Note: Descriptions are shown in the official language in which they were submitted.
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RESORBABLE, MACRO-POROUS, NON-COLLAPSING AND FLEXIBLE
MEMBRANE HARRIER FOR SKELETAL REPAIR AND REGENERATION
Hackg~round of the Invention
Field of the Invention
The present invention relates generally to implants
for use in repairing various portions of the mammalian
skeletal system and, more particularly, to implants for
use in clinical procedures such as bone fracture repair,
regeneration of bone loss, augmentation of deficient
bone, and related procedures.
Description of Related Art
Various types of defects in the mammalian skeletal
system can be treated by various surgical procedures.
Defects in the mammalian skeletal system may include
bone fracture, loss of bone occurring from traumatic,
surgical, or infectious sources, and bone deficiencies
stemming from conditions such as atrophy and congenital
anomalies.
One procedure that is common in the prior art for
treating bone defects involves the placement of
additional bone into the bone defect area. This
procedure, which is commonly referred to as bone
grafting, is the second most frequently performed
surgical grafting procedure, with skin grafting the most
common surgical grafting procedure. Current bone
grafting procedures include the use of vascularized or
non-vascularized autografts and allografts.
A bone autograft is a portion of bone taken from
another area of the skeletal system of the patient. A
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bone allograft, in contrast, involves a human donor
source other than the recipient patient. Allogenic bone
graft typically comprises bone harvested from cadavers,
which is subsequently treated and stored in a bone bank
and ultimately used as a bone graft implant. Allogenic
bone graft is known to have osteoconductive and
osteoinductive capabilities, although the osteoinductive
properties are limited because of the necessary tissue
sterilizing and cleaning procedures associated with
harvesting these bone grafts. The term osteoconduction
refers to a class of biomaterials which provide a three-
dimensional porous framework to conduct the ingrowth of
new living bone into this structure. The term
osteoinduction refers to a class of materials having
capabilities of recruiting mesenchymal stem cells of the
patient and promoting their differentiation into
osteoblasts, which are bone forming cells. An
osteoinductive material will typically form bone if
implanted into an area where bone would not normally
grow. For example, the placement of bone morphogenic
proteins into the muscle of a patient will result in
ectopic (outside of bone) bone formation.
Both bone autografting procedures and bone
allografting procedures are associated with shortcomings
in the healing of bone defects within the mammalian
skeletal system. Bone autografting procedures are
typically associated with limitation of donor sites,
bone quantity, and donor site morbidity (especially if
multiple donor sites are required). Bone allografting
procedures, to begin with, only have limited
osteoinductive capabilities. In addition to the very
limited osteoinduction properties of allogenic bone
grafts, compared to autograft samples, allografts are
immunogenic to a certain degree, bear the risk of
disease transmission (e. g, HIV and Hepatitis), and,
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depending on the size of the allograft, require a long
time for ingrowth and partial substitution with new
bone. This long substitution process often requires a
time duration of greater than one year before
satisfactory clinical results are obtained.
Additionally, pressure fram the adjacent musculature may
dislocate bone graft material. Bone grafts may re-
fracture after fixator removal if bone ingrowth and
substitution is inadequate.
. As a substitute to actual bone grafts, which
include autografts and allografts, various bone graft
substitutes have been used by the prior art for treating
bone defects in the mammalian skeletal system.
Porous ceramic bone graft substitutes, for
instance, such as coralline hydroxyapatites, operate
similarly to bone grafts by providing a three-
dimensional structural framework. This framework
conducts the regenerating bone of the patient into the
porous matrix of the three-dimensional structural
framework. This process of conducting the regenerating
bone into the porous matrix is commonly referred to as
osteoconduction, as opposed to osteoinduction discussed
above. Permanent, non-resorbable, inorganic, ceramic
implants have shortcomings such as inherent brittleness
and large framework volume fractions. The framework
volume fraction of a typical bone graft substitute
comprises approximately 40 percent of the volume where
new bone could otherwise grow. This 40 percent volume
occupied by a bone graft substitute, consequently,
cannot be occupied by the regenerating bone of the
patient.
A process referred to as guided tissue regeneration
is widely used by periodontists to regenerate bone and
periodontal ligaments (ligaments between the tooth root
and the bone) around dental implants, for example. This
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surgical procedure uses cell-occlusive (cells cannot
pass through) but fluid-permeable membranes, which are
otherwise known as semipermeable membranes, in order to
cover and segregate a bone defect from the surrounding
soft tissues. U.S. Patent No. 3,962,153 discloses such
a cell-occlusive, fluid-permeable membrane. Use of
these cell-occlusive, fluid permeable membranes, has
been predominantly developed and used by periodontists
over the last decade, who worked in the mouth around
teeth. The human body has many tissue types which
originate from three primary germ layers of the embryo:
the ectoderm, the mesoderm and the entoderm. From the
ectoderm are derived the skin and its attached tissues,
such as nails, hair and glands of the skin, the nervous
system, external sense organs and the epithelial lining
of the mouth and anus. From the mesoderm are derived
the connective tissues, bone, cartilage, muscle, blood
and blood vessels. From the entoderm are derived, among
others, the digestive tract, bladder and urethra. The
~~precursor~~ cells of these layers are limited to only
becoming cells of their respective tissue type. Bone,
muscle, connective tissue, blood vessels and cartilage
are of mesenchymal origin which means from the meshwork ..
of embryonic connective tissue in the mesoderm, and are
formed from versatile mesenchymal stem cells, whereas
the lining of the mouth is of ectodermal origin and is
formed of epithelial cells derived from the ectoderm.
Ectodermal cells do not have the potential to become
bone forming cells and, conversely, mesenchymal cells do
not have the potential to form epithelium.
Epithelial cells are present in the mouth, but are
not present in many other areas of the mammalian
skeletal system, such as areas near long bones of the
mammalian skeleton. The development of cell-occlusive,
fluid permeable membranes was developed in the context
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of periodontal and oral applications, for the purpose of
excluding the introduction of epithelial cells into the
bone defect area of the patient because they are
believed to hinder bone formation. Epithelial cells
proliferate faster than bone cells and, therefore, the
exclusion of these epithelial cells from the bone defect
area has been considered to be essential for optimal
bone and ligament regeneration in these periodontal and
oral applications. Although cell-occlusive, fluid
permeable membranes have been predominantly used in
periodontal and oral applications, these cell-occlusive
membranes have recently also been applied for tissue
segregation in other defect sites in the mammalian
skeletal system, such as long bone defects.
These cell-occlusive membranes of the prior art
have a shortcoming of blocking blood vessels and
mesenchymal cells from entering into the bone defect
area. Thus, the advantage of precluding epithelial
cells from the bone defect area in the oral cavity is
achieved at the expense of also precluding entry of
blood vessels and surrounding mesenchymal cells into the
bone defect area, as well. In periodontal and oral
applications, the advantage of precluding epithelial
cells is believed to be worth the shortcoming of also
precluding blood vessels and surrounding mesenchymal
cells from the bone defect area. In other areas of the
mammalian skeletal system, however, where epithelial
cells are not present, these cell-occlusive, fluid-
permeable membranes preclude the introduction of blood
vessels and surrounding mesenchymal cells for no
apparent reason. Thus, a need has existed in the prior
art for a cell-permeable membrane barrier to protect
non-periodontal bone defects from gross soft tissue
prolapse and to thereby facilitate bone regeneration.
