Mandibular reconstruction with a recombinant bone-inducing factor. Functional, histologic, and biomechanical evaluation.
Mandibular reconstruction with a recombinant bone-inducing factor. Functional, histologic, and biomechanical evaluation.
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用重组骨诱导因子进行下颌骨重建。
DOI：
10.1001/archotol.1991.01870220049009
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
E. Wang
中科院分区：
文献类型：
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作者：
D. Toriumi;H. Kotler;D. Luxenberg;M. Holtrop;E. Wang
骨形态发生蛋白-2(BMP-2)是一种人重组骨诱导因子，可在14天内刺激骨形成。26只狗接受了3厘米全厚下颌骨缺损的重建。用不锈钢重建钢板固定缺损后，将灭活狗骨基质载体和人重组骨形态发生蛋白-2组成的试验种植体植入12只动物的缺损处(第1组)。10只动物(第2组)采用对照种植体(不含BMP-2载体)，4只动物(第3组)下颌骨缺损处未植入种植体。分别在3个月和6个月时处死动物。重建的节段通过X线片、功能稳定性分析、组织学、组织形态计量学和三点弯曲试验的生物力学强度分析进行评估。在第一组中，重建钢板在10周时被取出，因为在缺损处形成了僵硬的、不可压缩的矿化骨，使动物能够咀嚼固体食物。第2组和第3组的缺陷显示出极少量的骨形成，并且仍然非常不稳定，不能取出钢板或推进到固体饮食。6个月时组织形态计量学分析显示，第1组有68%的种植体被矿化骨替代，而第2组和第3组矿化骨所占比例不到4%。6个月生物力学测试显示，第1组重建的半下颌骨平均弯曲强度(占对侧半下颌骨的百分比)为27%，第2组为0。BMP-2修复的缺损区的生物力学强度在3~6个月显著增加，并与矿化程度和骨桥接厚度有关。
Bone morphogenetic protein-2 (BMP-2) is a human recombinant bone-inducing factor that stimulates bone formation within 14 days. Twenty-six dogs underwent reconstruction of 3-cm full-thickness mandibular defects. After stabilizing the defects with stainless steel reconstruction plates, test implants composed of inactive dog bone matrix carrier and human recombinant BMP-2 were placed in defects of 12 animals (group 1). Control implants (carrier without BMP-2) were used in 10 animals (group 2), and no implants were placed in mandibular defects of four animals (group 3). Animals were killed at 3 and 6 months. The reconstructed segments were evaluated by roentgenography, analysis of functional stability, histology, histomorphometry, and analysis of biomechanical strength using three-point bend testing. In group 1, reconstruction plates were removed at 10 weeks because stiff, noncompressible mineralized bone formed across the defects, allowing the animals to chew a solid diet. The defects from groups 2 and 3 showed minimal, if any, bone formation and remained grossly unstable, prohibiting plate removal or advancement to a solid diet. Histomorphometric analysis at 6 months revealed that 68% of the group 1 implants were replaced by mineralized bone, whereas mineralized bone occupied less than 4% of the implants in groups 2 and 3. Biomechanical testing at 6 months revealed that the average bending strength of the reconstructed hemimandibles (expressed as a percentage of the contralateral hemimandible) was 27% for group 1 and 0% for group 2. The biomechanical strength of the defects reconstructed with BMP-2 increased significantly from 3 to 6 months and was related to degree of mineralization and thickness of bone bridging the defect.