THE USE OF DEMINERALIZED BONE-MATRIX IN THE REPAIR OF SEGMENTAL DEFECTS - AUGMENTATION WITH EXTRACTED MATRIX PROTEINS AND A COMPARISON WITH AUTOLOGOUS GRAFTS
THE USE OF DEMINERALIZED BONE-MATRIX IN THE REPAIR OF SEGMENTAL DEFECTS - AUGMENTATION WITH EXTRACTED MATRIX PROTEINS AND A COMPARISON WITH AUTOLOGOUS GRAFTS
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DOI：
10.2106/00004623-198668080-00018
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发表时间：
1986-10-01
影响因子：
5.3
通讯作者：
BALIAN, G
中科院分区：
文献类型：
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作者：
BOLANDER, ME;BALIAN, G
骨的可溶性蛋白质成分骨形态发生蛋白和脱钙骨基质已被证明可诱导骨外组织中骨的形成。研究这些材料作为骨移植物的临床和动物研究显示了骨形成的放射学和组织学证据，但这些移植物的临床用途仍然未知。本研究比较了等离子体涂层脱钙骨基质和自体松质骨移植节段性骨缺损的愈合过程。采用标准程序，在48只成年新西兰白色家兔的尺骨双侧造成2厘米缺损。在每只家兔中，将一处尺骨缺损用自体柠檬酸盐等离子体涂层脱钙骨基质移植，而另一处缺损作为对照，并移植来自髂嵴的自体松质骨、脱钙骨基质或用盐酸胍提取的骨蛋白增强的脱钙骨基质。尺骨缺损由完整的桡骨稳定，不需要辅助固定装置。为了检查该模型中的自发愈合，一组兔子具有未移植的对照缺损。通过X线片定期评估移植物，手术后12周收获移植物并在标准扭转测试机中测试至失效。计算力学参数，并对移植物的主要碎片进行组织学检查。影像学和组织学评价结果显示，所有移植的尺骨均愈合，移植物与缺损的切端融合，重建了近似正常的解剖结构。未植骨的尺骨缺损均未愈合。通过比较每只动物中用等离子体涂层脱矿骨基质移植的缺损与对照移植物，评价力学测试的结果。这些数据表明：（1）移植后12周，正常尺骨的强度明显高于等离子体涂层脱钙骨基质移植的尺骨：（2）等离子体涂层脱钙骨基质移植的尺骨与自体骨移植的尺骨强度相当;（3）移植后12周，用提取的骨蛋白增强的脱矿骨基质移植物比没有增强的移植物明显更强。临床相关性：在该模型中，由具有等离子体涂覆的脱矿骨基质的移植物诱导的骨显示出与自体松质骨移植后形成的骨一样坚固。因此，用等离子涂层脱钙骨基质移植可能是使用自体移植物的合理替代方案。用骨蛋白和血浆增强使脱矿骨移植在临床上更具吸引力。
A souble protein component of bone, bone morphogenetic protein, and decalcified bone martrix have been shown to induce the formation of bone in extraosseous tissue. Clinical and animal studies investigating the use of these materials as bone grafts have shown radiographic and histological evidence of formation of bone, but the clinical usefulness of these grafts remains unknown. This study compared the healing processes when plasma-coated demineralized bone matrix and autologous cancellous bone were used to graft segmental defects of bone. A standard procedure was used to make a two-centimeter defect bilaterally in the ulna of forty-eight skeletally mature New Zealand White rabbits. In each rabbit, one ulnar defect was grafted with autologous citrated plasma-coated demineralized bone matrix while the other defect served as a control and was grafted with either autologous cancellous bone from the iliac crest, demineralized bone matrix, or demineralized bone matrix augmented with bone proteins that had been extracted with guanidinium hydrochloride. The ulnar defect was stabilized by the intact radius, and no supplemental device was necessary for fixation. To examine spontaneous healing in this model, one group of rabbits had a control defect that was not grafted. The grafts were periodically evaluated by radiographs, and twelve weeks after surgery the grafts were harvested and tested to failure in a standard torsion-test machine. The mechanical parameters were calculated, and histological examination of major fragments of the grafts was performed. The results of the radiographic and histological evaluation showed that all of the grafted ulnae healed, with fusion of the graft to the cut ends of the defect and reformation of approximately normal anatomy. no ungrafted ulnar defects healed. The results from the mechanical tests were evaluated by comparing the defect that was grafted with plasma-coated demineralized bone matrix with the control graft in each animal. These data showed that: (1) twelve weeks after grafting, the normal ulnae were significantly stronger than the ulnae that had been grafted with plasma-coated demineralized bone matrix: (2) the ulnae that had been grafted with plasma-coated demineralized bone matrix and those that had been grafted with autologous bone were equivalent in strength; and (3) twelve weeks after grafting, grafts of demineralized bone matrix that were augmented with extracted bone proteins were significantly stronger than those that had not been so augmented. Clinical Relevance: In this model, the bone that was induced by grafts with plasma-coated demineralized bone matrix was shown to be as strong as the bone that formed after grafting with autologous cancellous bone. Therefore, grafting with plasma-coated demineralized bone matrix might be a reasonable alternative to the use of autografts. Augmentation with bone proteins and plasma makes grafting with demineralized bone even more attractive clinically.