Center for Excellence in Hip, Scottish Rite for Children, Dallas, Texas, USA.
Department of Orthodontics, Texas A&M School of Dentistry, Dallas, Texas, USA.
J Orthop Res. 2023 Jul;41(7):1482-1493. doi: 10.1002/jor.25496. Epub 2022 Dec 14.
Avascular necrosis (AVN) involves ischemic cell death of the bone. AVN leaves an abundance of necrotic lipids and debris in the bone marrow, which instigates inflammatory bone repair. Consequently, the necrotic bone microenvironment stimulates excessive bone resorption, leading to joint deformities and osteoarthritis. Here, we performed a detergent-assisted bone wash using poloxamer 407 (P407) to clean the necrotic bone environment by removing lipids and necrotic debris. The new concept was tested using an established ex vivo AVN model of porcine cadaver humeral heads. The P407 wash was performed using P407 solution and followed with saline via two intraosseous needles. Visual inspection and image analyses of average pixel light intensity showed that the P407 wash produced a better-cleaned bone than the saline wash. Analyses of the collected bone wash solution showed a two-fold increase in triglycerides (101 vs. 53 mmol/head, p = 0.006) and a 10-fold increase in the dry weight of the removed debris (1.34 vs. 0.13 g/head, p = 0.02) with the P407 wash compared to saline. The histological evaluation showed significantly decreased Oil-Red-O (fats) staining in the P407-washed bone compared with the saline-washed bone. The in vitro assays of Alizarin red and qPCR showed the P407 wash neither altered the osteogenic behaviors of porcine bone marrow-derived mesenchymal cells (pBMMCs) nor raised inflammatory responses of porcine bone marrow-derived macrophages (pBMMs). In conclusion, detergent-assisted bone wash using P407 produced a better removal of nonsoluble debris from the bone marrow space than the saline wash without causing changes to osteogenesis or inflammatory reactions.
骨无菌性坏死（AVN）涉及骨细胞的缺血性死亡。AVN 会在骨髓中留下大量坏死的脂质和碎片，从而引发炎症性骨修复。因此，坏死的骨微环境会刺激过度的骨吸收，导致关节畸形和骨关节炎。在这里，我们使用泊洛沙姆 407（P407）进行去污剂辅助骨冲洗，通过去除脂质和坏死碎片来清洁坏死的骨环境。该新概念通过猪尸体肱骨头的既定体外 AVN 模型进行了测试。使用 P407 溶液进行 P407 冲洗，然后通过两根骨髓内针用生理盐水冲洗。平均像素光强度的目视检查和图像分析表明，P407 冲洗比生理盐水冲洗产生了更好的清洁骨。对收集的骨冲洗液的分析表明，与生理盐水冲洗相比，P407 冲洗可使甘油三酯增加两倍（101 与 53mmol/头，p=0.006），去除的碎片干重增加十倍（1.34 与 0.13 克/头，p=0.02）。组织学评估显示，与生理盐水冲洗相比，P407 冲洗的骨中油红 O（脂肪）染色明显减少。茜素红和 qPCR 的体外检测表明，P407 冲洗既不会改变猪骨髓间充质细胞（pBMMCs）的成骨行为，也不会引起猪骨髓来源的巨噬细胞（pBMMs）的炎症反应。总之，与生理盐水冲洗相比，P407 辅助的去污剂骨冲洗可更好地从骨髓腔中清除不溶性碎片，而不会引起成骨或炎症反应的变化。
