gli innesti omoplastici morcellizzati nelle gravi perdite di sostanza

Homologous morcelized defatted
bone graft additionated with
antibiotic and PMMA “in vivo”:
preliminary histologic evaluation.
G. Gualdrini.
Rizzoli Institute
VII Department of Orthopaedic and Traumatology
Orthopaedic Clinic - University of Bologna - Italy
Director prof. Armando Giunti
1947 De Grood M.
1980 McCollum D.E.
1982 Roffmann M.
1984 Sloof T.
1985 Ling R.
1987 Oakeshott R.
1991 Oliver H.
1993 Gie GA.
1994 Schreurs B.W.
1996
Hovelius e Ullmark
“Impacted morselized allograft and cement for
revision total knee arthroplasty”
Acta Orthop. Scand. 1996
1998
Bone Bank
Rizzoli Institute
Omologous morcelized
defatted bone graft
Howex@
Chips 3 mm
Thorèn K.: “Lipid-extracted bone graft”, 1994.
• three sterile envelops
• 25 kGy,
• - 80° C,
4 weeks
With G. Ullmark kind permit
6 months
With G. Ullmark kind permit
4 years
With G. Ullmark kind permit
4 years
With G. Ullmark kind permit
10/1998 -08/2002
249 patients
82 hip p. revisions
6 knee p. revisions
13 post-trauma hip prosthesis
51 spinal fusions
50 bone lesions filling
47 long bone non-unions
Paprosky 2B
Paprosky 2B
Paprosky 3B
3 months
2 years
GCT
12 months
Bone cyst
1month p.o.
3 months
6 months
Remarks about “MOD-B”
•
•
•
•
High plastic properties
Loss bone-stock recovery
High resistance to septic risk
Low resistance to mechanical strenght
“Adsorption and release of antibiotics
from morselized cancellous bone.
In vitro studies of 8 antibiotics.”
Witso E., Persen L., Loseth K., Bergh K.
Acta Orthop. Scand. 1999 Jun; 70 (3): 298-304
“Vancomycin-Tobramycin composite
grafts -a new treatment for chronic
osteomyelytis of the neuropatic food.”
Winkler H., Berger C., Kristen K.H., Engel A.
Annual Meeting EBJIS, May 25-27, 2000 Berlin.
inserire rx tappari, avambracci,
Navacchia
Morcelized bone combined with
acrylic cement enhances in vitro
release of vancomycin
G.Gualdrini, A.Bassi*, A. Giunti
VII Department Orthopaedic and Traumatology
*Muscoloskeletal Tissue Bank
Rizzoli Orthopaedic Institute, Bologna.
in press
16 cylinders:
10 C-A-MB : PMMA g 0.5 +
vancomycin g 0.1 + bone g 0.8
6 C-A : PMMA g 0.5 +
vancomycin g 0.1
Human plasma
Saline solution
Four weeks
37°C
Antibiotic total release
bone pla vs cem pla
1600
p=0.04
1400
1200
m g/ml
1000
800
600
400
200
1515
1447
719
1287
bone pla
bone sal
cem pla
cem sal
0
Antibiotic release
first week
700
bone pla
bone sal
cem pla
cem sal
600
mg/ml
500
400
300
200
100
0
days
0
1
2
3
4
5
6
7
Antibiotic release
second-fourth week
1400
bone pla
bone sal
cem pla
cem sal
1200
mg/ml
1000
800
600
400
200
0
week
I
II
III
IV
“Mechanical characterization of an
antibiotic cement-morcelized bone
graft composite”
M.Baleani, R.Fognani, A.Toni, A.Bassi°, G.Gualdrini*
Medical Tecnology Lab.- I Orthopaedic Department
°Muscoloskeletal Tissue Bank
*VII Orthopaedic Department
Rizzoli Orthopaedic Institute, Bologna.
In press.
COMPRESSIVE STRENGTH (MPa)
20
15
10
5
0
02 DAYS
1 WEEK
4 WEEK
TENSILE STRENGTH (MPa)
20
15
10
5
0
02 days
1week
4week
Homologous morcelized defatted
bone graft additionated with
antibiotic and PMMA “in vivo”:
preliminary histologic evaluation.
G.Gualdrini, A.Bassi, A.Giunti.
Remarks about “CAMB”
•
•
•
•
•
High plastic properties
Loss bone-stock recovery
Good antibiotic delivery
High resistance to mechanical loading
Good “in vivo” biocompatibility