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Turning to Figure l, a typical cell-occlusive,
fluid permeable membrane 10 is illustrated surrounding a
first section of the long bone 12 and a second section
of long bone 14. The bone defect area 20 is bounded by
the two ends 16, 18 of the first section of long bone 12
and the second section of long bone 14, respectively,
and by the cell-occlusive, fluid-permeable membrane I0.
Although this bone defect area 20 can receive blood from
the bone vessels 23, blood and cells from the
surrounding blood vessels 25 and tissues 27 is precluded
from entering the bone defect area 20. The periosteum
31 and the surrounding tissues 27 are just external to
the cell- occlusive, fluid-permeable membrane 10 and are
guided in the directions of the arrows A1 and A2.
In addition to being cell-occlusive, the cell-
occlusive, fluid permeable membrane 10 suffers from a
lack of rigidity, as evidenced by the hour-glass
configuration~of the cell-occlusive, fluid-permeable
membrane 10 in Figure 1. A typical thickness of the
cell-occlusive, fluid-permeable membrane 10 comprises
less than 5 microns. Since periodontal defects are
typically small, and since oral soft tissues typically
do not apply much pressure, the cell-occlusive, fluid-
penaeable membrane l0 of the prior art has maintained
its very thin and flexible configuration. Unfortunately,
this very thin and flexible configuration, which is
somewhat suitable for periodontal and oral applications,
is not suitable for maintaining and protecting a
sufficiently large bone defect area 20 in non-
periodontal and non-oral applications. Since muscles
are much larger and more powerful in orthopedic
applications, for example, the cell-occlusive, fluid-
permeable membrane 10 cannot provide sufficient
protection against the prolapse of soft tissues into the
bone defect area 20. When the surrounding tissues
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prolapse into the bone defect area 20, these interposed
tissues present a physical barrier for the regenerating
bone. The regenerating bone will not be able to push
the interposed soft tissues out of the bone defect area,
and subsequently, further regeneration of the bone in
these areas occupied by the prolapsed soft tissues is
prevented. A "non-union" (or pseudoarthrosis which
means pseudo-joint) may result, comprising fibrous scar
tissue instead of bone. Additionally, the prior art
cell-occlusive, fluid-permeable membrane 10 is non-
resorbable, and cannot be absorbed by the patient's
body. Consequently, in order to avoid the risk of
bacterial infection, the cell-occlusive, fluid-permeable
membrane 10 must be removed during a subsequent
operation, which may introduce further complications and
risks to the patient. Thus, in addition to being cell-
occlusive, prior membranes suffer from lack of inherent
strength and non-resorbability.
A few other devices have been developed in the
prior art for treating bone defects, but these devices
comprise either fixation devices or prosthetic devices.
A fixation device, comprising a titanium screen mesh, is
disclosed in U.S. Patent No. 5,346,492. This titanium
screen mesh forms a fixation device, which is designed
to be non-resorbable. The fixation device comprises a
metallic plate structure which provides the necessary
strength, at the cost of being non-resorbable. To date,
any known resorbable material would not be capable of
providing the equivalent rigidity and function of the
titanium mesh screen. The metallic plate structure of
the fixation device comprises a number of perforations
designed specifically for accommodating screws for
fixation. These screw perforations have diameters
(between 4.8 millimeters and 17.5 millimeters), which do
nat prevent .gross prolapse of soft tissues into the bone
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defect area. Such gross prolapse of soft tissues
occupies space which would otherwise be filled with new
bone. The physical barrier presented by the prolapsing
soft tissues greatly impairs new bone formation within
the bone defect area. The fixation device is secured
onto the bone of the patient with the screws and is
designed to be permanently left inside the patient. Any
proliferation of blood vessels through these screw holes
would be destroyed by any subsequent removal of the
fixation device. On the other hand, if the fixation
device is left in permanently, which is a disclosed
embodiment, the bone of the patient will be permanently
stress shielded. In other words, the mended bone, after
initial healing will subsequently start to resorb, since
this new bone is not exposed to functional (mechanical)
stress. The fixation device, if left in the patient,
will shield the bone defect area from functional stress
and thus, prevent an optimal amount of new bone
formation.
A prosthetic device, which comprises holes punched
into a planar material for facilitating suturing of the
prosthetic device, is disclosed in U.S. Patent No.
5,222,987. This prosthetic device, however, is only
disclosed in the context of fabricating artificial bone
structure. In other words, this prosthetic device is
not used in any process associated with bone
regeneration. The prosthetic device comprises a fabric-
like composite onto which a polymer or resin is added,
before the resulting product is molded into the shape of
a bone. A polymerizable initiator is subsequently added
to harden and bond the materials together. Small holes
or ports may be added to accommodate sutures for
attaching the prosthetic device to the body. The
prosthetic device is specifically designed as a
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replacement for the rib cage of a mammalian skeletal
system, and does not facilitate bone regeneration.
Other porous devices, in addition to the above-
mentianed fixation and prosthetic devices, have been
.5 implemented by the prior art. One such device, which is
disclosed in U.S. Patent Nos. 5,306,304, 5,464,439, and
4,932,973, disclose an allogenic bone graft membrane
having pores therein. The allogenic bone graft membrane
is disclosed in these patents as providing a filler for
bone defects. The matrix-like properties of the
allogenic bone graft provide osteoconduction, and the
morphogenic proteins within the allogenic bone graft
provide osteoinductive properties. As mentioned before,
an allogenic bone graft is typically harvested from a
human cadaver and subsequently processed for
implantation. The allogenic bone graft is intended to
become integrated with the new bone of a patient and
partially remodeled over time into a composite of both
cadaver bone and new regenerated natural bone, while
permanently remaining Within the bone defect area of the
patient. The pores in the allogenic bone graft membrane
of these patents are designed to maximize the exposed
surface area in order to enhance its osteoinductive
contribution, as bone morphogenic proteins are released
25~ from the surface of the allogenic bone graft. This
allogenic bone graft matrix will never be completely
resorbed. This is obviously disadvantageous, because
its structure reduces the space for new bone
regeneration.
Another device, which comprises apertures or pores
for facilitating tissue growth therein, is disclosed in
U.S. Patent No. 5,326,356. This patent is directed to
an apparatus for generating artificial skin grafts.
Bio-compatible membranes comprising natural, synthetic,
or semi-synthetic origin are used as a support for the
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in vitro (outside of a living organism) growth of
epithelial skin cells. These epithelial skin cells are
grown into the pores of the membrane outside of the body
of the patient. The resulting artificial skin graft is
obviously not intended for use on the mammalian skeletal
system. This artificial skin graft, in any event, would
be far too thin and flexible for use on the mammalian
skeletal system, and further would not have adequate
fixation strength. Moreover, the epithelial cells which
comprise the artificial skin graft are not present in
the non-periodontal and non-oral applications, such as
long bones, where a cell-permeable membrane is needed in
the prior art for facilitating bone regeneration.
