With the aging of the population, the risk of osteoporotic vertebral compression fractures (OVCF) caused by osteoporosis increases rapidly. Surgeons often fill the bone defect with injectable polymethylmethacrylate (PMMA) bone cement through vertebroplasty. However, compared with cancellous bone, the higher mechanical properties of PMMA bone cement can easily lead to the fracture of the adjacent cone. Besides, the wound infection caused by surgery is also a serious problem. In order to solve these problems, we designed a new type of PMMA bone cement, by adding gelatin as a pore former, 5% (w/w) gentamicin sulfate (GS) for antibacterial purpose, and 30% (w/w) barium sulfate (BaSO4) to provide excellent radiopacity. Compared with the traditional PMMA bone cement, with the dissolution of gelatin after being immersed in phosphate buffered saline (PBS) for 14 d, the mechanical properties of modified PMMA bone cement decreased by approximately 67%, which is close to the human cancellous bone. Besides, the release of GS increased 3.8 times, and the GS concentration remained above the minimum inhibitory concentration (MIC) for 12 d. In addition, the setting properties, contact angle, antibacterial ability, and cell compatibility of PMMA bone cement also maintained well. The integration and dissolution of gelatin were observed by a scanning electron microscope (SEM). All results indicate that the new type of gelatin-modified PMMA bone cement is a potential candidate material for vertebroplasty.
Polymethyl methacrylate (PMMA) bone cement is now widely used in percutaneous vertebro plasty (PVP) and percutaneous kyphoplasty (PKP). However, studies showed that the radiopacifiers (zirconia, barium sulfate, etc.) added to PMMA will have a negative impact on its use, e.g. barium sulfate will weaken the mechanical properties of bone cement and lead to bone absorption and aseptic loosening. Iodine is an element existing in the human body and has good imaging performance. Iodine contrast agent has been used in clinic for many years and has abundant clinical data. Therefore, using iodine instead of barium sulfate may be a promising choice. In this paper, the effect of different content of diatrizoate sodium (DTA, C11H8I3N2NaO4) on the properties of PMMA was studied and compared with the traditional PMMA bone cement containing 30 wt% barium sulfate. The mechanical properties, setting properties, radiopacity, and biocompatibility of bone cement were evaluated. The compressive strength of PMMA bone cement with 20 wt% DTA can reach 76.38 MPa. DTA released from bone cement up to 14 days accounted for only 2.3% of its dosage. The water contact angle was 62.3°. The contrast of bone cement on X-ray film was comparable to that of bone cement containing 30 wt% barium. The hemolysis rate was lower than 4%, and there was no obvious hemolysis. PMMA with 20 wt% DTA can maintain the relative growth rate of MC3T3-E1 and L929 cells above 80%. The results show that adding 20 wt% DTA into PMMA can obtain good radiopacity while maintaining its mechanical properties, setting properties, and biocompatibility. DTA can be used as a promising candidate material for PMMA bone cement radiopacifier.
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