Miyamoto Y, Ishikawa K, Takechi M, Toh T, Yuasa T, Nagayama M, Suzuki K
First Department of Oral and Maxillofacial Surgery, School of Dentistry, Tokushima University, Japan.
J Biomed Mater Res. 1999 Spring;48(1):36-42. doi: 10.1002/(sici)1097-4636(1999)48:1<36::aid-jbm8>3.0.co;2-i.
To evaluate the soft tissue response of calcium phosphate cement (CPC), consisting of an equimolar mixture of tetracalcium phosphate (TTCP) and dicalcium phosphate anhydrous (DCPA) under conditions close to those encountered in actual surgical procedures, we implanted three types of CPC [conventional CPC (c-CPC), fast-setting CPC (FSCPC), and antiwashout type FSCPC (aw-FSCPC; formerly called nondecay type FSCPC or nd-FSCPC)] subcutaneously in the abdomens of rats immediately (1 min) after mixing. At 1 week after surgery, histological examination and compositional analysis were performed using light microscopy and powder X-ray diffraction (XRD), respectively. The implanted c-CPC was crumbled completely, whereas FSCPC and aw-FSCPC retained their shape. Large vesicles containing copious inflammatory effusion were subcutaneously formed around the c-CPC. Histologically, many foreign-body giant cells were collected around the c-CPC, and moderate inflammatory cell infiltration was observed at 1 week after surgery. In contrast, the FSCPC and aw-FSCPC were covered with a thin layer of granulation tissue that included few giant cells and presented slight inflammatory cell infiltration, and no effusion was observed. The XRD analysis of the c-CPC revealed the presence of some unreacted DCPA even 1 week after implantation, whereas almost no DCPA was found in the FSCPC or aw-FSCPC. In conclusion, it was found that CPC does not always show excellent tissue response. When c-CPC is implanted subcutaneously in rats immediately after mixing, it fails to set and causes a severe inflammatory response. Therefore, the type of CPC should be chosen according to the clinical particulars. CPC should be used in a manner that assures its setting reaction. We recommend the use of FSCPC and aw-FSCPC for surgical applications, such as orthopedics, plastic and reconstructive surgery, and oral and maxillofacial surgery, where the cement might otherwise crumble due to the pressure before setting.
为了评估磷酸钙骨水泥（CPC）在接近实际手术操作条件下的软组织反应，该骨水泥由磷酸四钙（TTCP）和无水磷酸二钙（DCPA）的等摩尔混合物组成，我们在混合后立即（1分钟）将三种类型的CPC[传统CPC（c-CPC）、快速凝固CPC（FSCPC）和抗冲洗型FSCPC（aw-FSCPC；以前称为非降解型FSCPC或nd-FSCPC）]皮下植入大鼠腹部。术后1周，分别使用光学显微镜和粉末X射线衍射（XRD）进行组织学检查和成分分析。植入的c-CPC完全破碎，而FSCPC和aw-FSCPC保持其形状。在c-CPC周围皮下形成了含有大量炎性渗出液的大水泡。组织学上，c-CPC周围聚集了许多异物巨细胞，术后1周观察到中度炎性细胞浸润。相比之下，FSCPC和aw-FSCPC覆盖着一层薄的肉芽组织，其中几乎没有巨细胞，炎性细胞浸润轻微，未观察到渗出液。对c-CPC的XRD分析显示，即使在植入1周后仍存在一些未反应的DCPA，而在FSCPC或aw-FSCPC中几乎未发现DCPA。总之，发现CPC并不总是表现出良好的组织反应。当在混合后立即将c-CPC皮下植入大鼠体内时，它无法凝固并引起严重的炎症反应。因此，应根据临床具体情况选择CPC的类型。CPC应以确保其凝固反应的方式使用。我们建议在骨科、整形和重建手术以及口腔颌面外科等手术应用中使用FSCPC和aw-FSCPC，在这些手术中，骨水泥否则可能会因凝固前的压力而破碎。