Summary of the Invention
The present invention recognizes that a cell-
occlusive, fluid permeable membrane is not suitable for
bone regeneration in non-periodontal and non-oral
applications. In addition to lacking rigidity and
resorbability, the present invention recognizes that
these prior art cell-occlusive, fluid-permeable
membranes hinder bone regeneration by blocking the
ingress of blood vessels and cells into the bone defect
area. The protective bone regeneration membrane of the
present invention has a much smaller net surface area,
compared to prior art cell-occlusive, fluid permeable
membranes, resulting from the introduction of cell-
permeable apertures into the membrane of the present
invention. In addition to having a smaller net surface
area, the protective bone regeneration membrane of the
present invention is substantially stronger and more
rigid than prior art cell-occlusive, fluid permeable
membranes.
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According to one aspect of the present invention,
an implant for protecting biological tissue defects from
a prolapse of adjacent soft tissues during in vivo
repair of the biological tissue defects includes a
substantially planar sheet of non-metallic base
material. The implant further includes a plurality of
apertures disposed in the substantially planar sheet of
non-metallic base material. The apertures are adapted
for allowing a proliferation of vasculature and
connective tissue cells, derived from the adjacent soft
tissues, into the biological tissue defect, while
preventing any gross prolapse of the adjacent soft
tissues into the biological tissue defect. The
connective tissue cells include mesenchymal cells, and
the implant may be impregnated with at least one
substance for cellular control. This substance for
cellular control may include at least one of a
chemotactic substance for influencing cell-migration, an
inhibitory substance for influencing cell-migration, a
mitogenic growth factor for influencing cell
proliferation, a growth factor for influencing cell
differentiation, and factors which promote
neoangiogenesis (formation of new blood vessels). The
biological tissue defect preferably comprises a bone
defect and, more preferably, comprises a non-
periodontal, non-oral bone defect.
The implant may be used in combination with a
fixation device for stabilizing the bone defect. The
material of the implant is flexible enough to conform to
a curvature of a bone and strong enough to reduce macro-
motion of the bone defect and limit transmission of
surrounding motion into the interior space when the
fixation device is attached to the bone defect. The
implant is adapted for protecting the bone defect from a
prolapse of adjacent soft tissues into the bone defect
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during repair of the bone defect and, further, is
adapted for preventing stress shielded resorption of
bone after the repair of the bone defect. The bone,
which is prevented from being resorbed, may include
either an autograft, an allograft, and/or new
regenerated bone within the bone defect.
According to another aspect of the present
invention, the implant is resorbable. The resorption of
the implant, according to the present invention, can
prevent stress shielding of the bone defect, to thereby
prevent resorption of new bone which would occur if the
bone defect were stress shielded by either the fixation
device or the implant, or both. The fixation device may
be resorbable or non-resorbable. When the fixation
device is resorbable, the fixation device loses its
mechanical strength within 24 months and, more
preferably, within 4 to 12 months. This loss of
mechanical strength of the fixation device can prevent
resorption of new bone near the bone defect which would
occur if the bone defect were stress shielded by either
the fixation device, the implant, or both. If the
fixation device is non-resorbable, according to the
present invention, the resorption of the implant can
reduce stress shielding of the bone defect area to
thereby minimize resorption of new bone near the bone
defect. As another option, the implant may be non-
resorbable, but flexible enough to prevent stress
shielding of the bone defect after the resorbable
fixation device has lost its mechanical strength.
Each of the apertures within the implant has a
diameter in a range between 20 microns and 3000 microns,
and, preferably, has a diameter of approximately 1500
microns. The implant has a thickness in a range between
100 microns and 2000 microns, but may also be configured
as thin as 10 microns. This implant comprises at least
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one of a biodegradable synthetic material and a
biodegradable natural material, that is also a non-
osteogenic, non-metallic substance having a stiffness
sufficient to prevent gross soft tissue prolapse into an
area of the bone defect where new bone ideally would
grow.
According to one aspect of the present invention, a
planar membrane is provided for preventing soft tissue
from prolapsing into a protected area of a bone defect.
The planar membrane is adapted for being placed outside
of the bone defect area, as opposed to being placed
within the bone defect area where new bone would ideally
grow, to thereby facilitate entirely new bone growth
only within the protected area. The planar membrane
Z5 includes a plurality of apertures disposed therein. Each
of the plurality of apertures is adapted for allowing a
proliferation of vasculature and connective tissue cells
into the protected area, while preventing a prolapse of
adjacent soft tissues into the protected area. The
2o planar membrane is adapted for resorption into the body
of a patient, within a period of approximately 24 months
from an initial implantation of the planar membrane into
the body of the patient.
According to another aspect of the present
25 invention, a resorbable membrane is provided for
facilitating protected bone regeneration. The
resorbable membrane is adapted for being wrapped around
the bone defect area, to thereby cover and surround the
entire bone defect area and to overlap adjacent areas of
30 bone near the bone defect area. The resorbable membrane
has a strength sufficient to prevent prolapse of
adjacent soft tissues into the bone defect area and to
thereby facilitate bone regeneration independently,
without any aid from a fixation device, when the
35 resorbable membrane is secured around the bone defect
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area and secured to the adjacent areas of bone near the
bone defect area. The resorbable membrane forms a tube
surrounding the entire bone defect area and overlapping
the adjacent areas of bone near the bone defect area,
when the resorbable membrane is secured both around the
bone defect area and to the adjacent areas of bone near
the bone defect area. The resorbable membrane can be
frictionally secured around the bone defect area, or can
be secured around the bone defect area using at least
one of clamps, staples, screws, sutures, and tacks. The
fixation device can include at least one of a plate, a
screw, an intramedullary rod, and an external fixation
device.
According to yet another aspect of the present
invention, a method of protecting a biological tissue
defect area from soft tissue interposition is provided.
The method includes a step of placing a resorbable
membrane outside of a boundary of the biological tissue
detect, where the resorbable membrane comprises a
plurality of apertures adapted for allowing a
proliferation of vasculature and connective tissue cells
therethrough, while preventing the prolapse of adjacent
soft tissues into the biological tissue defect. The
biological tissue defect area can include a bone defect
area, and the step of placing a resorbable membrane
outside of the boundary of the bone defect area can
include a step of wrapping the resorbable membrane
around two ends of a long bone to thereby surround a
void between the two ends of the long bone. A rigid
fixation device can subsequently be secured between the
two ends of the long bone.
The present invention, together with additional
features and advantages thereof, may best be understood
by reference to the following description taken in
connection with the accompanying illustrative drawings.
