Human segmental mandibular defects treated with naturally derived bone morphogenetic proteins
Human segmental mandibular defects treated with naturally derived bone morphogenetic proteins
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DOI：
10.1097/00001665-200205000-00014
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发表时间：
2002-05-01
影响因子：
0.9
通讯作者：
Ripamonti, U
中科院分区：
文献类型：
--
作者：
Ferretti, C;Ripamonti, U
已在非人灵长类动物的异位和原位部位反复证明了用提取和部分纯化的天然来源的骨形态发生蛋白（BMP）进行骨诱导。这引发了对使用天然来源的BMP的人类患者的下颌骨缺损中的骨再生的研究，并将其与使用自体骨移植物（ABG）治疗的患者中的骨生成进行比较。将成骨装置（OD）配制为人脱钙骨基质的组合，作为用天然来源的BMP重建的递送系统。用离液剂从牛骨中提取骨形成蛋白，并通过连续色谱法纯化。13例下颌骨节段性缺损患者入组试验，其中6例接受OD，7例接受ABG。用预制钛网重建缺损。将OD与无菌生理盐水混合，并作为糊剂应用于缺损部位。将来自髂嵴的自体骨制备为皮质松质骨移植物，并加载到钛网中。在植入后1周和6周、3个月、6个月和12个月对患者进行临床和影像学随访。在植入后3个月对植入物进行环钻活检，并在连续不脱钙切片上检查标本。组织学检查显示，治疗的6例患者中有2例OD诱导骨形成。成功植入OD的组织学检查显示矿化骨小梁，具有由连续成骨细胞内衬的大量类骨质缝。骨直接沉积在非活性基质上提供了骨诱导的明确证据。在7例植入ABG的患者中，5例有成骨的组织学证据。组织切片的形态学分析表明，当成功时，OD治疗的缺损与ABG相比具有高度活跃的成骨作用。虽然这项试验提供了有价值的见解，使用骨形态发生蛋白在下颌骨重建进一步的工作是需要产生一个OD，将在临床上可靠地执行。
Bone induction with extracted and partially purified, naturally derived bone morphogenetic proteins (BMPs) has been demonstrated repeatedly in heterotopic and orthotopic sites of non-human primates. This spawned the investigation of bone regeneration in mandibular defects of human patients with naturally derived BMPs and was compared with osteogenesis in patients treated with autologous bone grafts (ABGs). The osteogenic device (OD) was formulated as a combination of human demineralized bone matrix as delivery system reconstituted with naturally derived BMPs. BMPs were extracted from bovine bone with chaotropic agents and purified by sequential chromatography. Thirteen patients with segmental mandibular defects were enrolled in the trial, 6 of whom received the OD and 7 the ABGs. Defects were reconstructed with a preformed titanium mesh. The OD was combined with sterile saline and applied to the defects as a paste. Autologous bone from the iliac crest was prepared as a corticocancellous bone graft and loaded into the titanium mesh. Patients were followed-up clinically and radiographically at 1 and 6 weeks, 3, 6, and 12-month post-implantation. A trephine biopsy of the implants was performed at 3 months post-implantation and the specimens examined on serial undecalcified sections. Histological examination showed that the OD induced bone in 2 of 6 patients treated. Histological examination of successful implanted OD exhibited mineralized bone trabeculae with copious osteoid seams lined by contiguous osteoblasts. Bone deposition directly onto non-vital matrix provided unequivocal evidence of osteoinduction. Of the 7 patients grafted with ABGs, 5 had histological evidence of osteogenesis. Morphometric analysis of the histological sections showed that, when successful, OD-treated defects had highly active osteogenesis compared with ABGs. Whilst this trial provides valuable insights for the use of BMPs in mandibular reconstruction further work is required to produce an OD that will perform reliably in clinical contexts.