatite (HAp). Sintering at temperatures of 1273 - 1773 K caused this TMA sintered bodies to recrystallize and form a varying mix of α-TCP (tricalcium phosphate), β-TCP and Perovskite-CaTiO3 phases. The Perovskite crystals proved to be quite stable and hard, forming a uniform distribution of similarly sized fibers in all directions under vacuum sintering, but an irregular distribution and size when sintered in the presence of oxygen. Complete recrystallization was achieved by vacuum sintering at temperatures in excess of 1473 K. In particular, TMA vacuum-sintered bodies at 1573 K are given the maximum value;a Vickers hardness of 400, a bending strength of 43 MPa, a compressive strength of 270 MPa and a density of approximately 2300 kg/m3 was achieved that closely corresponds to that of compact bone or a tooth. As these TMA bodies could also be cut into various forms, they are considered a promising biomaterial for use as artificial bone in the regeneration of natural bone, or to provide reinforcement of bone junctions in dental and orthopedic surgery.

An investigation on plasma spraying with artificial bone powder and bonding characteristics of coating

Artificial bone powder is satisfactorily deposited onto the surface of synthetic metal arthrosis(Co-Cr-Mo) with plasma spraying process. Factors influencing the quality of coating are investigated. Bond of artificial bone powder coating sprayed with different parameters is measured. and the coatings are anlyzed with metallographic examination and electron probe analysis. Experiments show that artificial bone powder coating sprayed onto synthetic metal arthrosis with satisfactory bond strength can be obtained by manipulating plasma spraying.

Study on the physical properties and chemical compositions of artificially synthesized coral hydroxyl apatite (CHA) bone

To develop synthesized coralline hydroxyl apatite (CHA) bone graftsubstitute and measure its physical and chemical characteristics. Methods: The CHA bone graft substitute was synthesized from natural mineral―coralline through hydrothermal exchange process. This process was designed and developed independently by the authors. Its physical and chemical characteristics have been determined and studied using various techniques including Scanning Electron Microscopy (SEM), electron microscope image processing, scanning electron microscope energy spectrography; chemical analysis, ICP-AES, X-ray diffraction, etc. Clinical trials have been conducted. Results: Independently developed CHA bone graft-substitute is white in color; its porosity is 25.87%–53.58%, which is approximate to that of human bones and original coral. It is larger than 3–4 in hardness by Mohs hardness scale and the compressive strength ranges from 4.87 to 12.31 MPa. The chemical compositions of the CHA are 53.13%–64.09% CaO and 35.52%–46.48% P2O5. CaO/P2O5 is 1.143–1.804. ICP-AES analysis detected twenty-four trace elements including Pb, Co, Ni, Ba, Mn, Cr, Th, V, Cu, Ti, K, Mo, Zn, Mg, Nb, Be, Sc, Al, Sr, Na, Li, etc. Ca, P, K, Na, Al and Sr are relatively high while the rest are less than n–n×10-6, which is acceptable by human body. The REE level in the CHA bone measured by ICP-MS is 1.433×10-9–2.212×10-9, which is within the acceptable range for human beings. Conclusions: The process of synthesized CHA bone graft-substitute is an innovated independently developed method and concept. Its color, porosity and chemical composition are similar to those of human bones; therefore it has very good biocompatibility and excellent conductivity. Sixty clinical cases have proved that CHA bone graft-substitute has a strong bone-forming ability, no toxicity, no side effect, and better sacralization. It is a fine substitute for bone transplantation.

Fractional Order Nonlinear Bone Remodeling Dynamics Using the Supervised Neural Network

This study aims to solve the nonlinear fractional-order mathematical model(FOMM)by using the normal and dysregulated bone remodeling of themyeloma bone disease(MBD).For themore precise performance of the model,fractional-order derivatives have been used to solve the disease model numerically.The FOMM is preliminarily designed to focus on the critical interactions between bone resorption or osteoclasts(OC)and bone formation or osteoblasts(OB).The connections of OC and OB are represented by a nonlinear differential system based on the cellular components,which depict stable fluctuation in the usual bone case and unstable fluctuation through the MBD.Untreated myeloma causes by increasing the OC and reducing the osteoblasts,resulting in net bone waste the tumor growth.The solutions of the FOMM will be provided by using the stochastic framework based on the Levenberg-Marquardt backpropagation(LVMBP)neural networks(NN),i.e.,LVMBPNN.The mathematical performances of three variations of the fractional-order derivative based on the nonlinear disease model using the LVMPNN.The static structural performances are 82%for investigation and 9%for both learning and certification.The performances of the LVMBPNN are authenticated by using the results of the Adams-Bashforth-Moulton mechanism.To accomplish the capability,steadiness,accuracy,and ability of the LVMBPNN,the performances of the error histograms(EHs),mean square error(MSE),recurrence,and state transitions(STs)will be provided.