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Brief Description of the Drawings
Figure 1 illustrates a longitudinal cross-section
of a cell-occlusive membrane secured around a long bone
defect according to the prior art:
Figure 2 illustrates a longitudinal cross-section
of the protective bone regeneration membrane secured
around a long bone defect according to the presently
preferred embodiment;
Figures 3a and 3b illustrate the protective bone
regeneration membrane according to the presently
preferred embodiment;
Figure 4 illustrates the protective bone
regeneration membrane of the present invention, as
applied to a long bone defect;
Figure 5 illustrates the protective bone
regeneration membrane of the present invention, applied
to various bone defect areas of a human skull;
Figure 6 illustrates the protective bone
regeneration membrane of the presently preferred
embodiment, used to facilitate bone regeneration of the
iliac crest of a patient, after a bone autograft has
been harvested from the patient:
Figure 7 illustrates the protective bone
regeneration membrane of the present invention, as
applied to a mandibular (lower jaw) bone defect of a
patient; and
Figure 8 illustrates the protective bone
regeneration membrane of the present invention, used in
combination with a fixation device, as applied to a long
bone defect of a patient.
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Detailed Description of the Presently Preferred
Embodiments
Turning to Figure 2, a protective bone regeneration
membrane 42 is illustrated, comprising a base material
44 and apertures 46. The protective bone regeneration
membrane 42 is shown in Figure 2 wrapped around a bone
defect area 49. The bone, which is surrounded by the
protective bone regeneration membrane 42, comprises a
first section of long bone 51, a second section of long
l0 bone 53, and a partially healed intermediate section of
long bone 55. The protective bone regeneration membrane
42 is rigid enough to prevent prolapse of the
surrounding tissues 57 into the bone defect area 49.
Additionally, the apertures 46 of the protective bone
regeneration membrane 42 are large enough to allow for a
proliferation of blood vessels 61 therethrough and into
the first section of long bone 5I, the second section of
long bone 53, and the partially healed bone defect 49.
Since the protective bone regeneration membrane 42 of
the presently preferred embodiment is rigid enough to
withstand prolapse of the surrounding tissue 57, the
regeneration of the partially damaged periosteum 64 is
guided over the protective bone regeneration membrane 42
in a direction substantially parallel to the arrows A3
and A4.
The apertures 46 within the protective bone
regeneration membrane 42 are both cell and fluid
permeable, and the base material 44 of the protective
bone regeneration membrane 42 is rigid enough to
maintain the available space between the first section
of long bone 51 and the second section of long bone 53
for ideal bone regeneration. Additionally, the base
material 44 is resorbable, according to the presently
preferred embodiment. The cell-occlusive membrane of
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the prior art membrane 10 (Figure 1), in contrast, is
specifically designed to prevent the proliferation of
cells and vessels therethrough. This membrane 10 is
also insufficiently rigid and non-resorbable.
Figures 3a and 3b illustrate different embodiments
of a sheet of the protective bone regeneration membrane
42, comprising the base material 44 and the apertures_
46. As presently embodied, the protective bone
regeneration membrane 42 comprises either a
biodegradable synthetic material or a biodegradable
natural material, or both. The biodegradable synthetic
material may comprise polymers, for example, and the
biodegradable natural material may comprise collagen,
for example. Each of the apertures 46 preferably has a
diameter within a range of between 20 microns and 3000
microns. In the presently preferred embodiment, each
aperture 46 comprises a diameter of approximately 1500
microns. A thickness of the base material 44 is
preferably within a range between 100 microns and 2000
microns, but may also be configured as thin as 10
microns. The pattern of distribution of the apertures
46 may vary according to the bone defect being treated.
The ranges of aperture 46 sizes, base material 44
thickness, and aperture 46 shape and distribution is
preferably implemented by the present invention in order
to optimize the protective bone regeneration membrane 42
to different environmental conditions. Examples of the
different environmental conditions encountered in
different bone defects include the location of the
defect (long bone or flat bone), the type of defect
(discontinuity defect, contour defect, window defect,
trephine defect), size of the defect, the presence or
absence of periosteum 64, and the general condition of
the adjacent soft tissues covering the bone defect.
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Figure 4 illustrates the protective bone
regeneration membrane 42 applied to a long bone 68 of a
patient. The protective bone regeneration membrane 42
is applied to the long bone 68 in combination with a
fixation device 70. The fixation device 70 can be
secured to the long bone 68 using conventional means,
such as tacks or screws 72.
The fixation device 70, the screws 72, and the
protective bone regeneration membrane 42 together
securely hold the first section 75 of the long bone 68
to the second section 77 of long bone 68. A bone defect
area 79 is protected against the prolapse of adjacent
soft tissues, for example, by the protective bone
regeneration membrane 42.
In contrast to the titanium screen mesh of the
prior art, the inventors believe that the combination of
the protective bone regeneration membrane 42 and the
fixation device 70 may in some instances be adapted for
operating together to relieve stress shielding of the
long bone 68, to thereby prevent subsequent resorption
of new bone. The prior art titanium screen mesh is
designed to remain permanently attached to the bone,
resulting in long-term stress shielding and resorption
of newly fonaed bone within the bone defect area 79. In
contrast to the prior art titanium screen mesh, the
protective bone regeneration membrane 42 of the present
invention is preferably configured of a resorbable,
bio-compatible material. At about the time that the new
bone within the bone defect area 79 is fully
regenerated, the protective bone regeneration membrane
42 of the presently preferred embodiment will have
resorbed sufficiently to no longer shield stress from
the bone defect area 79 to thereby encourage an increase
of bone formation. In addition, according to the
presently preferred embodiment, the fixation device 70,
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and/or the screws 72, are also formed of a resorbable
material. That is, the combination of the fixation
device 70, the screws 72, and the protective bone
regeneration membrane 42 prevent excessive motion
between the first section 75 and the second section 77
of the long bone 68.
As presently embodied, this period of time
sufficient for complete new bone regeneration within the
bone defect area 79 is between approximately 2 to 24
months. Thus, according to the present invention, the
resorption of the protective bone regeneration membrane
42 to a point where the protective bone regeneration
membrane 42 can no longer shield significant mechanical
stress on the first section 75 and the second section 77
is between approximately 2 and 24 months.
In an alternative embodiment, the protective bone
regeneration membrane 42 may comprise a non-resorbable
material. In.this alternative embodiment where the
protective bone regeneration membrane 42 is non-
resorbable and the fixation device 70 is resorbable,
resorption of newly formed bone within the bone defect
area 79 is still prevented. More particularly, the
protective bone regeneration membrane 42 is configured
to be flexible enough to prevent stress shielding
between the first section 75 and the second section 77,
after the fixation device 70 has been resorbed to a
point where the fixation device 70 no longer exerts
mechanical strength on the first section 75 and the
second section 77 of the long bone 68.
As another distinguishing feature, the protective
bone regeneration membrane 42 of the present invention
is designed to be used in combination with a fixation
device 70, in a preferred embodiment, while the titanium
screen mesh of the prior art comprises a fixation device
designed predominantly to be used alone. In one
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conceivable embodiment of the present invention, the
protective bone regeneration membrane 42 of the present
invention may be used in combination with the prior art
titanium screen mesh, as well as in combination with any
other conventional fixation device. Generally, internal
fixation devices can be divided into two classes.
