No abstract

Many growth factors have been studied as additives accelerating lumbar fusion rates in different animal models. However, their low hydrolytic and thermal stability both in vitro and in vivo limits their workability and use. In the proposed work, a stabilized vasculogenic and prohealing fibroblast growth factor-2 (FGF2-STAB®) exhibiting a functional half-life in vitro at 37 °C more than 20 days was applied for lumbar fusion in combination with a bioresorbable scaffold on porcine models. An experimental animal study was designed to investigate the intervertebral fusion efficiency and safety of a bioresorbable ceramic/biopolymer hybrid implant enriched with FGF2-STAB® in comparison with a tricortical bone autograft used as a gold standard. Twenty-four experimental pigs underwent L2/3 discectomy with implantation of either the tricortical iliac crest bone autograft or the bioresorbable hybrid implant (BHI) followed by lateral intervertebral fixation. The quality of spinal fusion was assessed by micro-computed tomography (micro-CT), biomechanical testing, and histological examination at both 8 and 16 weeks after the surgery. While 8 weeks after implantation, micro-CT analysis demonstrated similar fusion quality in both groups, in contrast, spines with BHI involving inorganic hydroxyapatite and tricalcium phosphate along with organic collagen, oxidized cellulose, and FGF2- STAB® showed a significant increase in a fusion quality in comparison to the autograft group 16 weeks post-surgery (p = 0.023). Biomechanical testing revealed significantly higher stiffness of spines treated with the bioresorbable hybrid implant group compared to the autograft group (p < 0.05). Whilst histomorphological evaluation showed significant progression of new bone formation in the BHI group besides non-union and fibrocartilage tissue formed in the autograft group. Significant osteoinductive effects of BHI based on bioceramics, collagen, oxidized cellulose, and FGF2-STAB® could improve outcomes in spinal fusion surgery and bone tissue regeneration.

PŮVODNÍ PRÁCE ORIGINAL PAPERje přítomna, maximálně do 30 minut. MTBI se dělí dále do tří kategorií, na základě GCS a ev. přítomnosti rizikových faktorů. MTBI zahrnuje i prostý úraz hlavy (kategorie 1), který se vyznačuje GCS 15 a ev. přítomností jednoho z minoritních rizikových faktorů (ztráta vědomí, přetrvávající anterográdní amnézie, ložiskový neurologický deficit a hematom v oblasti skalpu) (32). Incidence MTBI je asi 130 případů/100 000 obyvatel, je přitom pravděpodobně podhodnocena, protože řada zraněných nevyhledá lékařskou péči. MTBI tak tvoří až 95 % všech mozkových poranění [1]. Management těchto ÚVOD Kraniocerebrální traumata se podílejí ze 40 % na úrazové mortalitě (1). Incidence mozkových traumat v České republice se pohybuje v rozmezí 180-220 případů na 100 000 obyvatel ročně. Ve věkové skupině do 45 let jsou nejčastější příčinou úmrtí. Každoročně je hospitalizováno téměř 36 tisíc pacientů pro nitrolební poranění, z čehož přibližně 30 tisíc hospitalizací tvoří pacienti s komocí mozku (23). Právě lehká mozková traumata (Mild Traumatic Brain Injury -MTBI) tvoří největší skupinu poranění hlavy. Jsou definována Glasgow Coma Scale (GCS) v rozmezí 13-15 a ztrátou vědomí, pokud

The main goal of this study was to assess the progress of vertebral stability after lumbar interbody fusion related to microcomputed tomography (micro CT), biomechanical analysis, and histological assessment towards spine fusion. Twelve male pigs were used; each underwent L2-3 discectomy and implantation of an iliac crest bone graft in two groups; six spines were harvested eight weeks (A1) and six spines 16 weeks (A2) after surgery (7 native spines for biomechanical analysis). The CT was performed by GE phoenix datos|x 2.0 with a sample drift correction. The samples were divided according to fusion quality. Biomechanical evaluation was carried out on the MTS Mini Bionix testing system. In the nondestructive mode, three cycles of pure bending moments were applied (5 Nm load limit) at a rate of 20 °/min in flexion (+40 °) and extension (-40 °). Two representative histological sections from four samples were obtained (A1, n = 2; A2, n = 2); areas of mature bone were quantified. In micro CT, better results were achieved in group A2 (not significant). Eight weeks after the operation, flexural stiffness decreased to 48% of its initial value for native cadavers (P < 0.05); after 16 weeks it was comparable to native cadavers, demonstrating the suitability of the implanted graft (P < 0.05). The newly formed bone tissue occupied an average area of 94.205 mm2 (A1) and 26.240 mm2 (A2). It was confirmed that micro CT, biomechanical analysis, and histological assessment are technically feasible and suitable for the evaluation of results of other methods of large bone defect treatment.