Size matters: Effect of granule size of the bone graft substitute (Herafill®) on bone healing using Masquelet's induced membrane in a critical size defect model in the rat's femur
Size matters: Effect of granule size of the bone graft substitute (Herafill®) on bone healing using Masquelet's induced membrane in a critical size defect model in the rat's femur
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DOI：
10.1002/jbm.b.34495
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发表时间：
2019-11-13
影响因子：
3.4
通讯作者：
Henrich, Dirk
中科院分区：
文献类型：
--
作者：
Leiblein, Maximilian;Koch, Elias;Henrich, Dirk
Masquelet技术用于治疗大面积骨缺损是一种基于诱导膜的两阶段手术。据报道，支架的尺寸是骨愈合反应的关键因素。因此，我们的目的是研究骨移植替代物的颗粒大小对骨髓来源的单核细胞（BMC）支持的骨愈合与诱导膜组合的影响。我们在大鼠股骨临界尺寸缺损的体内比较了三种不同尺寸的Herafill颗粒（Heraeus Medical GmbH，Wehrheim）（含或不含BMC）。在126只大鼠中制造10 mm缺损，并通过PMMA间隔物诱导膜。3周后，取出间隔物，用不同颗粒尺寸填充膜。8周后取股骨进行放射学、生物力学、组织学和免疫组化分析。此外，将大鼠的全血与颗粒一起孵育，并评估29种肽介质的表达。与较大颗粒相比，最小颗粒显示出显著改善的骨愈合，然而，这并未导致缺损区的生物力学稳定性增加。小颗粒导致原位巨噬细胞积聚增加，大多数可归因于炎症亚型M1。与同基因骨和β-TCP相比，观察到体外趋化性和促血管生成活性因子的释放增加。骨移植替代品Herafill（R）的颗粒大小与Masquelet技术结合在骨形成和炎症潜力方面对关键尺寸缺损的骨愈合有显著影响。
The Masquelet technique for the treatment of large bone defects is a two-stage procedure based on an induced membrane. The size of a scaffold is reported to be a critical factor for bone healing response. We therefore aimed to investigate the influence of the granule size of a bone graft substitute on bone marrow derived mononuclear cells (BMC) supported bone healing in combination with the induced membrane. We compared three different sizes of Herafill (R) granules (Heraeus Medical GmbH, Wehrheim) with or without BMC in vivo in a rat femoral critical size defect. A 10 mm defect was made in 126 rats and a membrane induced by a PMMA-spacer. After 3 weeks, the spacer was taken out and membrane filled with different granule sizes. After 8 weeks femurs were taken for radiological, biomechanical, histological, and immunohistochemical analysis. Further, whole blood of the rat was incubated with granules and expression of 29 peptide mediators was assessed. Smallest granules showed significantly improved bone healing compared to larger granules, which however did not lead to an increased biomechanical stability in the defect zone. Small granules lead to an increased accumulation of macrophages in situ which could be assigned to the inflammatory subtype M1 by majority. Increased release of chemotactic respectively proangiogenic active factors in vitro compared to syngenic bone and beta-TCP was observed. Granule size of the bone graft substitute Herafill (R) has significant impact on bone healing of a critical size defect in combination with Masquelet's technique in terms of bone formation and inflammatory potential.