Cortical compression plates comprise a first class and
intramedullary rods comprise a second class. Both
classes of devices are unable to secure and stabilize
l0 shattered bone, because bone fragments are often small
and free floating within the fracture cavity.
Furthermore, the periosteum around such fracture sites
is usually destroyed and cannot serve as a membrane
barrier against the dislocation of bone fragments.
15 Multiple bone fragments are naturally resorbed unless
they can be rigidly held together and provided with
sufficient blood supply. Bone fragment resorption can
present a significant obstacle to efficient healing of
comminuted fractures. Bone fragment resorption often
20 necessitates additional bone grafting procedures. In
contrast to the protective bone regeneration membrane 42
of the present invention, both of the above mentioned
classifications of fixation devices are unable to
achieve this end.
25 The protective bone regeneration membrane 42 of the
presently preferred embodiment is preferably resorbed
within the body of the patient to a point where
substantial mechanical fixation is no longer exerted on
the first section 75 and the second section 77 of the
30 long bone 68, within a period of approximately 1 year.
Complete resorption of the protective bone regeneration
membrane 42 may subsequently occur after a total period
of 1'~ to 2 years have elapsed since the initial
implantation. In contrast to the allogenic bone grafts
35 of the prior art, the protective bone regeneration
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membrane 42 of the present invention is resorbed into
the body of the patient. Allogenic bone grafts are only
partially substituted with new bone over time, typically
comprising 1 to 2 years, forming a permanent composite
of viable (new) bone and non-viable cadaver bone. Thus,
allogenic bone grafts cannot achieve a complete
regeneration of the entire bone defect with new living
bone, as can the protective bone regeneration membrane
42 of the present invention. This benefit is achieved
l0 by placement of the protective bone regeneration
membrane 42 outside of the bone defect area 49, rather
than within the bone defect area 49. Additionally, the
holes within the allogenic bone graft of the prior art
are substantially occluded by induced bone formation
therein within approximately 2 to 3 Weeks after the
initial implantation. Finally, as a further
distinguishing feature between the protective bone
regeneration membrane 42 of the present invention and
the prior art allogenic bone graft, the prior art
allogenic bone graft is placed within the bone defect
area itself, since the purpose of the prior art
allogenic bone graft 42 is to become a part of the new
bone. In contrast, the protective bone regeneration
membrane 42 of the present invention is designed to be
placed completely outside of the bone defect area, in
order to maintain a maximal size of the bone defect area
79 for regeneration of new bone by the patient in the
area 79. Still further, allogenic bone grafts are
inferior to the protective bone regeneration membrane 42
of the present invention in providing a combination of
patient safety in preventing disease transmission,
optimal prolapse prevention and maximal space
preservation for bone regeneration, and vasculature
ingrowth potential. Similarly to the allogenic bone
graft of the prior art, the above-mentioned skin graft
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of the prior art comprises apertures which are quickly
occluded by the ingrowth of epithelial cells therein.
These prior art apertures, similarly to the allogenic
bone graft holes, are actually filled with the desired
tissues, whereas, the apertures of the protective bone
regeneration membrane 42 allow ongoing transmigration of
cells and blood vessels for generating the desired
tissue. Additionally, these apertures are formed having
a diameter of approximately 1 millimeter, whereas the
preferred diameter of the apertures of the present
invention are approximately 1.5 millimeters.
Additionally, the skin graft membrane of the prior art
is specifically designed for providing an in vitro
scaffold and subsequent transplantable skin graft,
whereas the present invention preferably operates in
vivo.
Many of the above-described differences between the
protective bone regeneration membrane 42 of the present
invention and prior art devices help point to a
fundamental difference between the present invention and
prior art devices. The present invention is directed to
maintaining a space, protected against adjacent soft
tissue prolapse, to thereby facilitate spontaneous bone
regeneration by the patient within the protected space.
The present invention recognizes that spontaneous bone
regeneration by the patient can be greatly accelerated
and enhanced by allowing the infiltration of surrounding
blood vessels and cells.
The present inventors recognize that mesenchymal
stem cells, Which can be found in surrounding mesodermal
tissues, are the precursor cells that eventually form
muscle, cartilage, tendons, ligaments, connective
tissues, and bone. These cells are present in these
tissues and are involved in the perpetual renewal of
each specific tissue, although in their earliest stage
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of development, these cells are not committed to
becoming any given tissue. An uncommitted mesenchymal
stem cell found in muscle, for example, will not
strictly become a muscle cell. If the mesenchymal stem
cell is needed to become a bone cell, the mesenchymal
stem cell may migrate to a bone defect and differentiate
into a bone forming cell. The mechanism for attracting
these cells and directing them to become a specific
tissue cell is understood by the present inventors to be
controlled by morphogenic proteins, although other
factors may be involved. In bone, for example, these
proteins are commonly referred to as bone morphogenic
proteins. The apertures 46 of the protective bone
regeneration membrane 42 harness this mechanism, by
allowing bone morphogenic proteins derived from within
the bone matrix to attract mesenchymal stem cells from
the surrounding connective tissues, musculature,
' periosteum, and vasculature. The attracted elements are
then directed to differentiate into bone forming cells,
which are essential for new bone formation by the
patient. In addition, the apertures 46 of the present
invention allow vital contributions of blood vessels
from surrounding tissues, musculature, and periosteum
into the protected area. Blood vessels invading the
bone defect through the protective bone regeneration
membrane 42 of the present invention greatly enhance the
generation of new bone, as compared to prior art cell-
occlusive membranes that limit the supply of blood to
that coming from within the bone defect itself. The
ability for capillaries from surrounding soft tissues to
proliferate through the protective bone regeneration
membrane 42 helps prevent migrating cells from the
osseous bed and the periosteum from outstripping their
proliferating blood supply. This proliferation of blood
vessels increases the potential of spontaneous bone
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regeneration within a given defect. Furthermore,
mesenchymal stem cells are believed to be perivascular
(around blood vessels) connective tissue cells, which
would additionally foster bone regeneration by the
transmembranous sprouting of capillaries, since most
vasculature has associated connective tissues.
The base material 44 (Figure 3), according to the
present invention, may be impregnated with a variety of
substances for promoting the regeneration of different
tissues such as bone and blood vessels. The base
material 44 may be impregnated with a chemotactic
substance for influencing cell-migration, an inhibitory
substance for influencing cell-migration, a mitogenic
growth factor for influencing cell proliferation and a
growth factor for influencing cell differentiation (e. g.
insulinelike growth factor, transforming growth factor-
beta, fibroblast growth factor, platelet-derived growth
factor), and factors which promote neoangiogenesis
(formation of new blood vessels).
According to the present invention, the base
material 44 is flexible both at the time of manufacture
and after hydration. This flexibility allows the
protective bone regeneration membrane 42 to be bent and
shaped such that, after the area is completely healed,
the contour of the healed bone matches the contour of
the original bone, or matches the contour of the
original bone as closely as possible. According to the
present invention, the base material 44 (Figure 3)
further provides an advantageous rigidity, which is
higher than other currently used membrane materials
(Figure 1) to thereby provide sufficient strength
against soft tissue pressure.
