Hyalonect'in psödoartroz tedavisinde kullanımı

Year 2013, Volume: 47 Issue: 6, 379 - 386, 07.02.2014

Ali Cagri Tekin Cem Esenyel Murat Cakar Meltem Esenyel Yusuf Ozcan Mehmet Saygili

Abstract

Amaç: Bu çalışmamızda, ekstrasellüler matrisin doğal bir bileşeni olan, hyaluronik asidin benzil esteri HYAFF’tan oluşan ve örgülü yapıda bir malzeme olan Hyalonect’in psödoartroz tedavisinde kullanımına dair kaynama oranları ve komplikasyonları değerlendirildi.
Çalışma planı: Çalışmaya, psödoartrozun tedavisi için Hyalonect ile cerrahi girişimde bulunulan ve yaş ortalaması 44.6 (dağılım: 23-57) olan 11 hasta (8 erkek, 3 kadın) dahil edildi. İlk tedavi ile cerrahi girişim arasında geçen süre ortalama 12.9 (dağılım: 8-48) ay idi. Dört hastada tibiada, 2 hastada femurda ve 5 hastada humerusta psödoartroz mevcuttu. Hastalara daha evvel 1 ila 6 kez cerrahi girişim uygulanmıştı. Tüm hastalara açık redüksiyon ve internal tespit yapıldı. Kırık bölgesine allogreft uygulandı ve etrafı Hyalonect ile sarıldı. Ortalama takip süresi 31 (dağılım: 12-48) ay olarak kaydedildi.
Bulgular: Tüm olgularda ortalama 6 (dağılım: 4-8) ayda kaynama elde edildi. Hastaların birinde yaklaşık 2 hafta kadar süren bir akıntı saptandı. Enfeksiyon gelişen diğer bir hasta uygun antibiyotik tedavisine cevap verdi. Kötü kaynama veya implant yetersizliği gözlenmedi. Bir hastada daha önceden var olan radyal sinir felcinin devam ettiği görüldü.
Çıkarımlar: Özellikle enfekte olmayan psödoartrozların cerrahi tedavisinde Hyalonect kullanımının güvenilir olduğu ve kaynama üzerine pozitif etkisi olduğu düşünülmektedir.

Keywords

Cerrahi örtüm aparatı; Hyalonect; hyaluronik asit; kaynamama; psödoartroz

Hyalonect in the treatment of pseudarthrosis

Abstract

Objective: The aim of this study was to evaluate union rates and complications of Hyalonect, a knitted mesh composed of HYAFF, a benzyl ester of hyaluronic acid, and a naturally occurring constituent of the extracellular matrix, for the treatment of pseudarthrosis.
Methods: The study included 11 patients (8 male, 3 female; mean age: 44.6 years; range: 23 to 57 years) operated for pseudarthrosis using Hyalonect. Average time between initial treatment and surgical procedure was 12.9 (range: 8 to 48) months. Pseudarthrosis of the tibia, femur and humerus was present in 4, 2 and 5 patients, respectively. All patients had undergone prior surgery (1 to 6 times). Each patient underwent open reduction and internal fixation. Allograft was applied to the pseudarthrosis area and covered with Hyalonect. Mean follow up period was 31 (range: 12 to 48) months.
Results: Union was achieved in all patients after an average of 6 (range: 4 to 8) months. One patient had a discharge for two weeks. Another developed an infection which responded well to appropriate antibiotic treatment. No malunion or implant failure was observed. One patient with pre-existing radial nerve palsy maintained the condition.
Conclusion: Use of Hyalonect appears to be a safe method with a positive impact on union in the surgical treatment of pseudarthrosis, particularly in the absence of any infection.

