Allograft alternatives: bone substitutes and beyond.
Allograft alternatives: bone substitutes and beyond.
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DOI：
10.3928/01477447-20100722-31
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发表时间：
2010-09-07
期刊：
影响因子：
1.1
通讯作者：
Goodman, Stuart B
中科院分区：
文献类型：
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作者：
Goodman, Stuart B
过多的磨损碎片、深层感染、假体周围骨折和其他原因可能导致与全关节置换术相关的骨质流失。在进行翻修时，外科医生常常全神贯注于失败的种植体和替换方法，而忽略了补充丢失骨的机会。因此，在制定全关节置换翻修计划时，外科医生不仅应考虑应使用的硬件，还应考虑恢复丢失的骨质的方法。自体移植骨提供了骨祖细胞、生长因子和支架的最佳来源。然而，自体移植物的供应有限，并且通常与另一个切口、解剖和伴随的发病有关。骨传导性骨空隙填充物，如颗粒状松质同种异体移植骨、聚合物支架和可生物降解陶瓷，各有其优点和缺点；然而，所有这些材料仅起到支架的作用，无法诱导骨形成。骨诱导生长因子对于骨骼生长和重塑至关重要；然而，外源生长因子价格昂贵，以大的非生理剂量给予，可能产生不可预测的临床结果，并且可能具有显着的副作用。脱矿骨基质含有支架和不同数量的多种生长因子。最近，间充质干细胞和骨祖细胞以及合适的支架载体的使用越来越受欢迎。通过添加适当的生长因子，这种组合可以提供成骨所需的所有成分。未来的基础和临床研究将确定新组合产品的适应症和结果，用于重建与修正全关节置换相关的丢失骨。
Excessive wear debris, deep infection, periprosthetic fracture, and other causes can lead to bone loss associated with total joint replacements. When performing revisions, surgeons are often preoccupied by the failed implant and the method of replacement, and neglect an opportunity to replenish lost bone. Thus, when formulating a plan for revision total joint replacement, the surgeon should consider not only the hardware that should be used, but also ways in which lost bone could be restored. Autograft bone provides the best source for osteoprogenitor cells, growth factors, and a scaffold. However, autograft is limited in supply, and is generally associated with another incision, dissection, and accompanying morbidity. Osteoconductive bone void fillers such as morselized cancellous allograft bone, polymeric scaffolds, and biodegradable ceramics each have their merits and deficiencies; however, all of these materials function as a scaffold only, without the ability to induce bone formation. Osteoinductive growth factors are essential to bone growth and remodeling; however, exogenous growth factors are expensive, are given in large nonphysiological doses, may yield unpredictable clinical results, and may have significant adverse effects. Demineralized bone matrix contains a scaffold and variable amounts of several growth factors. Recently, the use of mesenchymal stem cells and osteoprogenitors, together with a suitable scaffold carrier has gained increasing popularity. With the addition of appropriate growth factors, this combination can provide all the necessary components for osteogenesis. Future basic and clinical research will define the indications and outcomes for new combination products for reconstruction of lost bone associated with revision total joint replacement.