The method of the present invention generally
comprises a step of affixing the protective bone
regeneration membrane 42 (Figure 3) onto a portion of
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the mammalian skeletal system in need of repair. The
fixation of the protective bone regeneration membrane 42
may be accomplished by any conventional surgical
technique, including the use of resorbable pins, screws,
and sutures. Alternatively, the protective bone
regeneration membrane 42 of the present invention can be
implanted into the patient without being affixed to
existing bone, such as, for example, in the case of
orbital floor reconstruction 84 (Figure 5).
Other applications of the protective bone
regeneration membrane of the present invention are
illustrated in Figures 5-8. Figure 5 illustrates
several applications of the protective bone regeneration
membrane in the cranio-facial region of a human skull.
A protective bone regeneration membrane 80 is applied
over the burrholes and the trephination defect of a
human skull 82, after a neurosurgical procedure or
trauma. Inside the orbits of the skull, protective bone
regeneration membranes 84 are placed over orbital floor
fractures to prevent entrapment of overlying muscles and
nerves therein. Another protective bone regeneration
membrane 86 is applied over a defect area in the
maxillary sinus, and still another protective bone
regeneration membrane 88 is applied over a bone defect
area in the maxilla (upper jaw). Another protective
bone regeneration membrane 90 is applied over an
edentulous bone defect area in the mandible (lower jaw).
A protective bone regeneration membrane 80 is
illustrated in Figure 6, applied to the pelvis 82 of a
human patient, after a bone autograft has been harvested
therefrom. The protective bone regeneration membrane 8o
protects the bone defect area 84 from soft tissue
interposition, while allowing the ingrowth of blood
vessels and cells. If necessary, the protective bone
regeneration membrane 80 can be affixed onto the
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adjacent bone using pins, screws, sutures, or other
conventional means. Figure 7 illustrates a protective
bone regeneration membrane 93 applied around a segmental
defect 94 in a human mandible 95, for example. The
protective bone regeneration membrane 93 can be
implanted using an extra-oral (outside of the mouth)
surgical approach. According to this approach, the
epithelial lining of the mouth is not broken and the
protective membrane is placed beneath the epithelial
lining of the mouth (since the bone defect is accessed
from an extra-oral area such as below the chin).
Therefore the epithelial cells cannot enter the bone
defect. The present invention, however, is also
intended to apply in intra-oral surgical approaches.
i5 The defect may be a discontinuity defect, comminuted, or
just missing a part of the bone. The intact parts of
the mandible 95 are fixated together by a plate 97 and
screws 99, if. necessary, and the protective bone
regeneration membrane 93 protects the bone defect site
from interposition of surrounding soft tissue.
Additionally, the protective bone regeneration membrane
93 holds any free-floating fragments of bone in place
and provides additional circumferential stabilization to
the bone defect. Although,_the protective bone
.~ ,r
regeneration membrane 42,~is malleable to a certain
extent, the protective bone regeneration membrane,42 is
stiff enough to prevent collapse thereof under the
weight of adjacent soft tissues. The protective bone
regeneration membrane~42 can be easily cut with scissors
and shaped by the hand of a user to adapt three-
dimensionally to a bone defect area.
Figure 8 illustrates another application of the
protective bone regeneration membrane 105 of the present
invention, as applied to a bone defect area of a long
bone 101. The protective bone regeneration membrane 105
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is secured to the long bone 101 using fixation devices
107 and 109, and comprises a belt-like tab 111. The
belt-like tab 111 is adapted for being fed through a
slot 113, which is formed between the fixation member
107 and the long bone 101. In the presently preferred
embodiment, the protective bone regeneration membrane
105 is secured to the fixation member 107, and both the
protective bone regeneration membrane 105 and the
fixation member 107 are resorbable, in order to avoid a
second surgery for removal of the devices. Surgical
removal of non-resorbable, non-metallic membranes is
necessary in the prior art, in order to avoid risk such
as bacterial contamination and infection. A user can
grip the belt-like tab 111 to securely fasten the
protective bone regeneration membrane 105 around the
long bone 101. This secure fastening of the protective
membrane 105 around the long bone 101 can facilitate the
holding of bone fragments in place within the bone
defect area, in addition to adding stability to the bone
fracture. In the presently preferred embodiment, the
screws 109 are tightened into the long bone 101 after
the protective bone regeneration membrane 105 is
tightened around the long bone 101. The embodiment of
Figure 8 is especially advantageous for setting
comminuted fractures, having multiple bone fragments, to
thereby reduce the risk of bone fragment resorption.
The protective bone regeneration membrane 105 can be
tightened around the long bone 101, until a desired
tension is achieved for holding the native fracture
fragments in place. The protective bone regeneration
membrane 105 can also be used to prevent the dislocation
of bone grafts or bone graft substitutes. Of course,
the protective bone regeneration membrane 105 may be
used without a fixation device 107. If it is necessary
3~ to stabilize major bone fragments, the protective bone
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regeneration membrane 105 may be used in conjunction
with other rigid fixation devices, either internal or
external.
The protective bone regeneration membrane 105 may
be used with or without a belt-like tab 111 to form a
tube around a bone defect area of a long bone 101. If
the tube overlaps both fracture ends of the long bone
101, the tube may provide sufficient structural support,
resulting from the strength of the protective bone
regeneration membrane 105 and the structural
characteristics of the tube, to obviate the need for
additional plates, screws, or external fixation devices.
Structurally, a tube locates supporting elements in the
area of highest stress when loaded in shear,
compression, or in bending. The tube configuration,
according to this alternative embodiment, is superior to
intramedullary rods, which lay at the approximate
neutral load axis, or eccentrically placed orthopedic
plates, which support only one side of the fracture and
which may introduce asymmetrical, non-axial loading on
the fracture. In addition to superior strength in
bending, a tube configuration will also have superior
resistance to column (compression) loading. If the ends
and seam of the protective bone regeneration membrane
105 are suitably fixated, the configuration will also be
superior in shear strength. Although the present
material, configurations, and methods have been
described in the context of treating humans, these
materials, configurations, and methods can also be
useful in treating animals.
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The sizes of the apertures in the resorbable
membrane can range from 20 microns to about 3500 microns
in a broad aspect of the present invention. When
certain thermally pliable resorbable materials are used,
however, apertures having diameters from about 20
microns to about 500 microns may tend to contract when
the membrane is heated to its glass transition
temperature just before being implanted. Accordingly, a
preferred embodiment of the present invention has
aperture diameters from about 500 microns to about 3000
microns. In another embodiment, the apertures can be
engineered so that after the membrane is heated to the
glass transition temperature the pore diameter size
ranges from about 20 microns to about 3000 microns. For
example, if heating of the membrane reduces the pore
diameter (regardless of aperture size) by about 500
microns, then the diameter sizes of the apertures can
range from about 520 microns to about 3500 microns in
the pre-heated condition of the membrane. The example
illustrates that the contraction percentages of the
apertures upon heating can be accounted for to yield a
final post-heating aperture size. The apertures can
thus be formed in the membrane to achieve a desired
post-heating size.
