free vascularized bone grafting formed by stimulation of the periosteum with the BM (Bone Morphogenetic Protein)

大鼠胫骨内侧骨膜由隐动脉和隐静脉滋养。我们尝试用骨形态发生蛋白（BMP）刺激骨膜，产生一种新的骨，然后作为骨移植物转移。在手术显微镜下应用微血管精细器械对胫骨骨膜进行抬高。Wistar品系大鼠20只，分为4组。组1取胫骨骨膜，单纯闭合皮肤。第2组仅将BMP的载体置于凸起的骨膜下。3组骨膜上放置含有10 μg BMP的载体25 mg。第4组将BMP及其载体置于骨膜下。术后3周取大鼠胫骨，用x线摄影测量新生骨量。第1组和第2组仅形成少量骨。第3组几乎没有骨形成，而第4组则有大量骨形成。由此发现，骨膜下表面可以通过刺激BMP产生大量的骨，这些骨可以作为活骨移植物转移到另一个地方。通过腹主动脉导管进行的血管造影清晰地描绘了股动脉及其分支。在手术胫骨股骨远端三分之一处形成骨缺损。隐骨以及股动脉和股静脉被剥离，胫骨内侧形成的新骨被转移到股骨缺损处作为带血管的骨移植物。股骨的可靠愈合可能是由于移植物骨固定不良所致。然而，移植的骨被发现在股骨远端保留了很长时间而没有被吸收，这与刺激BMP在肌肉中异位形成的新骨相反。

The medial periosteum of the rat tibia is nourished by the saphenous artery and vein. An attempt was made to produce by stimulating this periosteum by the bone morphogenetic protein (BMP) a new bone that could then be transferred as a bone graft. The periosteum was raised on the tibia using microvascular fine instruments under operating microscope. Twenty Wistar strain rats were divided in 4 groups. The periosteum was raised from the tibia and the skin was simply closed in Group 1. Only a carrier of the BMP was placed under the raised periosteum in Group 2. The 25 mg carrier containing 10 μg BMP was placed on the periosteum in Group 3. The BMP and its carrier was placed under the periosteum in Group 4. The operated rat tibia was taken three weeks postoperatively and amount of the newly-formed bone was measured radiographically. Only a small amount of bone was formed in Group 1 and 2. While there was virtually no bone formation in Group 3, a good amount of bone was seen in Group 4. It was thus found that the undersurface of the periosteum could produce by stimulation of the BMP a good amount of bone that could be transferred to another place as a living bone graft. Angiography performed through a catheter introduced in the abdominal aorta depicted the femoral artery and its branches clearly.A bone defect was created in the distal one third of the femur of the operated tibia. The saphenous as well as the femoral artery and vein were dissected with the new bone formed on the medial aspect of the tibia and the bone was transferred to the defect created in the femur as a vascularized bone graft. A reliable union of the femur has not been yet attained due to, probably, a poor fixation of the grafted bone. The transferred bone was, however, found to remain at the distal femur without absorption for a long time, contrary to a new bone formed ectopically in muscles with stimulation of the BMP.