Extracortical bone-bridging fixation with use of cortical allograft and recombinant human osteogenic protein-1
Extracortical bone-bridging fixation with use of cortical allograft and recombinant human osteogenic protein-1
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DOI：
10.2106/jbjs.f.00290
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发表时间：
2007-07-01
影响因子：
5.3
通讯作者：
Chao, Edmund Y. S.
中科院分区：
文献类型：
--
作者：
Fukuroku, Jun;Inoue, Nozomu;Chao, Edmund Y. S.
背景：骨桥固定义肢重建是治疗大面积骨丢失的有效方法。我们评估了重组人成骨蛋白-1 （rhOP-1）结合异体皮质骨条作为自体骨移植物的替代品用于皮质外骨桥的效果。方法：对8只成年公犬行双侧股骨骨干6cm段切除术，并用多孔节段假体重建。在实验方面，采用骨条结合rhOP-1与牛l型胶原腻子（OP-1腻子）混合的同种异体皮质板移植物。对照组采用同种异体皮质骨条外加自体松质骨片和骨髓。重建随访12周，每两周评估负重步态和x线片。手术后12周处死动物，对重建股骨进行生物力学、组织学和显微x线摄影研究。结果：其中一只动物被排除在分析之外，因为在手术后12周，x线片观察到对照侧股骨近端骨折。在整个实验期间，实验组和对照组之间的负重步态没有显著差异。连续x线片显示，实验侧矿化面积在第2周、第4周和第6周分别增加了1.9倍（p < 0.04）、2.7倍（p < 0.01）和2.4倍（p < 0.03）。单纯使用皮质外桥接骨固定的扭转刚度和强度分别是实验侧的2.3倍（p < 0.03）和2.2倍（p = 0.058）。实验侧同种异体移植物气孔率是对照侧的3.8倍（p < 0.02）。随样品数量的增加，实验侧与对照侧的矿物附着率无显著差异。结论：在采用皮质外骨桥原理的节段性骨置换假体固定动物模型中，同种异体皮质骨移植联合rhOP-1是自体骨移植的有效替代品。
Background: Prosthetic reconstruction with extracortical bone-bridging fixation is an effective method for the treatment of massive bone loss. We evaluated the effect of the use of recombinant human osteogenic protein-1 (rhOP-1) combined with allogenic cortical bone strips as a substitute for an autogenous bone graft for extracortical bone-bridging.Methods: Eight skeletally mature adult male dogs underwent a bilateral resection of a 6-cm segment of the femoral diaphysis and reconstruction with a porous segmental prosthesis. On the experimental side, an allogenic cortical onlay graft in the form of bone strips combined with rhOP-1 mixed with bovine type-l-collagen putty (OP-1 putty) was applied. On the control side, allogenic cortical bone strips augmented with autogenous cancellous bone chips and bone marrow were used. The reconstructions were followed for twelve weeks with biweekly evaluations of load-bearing gait and radiographs. The animals were killed twelve weeks after the surgery, and the reconstructed femora were studied biomechanically, histologically, and with microradiographs.Results: One animal was excluded from the analysis because a fracture of the proximal part of the femur on the control side was observed radiographically twelve weeks after the surgery. There were no significant differences in load-bearing gait between the experimental and control sides throughout the experimental period. Serial radiographs revealed a 1.9-fold (p < 0.04), 2.7-fold (p < 0.01), and 2.4-fold (p < 0.03) increase in mineralized area on the experimental side at two, four, and six weeks, respectively. The torsional stiffness and strength of the fixation attributed to the extracortical bridging bone alone were 2.3-fold (p < 0.03) and 2.2-fold (p = 0.058) greater on the experimental side, respectively. The allograft porosity on the experimental side was 3.8-fold (p < 0.02) greater than that on the control side. With the number of samples available, there was no significant difference in mineral apposition rate between the experimental and control sides.Conclusions: In an animal model of segmental bone-replacement prosthetic fixation with use of the extracortical bone-bridging principle, an allogenic onlay cortical graft combined with rhOP-1 was an effective substitute for autogenous bone graft.