Effects sought to be avoided by the aperture sizes
of the present invention are to prevent gross prolapse
of soft tissue through the pores into the bone defect
area and to provide sufficient rigidity to prevent
collapse of the membrane under pressure. Apertures that
are too large may not completely prevent gross prolapse
and/or may not provide sufficient rigidity. With
certain soft tissues, and with certain individual bone
healing applications, for example, aperture sizes less
than or equal to about 2500 microns and, more
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preferably, 2000 microns can provide greater protection
against prolapse (and/or gross prolapse) than larger
aperture sizes. These aperture sizes may enhance
rigidity of the membrane, as well. According to one
aspect of the present invention, the apertures range
from 20 to 2000 microns to attenuate any possibility of
prolapse of tissue into the bone defect area and/or to
enhance rigidity of the membrane. When aperture
contraction is a problem, as described in the above
paragraph, then apertures ranging from about 520 microns
to about 2000 microns are preferred. In other
embodiments, the apertures can be configured to take
contraction into account, so that the post-heating sizes
of the apertures range from about 20 microns to about
2000 microns.
Although the above embodiment seeks to attenuate
any possibility of prolapse of tissue into the bone
defect area, another aspect of the invention seeks to
maximize a proliferation of cells and vasculature
through the apertures of the membrane into the bone
defect area. Generally, greater proliferation of
mesenchymal cells and vasculature through the apertures
of the membrane into the bone defect area, yields
greater healing potential of the body. Apertures that
are too small do not optimize the proliferation of cells
and vasculature through the apertures of the membrane.
According to this aspect of the present invention, the
apertures range from about 1000 microns to about 3000
microns and, more preferably, from about 1500 microns to
about 3000 microns. (It may be conceivable that
apertures having diameters of between about 3000 microns
and about 3500 microns, may be used, so long as soft
tissue does not prolapse through the apertures into the
bone defect area.) When aperture contraction may be
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present, as described above, apertures ranging from
about 2000 microns to about 3500 microns are preferred
(assuming aperture contraction or shrinkage of, for
example, about 500 microns). In these embodiments, the
apertures are configured to take contraction into
account, so that the post-heating sizes of the apertures
range from about 20 microns to about 3000 microns.
An optimal range of aperture sizes exists for
reducing chances of tissue prolapse and enhancing
rigidity, and for optimizing a proliferation of cells
and vasculature through the apertures of the membrane
into the bone defect area. Although each of the above
embodiments in connection with the below disclosure
provides beneficial results, the inventors have
discovered that a preferred size of apertures is from
about 1000 microns to about 2500 microns and, more
preferably, from about 1500 to about 2000 microns.
Apertures having these sizes encourage maximum healing,
by reducing chances of tissue prolapse and enhancing
rigidity, and also by optimizing the proliferation of
cells and vasculature through the apertures of the
membrane into the bone defect area.
In a basic embodiment, as described in the above
referenced patent application, the resorbable membrane
comprises a relatively smooth interior surface which is
adapted to face the biological tissue defect area, and a
relatively smooth exterior surface which is adapted to
face away from the biological tissue defect area.
The resorbable membrane comprises a plurality of
pores which fluidly connect the relatively smooth
interior surface to the relatively smooth exterior
surface. Each of the pores penetrates through the
entire thickness of the resorbable membrane to thereby
allow for a profileration of vasculature and connective
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tissue cells (derived from adjacent soft tissues)
therethrough, while preventing gross prolapse of the
adjacent soft tissues into the biological tissue defect
area (which the resorbable membrane surrounds and
protects. The pores have a diameters from 20 to 3000
microns. Thicknesses of the membrane preferably range
from 20 to 2000 microns. Pages 3a, 3b and 3c describe
methods of constructing the resorbable membranes.
Figures A, B, C, D and E disclose a number of
embodiments of the resorbable membrane in accordance
with different aspects of the present invention. The
resorbable membrane of the present invention is
preferably thermally-pliable. In one embodiment, the
membrane can be shaped around a biological tissue defect
at temperatures in a range of 55-60 degrees Celsius
(last transition temperature).
The included document entitled "'DENT' TESTING OF
PROTECTIVE MEMBRANE FOR BONE REGENERATION" quantifies
specific properties of the resorbable membrane of the
present invention, according to one presently preferred
embodiment where the thickness is .5mm and the aperture
(hole) size is 2mm. The document shows that the
MacroPore resorbable membrane has a much higher
resistance to deformation (spring constant) or
"stiffness" (to use another term) than Prolastic or
MTAM. Embodiments of the resorbable membrane with hole
sizes less than 2mm (for example, 1.5mm holes or lmm
holes) have at least the same stiffness if not more.
Figure H through Figure R are various illustrations
relating to the included document.
The dimensions, pore sizes, thicknesses, bridge
thickness & configurations (defined as the planar areas
of the resorbable membrane which define the
apertures)(one parameter, for example, which defines the
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bridge thickness & configurations is the distance
between apertures). The particular materials used to
construct the particular embodiments of the resorbable
membranes of the present invention have individual
advantages associated therewith. Each of the above-
embodiments, and the below embodiments, has unique
advantages associated therewith, and the different
embodiments are not considered to be interchangeable
equivalents or obvious in view of one another. In
additional alternative, but not equivalent, embodiments
of the present invention the general dimensions of the
resorbable membranes may be constructed to deviate from
the five independent embodiments disclosed in Figures A,
B, C, D and E, which are constructed to have orthopedic
applications among other applications.
Regarding, for example, the Summary of the
Invention, lines 15-23 of page 11, one or more of the
implants may be seeded onto the surface of the
substantially planar sheet of non-metallic base
material, as an alternative to, or in addition to the
impregnation of or more of the implants into the
substantially planar sheet of non-metallic base
material.
Regarding the Detailed Description of the Presently
Preferred Embodiments, lines 14-34 of page 17, for
example, the present inventors have determined that
about 3000 to about 3500 microns is the maximum aperture
size that can be used in accordance with the present
invention, before detrimental soft tissue prolapse
through the apertures into the bone defect area occurs.
Figure F illustrates a membrane having 4 millimeter by 5
millimeter rectangular apertures. The figure, which is
a cross sectional view taken along the 9 millimeter
dimension of an aperture, illustrates soft tissue
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prolapsing through the aperture. The membrane having 4
millimeter by 5 millimeter rectangular apertures of
Figure F indicates substantial gross prolapse of
adjacent soft tissue into the bone defect area, which
led to incomplete healing.
The prolapse of the tissue into the bone defect
area prevents healing of bone, since the bone generally
cannot heal in the volume occupied by the prolapsing
tissue.
Regarding the Detailed Description of the Presently
Preferred Embodiments, lines 7-21 of page 23 and lines
7-19 of page 29, for example, transmembraneous
injections of, for example, mescnchymal stem cells
and/or bone marrow aspirates into the bone defect can be
performed in accordance with particular cases and
desired results. The transmembraneous injections can
comprise bone marrow aspirate, platelet rich plasma,
growth factors, peptides, &/or proteins, &/or any other
synthetic or natural inductive, osteoinductive, or
osteogenic material. Figure G illustrates a
transmembraneous injection in accordance with the
present invention.