基于深度神经网络的机会性CT骨质疏松筛查和骨密度预测研究

目的建立并评价基于机会性CT检查的骨质疏松筛查分类和骨密度值预测的深度学习神经网络模型。方法以定量计算机断层扫描(Quantitative Computed Tomography,QCT)骨密度测定为标准,将199例机会性CT检查数据用于建立密集卷积网络的深度学习神经网络的骨密度二分类模型和骨密度值预测回归模型,以五折交叉验证和随机分组的方法进行测试,并以来自不同设备的42例机会性CT检查病例进行独立测试,计算和评价模型的性能参数。结果受试者工作特征(Receiver Operating Characteristic,ROC)曲线显示:骨密度二分类模型的测试集和独立测试集的ROC曲线下面积均值分别为0.974、0.938,测试集的F1得分、召回率、精准度、特异性、准确度均≥0.91,独立测试集的上述评价参数均>0.862。在训练集、测试集和独立测试集上,骨密度值预测回归模型的平均绝对误差分别为1.42、8.52和13.89,均方根误差分别为1.93、10.80、20.36,预测值与QCT骨密度值呈极强正相关。结论基于机会性CT检查的深度学习神经网络模型对骨密度正常和降低具有较强的分类能力,且可较准确地预测骨密度值,避免多余的辐射风险,减少时间、经济消耗,有效扩大骨质疏松筛查的范围。

慢性化脓性中耳炎患者行鼓室成形术中植入钛人工听骨链在降低听力阈值及改善听力状态中的价值

目的探讨鼓室成形术中植入钛人工听骨链降低慢性化脓性中耳炎患者听力阈值、改善听力状态的效果。方法选取河南科技大学第二附属医院耳鼻咽喉科2019年1月至2022年1月80例慢性化脓性中耳炎患者作为研究对象,随机数字表法分为对照组(40例)和植入组(40例)。对照组采取单纯鼓室成形术,进行自体听骨链重建,未植入钛人工听骨链,植入组患者在行鼓室成形术中植入钛人工听骨链,对比两组术前术后纯音听力重建水平,听力状态改善效果及并发症、复发率。结果植入组听力改善有效率高于对照组(P<0.05);术后听力阈值均较术前降低,且植入组气导听力阈值、气骨导差低于对照组(P<0.05),骨导听力阈值组间差异无统计学意义(P>0.05);两组术后并发症发生率、复发率差异无统计学意义(P>0.05)。结论在行鼓室成形术中植入钛人工听骨链能有效提升慢性化脓性中耳炎患者的听力水平,降低气导听力阈值及气骨导差,且不增加术后并发症及疾病复发风险,效果确切,值得临床应用及进一步研究。

AI辅助下医生对骨龄评估的效能提升

目的:比较放射科医师在人工智能(artificial intelligence,AI)骨龄评价系统辅助前后对儿童左手X线摄影的骨龄评估效能。方法:回顾性分析在我院就诊的300例患儿左手X线平片。骨龄评测采用中华-05骨龄评定标准,两位低年资医师(医师1及医师2)分别在有无AI辅助下分别记录左手各骨质的骨龄发育等级,并记录时间。以两位高年资放射医师分别在有无AI系统辅助下评估结果的均值为参考标准,计算骨龄测评的准确率、均方根误差(root mean square error,RMSE)、测评时间。结果:无AI辅助下,医师1及医师2分析差值在6个月及12个月诊断准确率分别为77.3%和83%、88.7%和93.7%,RMSE值分别为9和8。在AI辅助下,医师1及医师2分析差值在6个月及12个月诊断准确率分别为88.7%和90.3%、97%和97.3%,RMSE值分别为6和6;差异均具有统计学意义。无AI辅助下,实验组医师和标准组医师,平均评测耗时分别为124.79 s和89.13 s;有AI辅助下实验组医师和标准组医师,平均评测耗时分别为86.10 s和63.87 s,在AI辅助下平均评测耗时均有较大幅度减少(P=0.000)。结论:AI辅助骨龄评价系统可显著提高医师工作效率,减少阅片时间。

人工智能与专家Greulich-Pyle图谱法骨龄评估的一致性比较

背景:人工智能骨龄评估已成为研究热点,国内外研究表明人工智能技术在医学影像领域发展迅速,为更准确快速的对骨龄进行评估提供了可能。目的:探讨人工智能Greulich-Pyle(智能GP)图谱骨龄评估系统与人工专家Greulich-Pyle(专家GP)图谱评估结果的一致性。方法:骨龄片采样对象为6-15岁儿童青少年,其中男672人,女650人。同一张骨龄片分别用智能GP与专家GP读出骨龄值。智能GP读片结果的准确性采用差值绝对值反映;骨龄结果一致性采用Pearson相关、Bland-Altamn分布图;评估一致性采用Kappa检验。结果与结论:①智能GP骨龄与专家GP骨龄差值95%置信区间男女总体分别为0.39岁(0.37-0.41岁),0.32岁(0.29-0.34岁),智能GP骨龄与专家GP骨龄差值Bland-Altamn偏差男女分别为(-0.096±0.482)岁,(0.014±0.415)岁;②智能GP骨龄与专家GP骨龄男女相关结果分别为r=0.991,r=0.992,P<0.0001;男女所有年龄段差值中位数均在0.5岁之内;Kappa检验值除男子9岁年龄段,其他各年龄段男女均大于0.4,总体Kappa值男女分别为0.603,0.659;③结果表明:在6-15岁儿童青少年范围内,人工智能GP图谱骨龄值与专家评估结果有高度一致性。