Keywords

Hyalonect, hyaluronic acid, nonunion, pseudarthrosis, surgical mesh

References

• Nwagbara IC. Osseous union in cases of non-union in long bones treated by osteosynthesis. Niger J Clin Pract 2010;13: 436Rubel IF, Kloen P, Campbell D, Schwartz M, Liew A, Myers E, et al. Open reduction and internal fixation of humeral non-unions: a biomechanical and clinical study. J Bone Joint Surg Am 2002;84-A:1315-22.
• Nakase T, Kawai H, Yoshikawa H. In situ grafting of excised fracture callus followed by Ilizarov external fixation for treatment of nonunion after open fracture of tibia. J Trauma 2009;66:550-3.
• Tonello C, Zavan B, Cortivo R, Brun P, Panfilo S, Abatangelo G. In vitro reconstruction of human dermal equivalent enriched with endothelial cells. Biomaterials 2003;24:1205
• Niu Y, Bai Y, Xu S, Liu X, Wang P, Wu D, et al. Treatment of lower extremity long bone nonunion with expandable intramedullary nailing and autologous bone grafting. Arch Orthop Trauma Surg 2011;131:885-91.
• Öztürkmen Y, Do¤rul C, Karl› M. Results of the Ilizarov method in the treatment of pseudoarthrosis of the lower extremities. [Article in Turkish] Acta Orthop Traumatol Turc 2003;37:9-18.
• Kumar A, Sadiq SA. Nonunion of the humeral shaft treated by internal fixation. Int Orthop 2002;26:214-6.
• Celebi L, Do¤an O, Muratli HH, Ya¤murlu MF, Yüksel HY, Biçimo¤lu A. Treatment of humeral pseudarthroses by open reduction and internal fixation. [Article in Turkish] Acta Orthop Traumatol Turc 2005;39:205-10.
• Rhodes NP, Hunt JA, Longinotti C, Pavesio A. In vivo characterization of Hyalonect, a novel biodegradable surgical mesh. J Surg Res 2011;168:e31-8.
• Zhang X, Awad HA, O’Keefe RJ, Guldberg RE, Schwarz EM. A perspective: engineering periosteum for structural bone graft healing. Clin Orthop Relat Res 2008;466:1777
• Hay ED. Development of the vertebrate cornea. Int Rev Cytol 1980;63:263-322.
• West DC, Kumar S. The effect of hyaluronate and its oligosaccharides on endothelial cell proliferation and monolayer integrity. Exp Cell Res 1989;183:179-96.
• West DC, Hampson IN, Arnold F, Kumar S. Angiogenesis induced by degradation products of hyaluronic acid. Science 1985;228:1324-6.
• Handley CJ, Lowther DA. Inhibition of proteoglycan biosynthesis by hyaluronic acid in chondrocytes in cell culture. Biochim Biophys Acta 1976;444:69-74.
• Boyce DE, Thomas A, Hart J, Moore K, Harding K. Hyaluronic acid induces tumour necrosis factor-alpha production by human macrophages in vitro. Br J Plast Surg 1997;50:362-8.
• Wisniewski HG, Vilcek J. TGS-6: an IL-1/TNF-inducible protein with anti-inflammatory activity. Cytokine Growth Factor Rev 1997;8:143-56.
• Aigner J, Tegeler J, Hutzler P, Campoccia D, Pavesio A, Hammer C, et al. Cartilage tissue engineering with novel nonwoven structured biomaterial based on hyaluronic acid benzyl ester. J Biomed Mater Res 1998;42:172-81.
• Grigolo B, Lisignoli G, Piacentini A, Fiorini M, Gobbi P, Mazzotti G, et al. Evidence for redifferentiation of human chondrocytes grown on a hyaluronan-based biomaterial (HYAff 11): molecular, immunohistochemical and ultrastructural analysis. Biomaterials 2002;23:1187-95.
• Zacchi V, Soranzo C, Cortivo R, Radice M, Brun P, Abatangelo G. In vitro engineering of human skin-like tissue. J Biomed Mater Res 1998;40:187-94.
• Gao J, Dennis JE, Solchaga LA, Goldberg VM, Caplan AI. Repair of osteochondral defect with tissue-engineered twophase composite material of injectable calcium phosphate and hyaluronan sponge. Tissue Eng 2002;8:827-37.