Regarding the Detailed Description of the Presently
Preferred Embodiments, lines 20-32 of page 24, for
example, the material 99 is preferably thermally
pliable. Since the material is preferably more pliable
when heated, a membrane of the material may be heated,
formed onto and/or around a bone. As the membrane cools
to body temperature, the membrane becomes less pliable.
An addition of text is made to the Claims ~on page
38 to clearly set forth and describe a preferred method
of the present invention.
Below are specific inventive aspects and inventive
applications of the resorbable of the present invention.
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For dental applications: the membrane (sheet) thickness
is between 100 to 500 microns, & preferably 150 microns;
any thinner than 100 microns is generally too weak; pore
size is between 50u to lmm, & preferably between
50microns & 300microns. (Because goes in tooth, can
palpate it more easily, can't feel the big bulky
membrane under there, not subject to as much soft-tissue
pressure. (In this embodiment may want to but bone-
graft or bone-graft substitute into bone defects area,
and therefore doesn't need to be as thick & strong.) If
an infection occurs in there it can't drain, so helps
clear. ((defects in dental applications are typically
smaller so the invention makes the membrane thinner
w/many more pores... soft tissue in dental applications
is thinner, finer & more susceptible to prolapse.))
Also, in dental applications the resorbable membrane
doesn't have to stay around as long so do thin membrane.
Middle sized: such as the orbital floor, pore size is
between 500microns-2mm (and preferably 1.5mm); thickness
is preferably 500u. The differences in porosity depends
on the graft material, when grafts are used, (so if
finer want smaller pores); pore size is function of type
& condition of local soft tissues. So if periosteum is
in tact then bigger pores (cuz sheet doesn't have to act
as a guide to the regenerating periosteum (per'm)). But
when perm is damaged or gone then (per'm is very
regenerative, needs a guide to help it grow back) our
sheet can act as a splint.) Therefore have smaller
pores. Pore size may be a function of concept of limited
contact & graft containment with pore size(many bone
graft substitutes sizes exist.) So when have smaller
pore size may want to increase the effective pore area
of membrane (ex., just add more pores).
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Larger sized: for most applications; long bone, skull,
flat bone (like around the crest to protect the bone
graft harvest site), spinal, ((muscles in contact w/bone
graft cause the bone graft to resorb more quickly, but
our membrane removes &/or dissipates the direct pressure
from the soft tissue)). Advantage is to control the
resorption rate: thicker membrane (& pore size too). is
slower resorption of bone graft. More keep the bone
graft the greater amount of remodeling into bone you
get. Ex. Skull--you want it really thick because bone
there heals very slowly, don't want membrane to resorb
too fast (sheet between dura(lining that protects the
brain), prevents micro-motion from pulsating brain,
prevents upward prolapse of duration bone defect area,
and prevents graft dislocation into the cranial cavity.
Thickest: lmm to 2mm thick, pores are 500u to 2mm;
preferred l.5mm pore & lmm thick. can be made to add
structural support. Ex. Do tube to contain the
substitute (& maybe for all above reasons) & to fixate
the bone fracture. cranial facial or long bone
Regarding bridge dimensions, wherein bridge is the
part of the membrane between pores, the present
inventors generally desire to maximize the porosity, but
also want to keep the strength. Bridge dimensions are
optimized between porosity & rigidity. The above-
mentioned principles can be used to apply all mamillians
across the phylogenetic tree.
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"DENT" TESTING OF PRorccTiYE MEMSRANF Fd>Z go
RE~'NEaAr~oN
lnt~oduction
Three different types of sheet material that are used for bone frxation were
tested for their ability to resist intrusion into a protected space. This was
done by
forming a cylinder from the material, and using a standardized indenter,
measuring the
force necessary to deform the cylinder.
Materials Tested
7. MacroPore, Inc. "Protego OSS Sheet", 0.5mm thick.
2. Howmedica Leibinger, Inc. "Micro Titanium Augmentation Mesh" (MTAM), .004"
thick.
3. Pittar Surgical, Inc. "Prolastic Sheeting, Reinforced 0.021 " thick.
Testing Method
The three materials were received as flat rectangular sheets. The Protego OSS
and the Prolastic sheet was already cut to 60mm x 80mm. The .004" thick "MTAM"
sheets were cut by us into 60 x 80mm size from larger sheet.
The Protego OSS material was heated in water and formed into a cylinder using
a .750" diameter mandrel. The formed cylinder was 60mm long, with an inside
diameter of .750". The other two materials were flexible enough to form a
cylinder by
wrapping around the .750" diameter.
The test fixture consisted of two .750" diameter steel rods spaced 1.75"
apart.
The 60mm (2.362") long test cylinders were placed across this 1.75" wide gap.
The
test cylinders extended approximately 8mm onto the steel rods at each end. The
test
cylinders were then fixed to each side of the fixture by 3/4" diameter "O"-
rings. The
indenter consisted of a 1 /4" diameter steel pin 1 " long, which contacted the
test
cylinder perpendicular to it's long axis.
An Insuon Universal Testing machine was used to apply the load, and also to
record the toad versus indentation into the test cylinder. The slope of the
Toad versus
deflection curve is a measure of the stiffness, or spring constant, of each
material.
The load and deflection scales were the same on each material, and these
curves are
included for reference.
Three samples of each material were tested. The tests were done in air at
72°F.
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PCT/US99/01403
Tes t ~ Results
The data in the table below is taken from the load/indentation curves, and the
scope, or spring constant of each test sample is calculated. The "MTAN1"
material had
an erratic deflection curve because the material has diamond shaped
perforations, and
when the indenter pushed into the material, the stiffness depended on whether
it was
pushing between the perforations, or bridging the perforations. The average
slope of
the curve was used for calculating the stiffness.
Material Sample Load Deflection Spring Constant
Tested No. (Lbs.) (in.) (lbs./in.)
"MTAM" .004" 1-1 2.4 .1032 23.2
"MTAM" .004" 1-2 2.4 .1045 23.0
"MTAM" .004" 1.3 2.4 .1313 18.3
Ave: 21. 5
Prolastic, .021 2-1 .096 .1275 .753
"
Prolastic, .021 I 2.2 .192 .134 i 1.433
"
Prolastic. .021 2-3 .1 12 .1 SS ~ , 723
"
Ave: .970
Protego OSS-, .5mm 3-1 4.0 .0325 123.1
Protego OSS, .5mm 3-2 4.0 .0205 195.1
Protego OSS. .5mm 3-3 4.0 .0230 173.9
Ave: 164.0
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WO 99/37240 PCT/US99/01403
Although an exemplary embodiment of the invention
has been shown and described, many other changes,
modifications and substitutions, in addition to those
set forth in the above paragraphs, may be made by one
having ordinary skill in the art without necessarily
departing from the spirit and scope of this invention.
39