弹性髓内钉固定技术联合经皮穿刺人工骨注射治疗单纯性骨囊肿的应用研究

目的:探究弹性髓内钉固定技术联合经皮穿刺人工骨注射治疗单纯性骨囊肿的效果。方法:纳入萍乡市人民医院儿外科于2015年7月—2020年7月经病理学检查确诊的64例单纯性骨囊肿患儿作为研究对象。采用随机数字表法将患儿分为联合组与对照组,其中对照组采用经皮穿刺人工骨注射+外固定+甲泼尼龙琥珀酸钠治疗,在此基础上联合组加弹性髓内钉固定技术治疗。所有患儿均需给予6个月连续随访。比较两组临床疗效、肌肉骨骼肿瘤协会(MSTS)评分、炎症因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、手术时间、术中出血量、住院时间;记录两组住院期间不良反应发生情况。结果:研究期间,联合组因未完成随访脱落1例,因改用其他治疗方案脱落1例,对照组因未完成后续随访脱落2例。联合组30例,对照组30例。联合组临床总有效率明显高于对照组,差异有统计学意义(P<0.05);术后1、3个月,两组MSTS评分较术前均增高,且联合组MSTS评分均高于对照组,差异均有统计学意义(P<0.05)。术后第7天,联合组的IL-6、TNF-α均明显低于对照组,差异均有统计学意义(P<0.05)。两组术中出血量比较,差异无统计学意义(P>0.05)。联合组住院时间明显短于对照组,手术时间明显长于对照组,差异均有统计学意义(P<0.05)。两组患儿均未出现不良反应。结论:弹性髓内钉固定技术联合经皮穿刺人工骨注射治疗可改善单纯性骨囊肿患儿肢体功能、降低炎症因子水平、缩短住院时间。

人工智能辅助机会性测量腰椎骨密度研究:与定量CT比较

目的本研究旨在比较人工智能(AI)定量CT辅助诊断系统与定量CT(QCT)在胸部低剂量CT检查时机会性测量腰椎骨密度的一致性。方法选择2022年6月至2022年12月在我院因各种临床适应症行胸部低剂量CT检查的受检者作为研究对象,应用AI定量CT辅助诊断系统与QCT分别在胸部低剂量CT图像上测量受检者腰椎平均体积骨密度(vBMD),绘制散点图、Bland-Altman图检验二者的关系,计算Pearson相关系数评价其一致性。结果AI定量CT辅助诊断系统测量vBMD平均值为116.38±36.07mg/cm^(3),QCT测量vBMD平均值为115.60±38.07mg/cm^(3),线性回归分析与Bland-Altman分析显示二者对腰椎骨密度的测量具有良好的一致性,二者呈显著正相关(相关系数r为0.977)。不同性别中,AI定量CT辅助诊断系统与QCT对腰椎骨密度的测量亦呈显著正相关。结论AI定量CT辅助诊断系统与QCT基于胸部低剂量CT机会性测量腰椎vBMD具有高度一致性。

复合人工骨在上颌骨重建中的应用

目的 研究医用树脂和羟基磷灰石复合型(EH)人工骨材料在个性化重建上颌骨缺损中的应用效果。方法 本研究入组郑州大学第一附属医院2021年1月至2022年10月收治的7例在数字化技术引导下使用EH复合型人工骨接受上颌骨重建的患者,并对其手术前后的基本资料、影像学资料及相关的临床资料进行分析。年龄27~66岁,中位年龄49岁。术后随访时间为5~22个月。结果 6例患者未发生任何术后并发症,对外观和功能结果满意。1例患者在术后第7个月时因为人工骨的暴露并反复感染而最终选择取出该植入物。结论 EH复合型人工骨可以修复上颌骨不同程度的缺损,重建上颌骨的形状。

Bio-oss骨代材料与Bio-gide膜治疗重度牙周病疗效评估

目的观察联合应用Bio-oss骨代材料和Bio-gide胶原膜行引导骨组织再生术治疗重度牙周炎的疗效。方法将46例重度牙周病患者随机分为实验组和对照组,各23例,实验组39颗患牙行Bio-oss、Bio-gide引导性组织再生术,对照组32颗患牙行常规翻瓣术刮治。分别记录术前,术后12个月患牙周牙探诊深度(periodontal probing depth,PPD)、附着丧失(attachment loss,AL)、龈沟出血指数(sulcus bleeding index,SBI)、牙松动度(teeth mobility,TM)及牙槽骨高度(alveolar bone height,AH)。结果与术前相比两组术后PPD、AL、SBI、TM均明显减少,且有显著性差异,实验组疗效优于对照组。X线根尖片显示,实验组骨缺损区有新骨形成,AH增加;对照组未见新骨形成,AH无明显改善。而且实验组骨密度增强较对照组明显增多(P<0.05)。结论牙周翻瓣术后植入Bio-oss骨代材料,联合应用Bio-gide可吸收胶原膜治疗重度牙周病能明显改善临床指标,且疗效优于单纯翻瓣刮治术。