• Lisignoli G, Fini M, Giavaresi G, Nicoli AN, Toneguzzi S, Facchini A. Osteogenesis of large segmental radius defects enhanced by basic fibroblast growth factor activated bone marrow stromal cells grown on non-woven hyaluronic acidbased polymer scaffold. Biomaterials 2002;23:1043-51.
• Rhodes NP, Srivastava JK, Smith RF, Longinotti C. Metabolic and histological analysis of mesenchymal stem cells grown in 3-D hyaluronan-based scaffolds. J Mater Sci Mater Med 2004;15:391-5.
• Cristino S, Grassi F, Toneguzzi S, Piacentini A, Grigolo B, Santi S, et al. Analysis of mesenchymal stem dimensional cells grown on a three-dimensional HYAFF 11-based prototype ligament scaffold. J Biomed Mater Res A 2005;73:275
• Revell PA, Damien E, Di Silvio L, Gurav N, Longinotti C, Ambrosio L. Tissue engineered intervertebral disc repair in the pig using injectable polymers. J Mater Sci Mater Med 2007;18:303-8.
• Pastorino L, Soumetz FC, Ruggiero C. Nanofunctionalisation for the treatment of peripheral nervous system injuries. IEE Proc Nanobiotech 2006;153:16-20.
• Lepidi S, Abatangelo G, Vindigni V, Deriu GP, Zavan B, Tonello C, et al. In vivo regeneration of small-diameter (2 mm) arteries using a polymer scaffold. FASEB J 2006;20: 103Lepidi S, Grego F, Vindigni V, Zavan B, Tonello C, Deriu GP, et al. Hyaluronan biodegradable scaffold for small-caliber artery grafting: preliminary results in an animal model. Eur J Vasc Endovasc Surg 2006;32:411-7.
• Zavan B, Brun P, Vindigni V, Amadori A, Habeler W, Pontisso P, et al. Extracellular matrix-enriched polymeric scaffolds as a substrate for hepatocyte cultures: in vitro and in vivo studies. Biomaterials 2005;26:7038-45.
• Tiedeman JJ, Garvin KL, Kile TA, Connolly JF. The role of a composite, demineralized bone matrix and bone marrow in the treatment of osseous defects. Orthopedics 1995;18:1153
• Sottosanti JS. Calcium sulfate-aided bone regeneration: a case report. Periodontal Clin Investig 1995;17:10-5.
• Babhulkar S, Pande K, Babhulkar S. Nonunion of the diaphysis of long bones. Clin Orthop Relat Res 2005;(431):50-6. Ring D, Jupiter JB, Sanders RA, Quntero J, Santoro VM, Ganz R, et al. Complex nonunion of fracture of the femoral shaft treated by wave-plate osteosynthesis. J Bone Joint Surg Br 1997;79:289-94.
• Zaslav KR, Meinhard BP. Management of resistant pseudarthrosis of long bones. Clin Orthop Relat Res 1988; (233):234-42.
• Öztürkmen Y, Karamehmeto¤lu M, Caniklio¤lu M, Ozlük AV. Treatment results of pseudarthrosis of the humeral shaft by open reduction and internal fixation with dynamic compression plating. [Article in Turkish] Acta Orthop Traumatol Turc 2004;38:305-12.
• Crolla RM, de Vries LS, Clevers GJ. Locked intramedullary nailing of humeral fractures. Injury 1993;24:403-6.
• Martínez AA, Herrera A, Cuenca J. Good results with unreamed nail and bone grafting for humeral nonunion: a retrospective study of 21 patients. Acta Orthop Scand 2002;73:273-6.
• Rommens PM, Blum J, Runkel M. Retrograde nailing of humeral shaft fractures. Clin Orthop Relat Res 1998;(350): 26Healy WL, White GM, Mick CA, Brooker AF Jr, Weiland AJ. Nonunion of the humeral shaft. Clin Orthop Relat Res 1987;(219):206-13.
• Atalar AC, Kocaoglu M, Demirhan M, Bilsel K, Eralp L. Comparison of three different treatment modalities in the management of humeral shaft nonunions (plates, unilateral, and circular external fixators). J Orthop Trauma 2008;22: 248Gomes JL, Ruthner RP, Moreira L. Femoral pseudoarthrosis and knee stiffness: long-term results of a one-stage surgical approach. Arch Orthop Trauma Surg 2010;130:277-83.