Computer aided skeletal reconstruction with use of Bone Morphogenetic Protein -Experimental study of new method for skeletal reconstructive surgery-

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Reconstruction of large bone defects at various site with various size and shape are often encountered in clinical practice as results from surgical resection of bone and for soft tissue tumors or from the high energy injury. However, current modalities to repair the large bone defects are not enough and clinical outcomes are usually not satisfactory, even if with use of autogenous bone grafting. And novel methods to repair such large bone defects with high efficacy and accuracy in short periods are urged. This study is aiming at development of such a new technology to promote bone repair with combined use of a bioactive protein (bone morphogenetic protein-2, BMP-2) produced by DNA recombination technology, synthetic biomaterial (HA, hydroxyapatite) a synthetic polymer (polylactic acid-polyethylene glycol block co-polymer, PLA-PEG) and a biodegradable β tricalcium phosphate (βTCP) powder. As a preclinical study, we generated a pelvic bone defect model in dog, where optional defect in t … More he iliac bone was generated and the real-sized and shaped bone defect was determined based on computer tomography scanning data by subtracting the three-dimensional image of the affected iliac bone from mirror-imaged contralateral normal ilium. The 3-dimensional CT data of the bone defect was utilized to fabricate HA implant correctively identical to the bone defect by a computer aided designing (CAD) system Tb combine the CAD fabricated HA implant with BMP, PLA-PEG polymer and βTCP powder, small dose of BMP-2 (-100 μg) was mixed into paste-natured PLA-PEG polymer/ βTCP powder. (〜100mg respectively) and coated the HA implant surface and placed into the bone defect by surgical procedures. After surgery, the bone forming reactions were followed weekly by routine and CT scanning radiographyof the pelvis. New bone covering the implant started to appear in 3 weeks after surgery and completely covered whole implant in 9 weeks, On gross appearance of the retreaved ilium at 9 weeks after surgery, the original bone defect was completely repaired with new bone formation and restored normal anatomy of the ilium. The results indicated potential repair of large bone defects with use of synthetic materials (recombinant BMP-2, PLA-PGE polymer βTCP and Hablock) without use of bone grafting in short periods of time. Less